Dental Practice Act
Connecticut General Statutes: Chapter 379 - Dentistry
Dental Hygiene Practice Act
Connecticut General Statues: Chapter 379a - Dental Hygienists
Recent Legislation: Dental hygienists with two years of experience can now practice without a dentist's general supervision at senior centers, managed residential communities, or licensed child care centers. As is already the case for such practice at other public health facilities, the bill requires hygienists practicing at senior centers, managed residential communities, or licensed child care centers to refer to a dentist any patients with needs outside of the hygienist's scope of practice (CGS § 20-126l(f)).
Under existing law and the bill, managed residential communities are facilities consisting of private residential units that provide a managed group living environment for persons who are primarily 55 years old or older. The term does not include state-funded congregate housing facilities.
EFFECTIVE DATE: October 1, 2018, except that the provision on child care centers took effect July 1, 2018.
Dental Assistants and the DANB Infection Control Examination
- The responsibilities of a Dental Assistant are found under the "Dental Practice Act," above.
- Dental Assistants and X-Rays (PDF) - Effective July 1, 2017
In 2016, legislation passed that established requirements for Connecticut Dental Assistants to take and pass the Dental Assistant National Board’s (DANB) Infection Control Examination (ICE). July 1, 2018 was established as the effective date for this requirement. We are pleased to report that, after speaking with officials at the Department of Public Health, they now interpret the statute such that:
- Current Connecticut dental assistants who have not passed the DANB Infection Control Exam prior to July 1, 2018 have until April 1, 2019 (an additional nine months) to receive on the job training by a licensed dentist to prepare for and pass the exam.
- New Connecticut dental assistants hired after July 1, 2018 have nine months from the start of employment to receive on the job training by a licensed dentist to prepare for and pass the exam, if they have not done so already.
- All dental assistants who have earned the CDA certification before 6/1/93 or the COA certification before 6/1/94 and have not taken the ICE exam in the interim, will need to take the ICE exam before April 1, 2019.
- After April 1, 2019, upon successful completion of the Dental Assisting National Board’s infection control examination, all dental assistants will be required to complete no less than one hour of training or education in infection control in a dental setting every two years.
Update on Infection Control for Dental Assistants (as of March 15, 2019)
As you know, current state law requires that Connecticut Dental Assistants must pass the DANB Infection Control Examination (ICE) by April 1, 2019. The CSDA has advocated for alternatives to the DANB exam including an extension of the compliance date. Although the bill to extend the deadline has been passed out of the Public Health Committee, the current DANB examination requirement and April 1, 2019 deadline will remain in place until an extension is approved by the General Assembly and the Governor. Unfortunately, this will not happen before April 1, and likely not before the end of May, 2019.
That leaves many members with the question of, "What do we do if an assistant does not pass the DANB exam before April 1, 2019?”
According to the Department of Public Health, verification of passage of the DANB ICE is complaint driven, meaning that proof of passage will not be required unless there is an investigation triggered by a complaint that is filed against your practice. The DPH will not ask for passage of the DANB ICE exam unless there is a reason to do so. This is similar to how they monitor continuing education credits for dentists and others.
However, if you are the subject of a DPH investigation before the deadline extension is signed in to law, the best advice is to ensure that you can demonstrate that you have, in good faith, tried to get your dental assistant compliant with the infection control requirement. Examples of good faith could include verification of attendance at continuing education courses or preparation courses, completion of preparatory exams and/or the DANB exam, and others. If there is no evidence to show that an effort has been made on behalf of the dental assistant to become compliant, the DPH could impose severe penalties depending on the findings of their investigation.
We will continue to keep our members updated on the status of the compliance extension, acceptable alternatives to the DANB exam, and any other developments related to infection control.
Expanded Function Dental Assistants
During the 2016 Legislative Session, the Legislature passed Public Act 16-66 which established a new designation of dental assistants called expanded function dental assistants or EFDAs in Connecticut.
This new law allows a dentist to delegate more procedures if the assistant becomes an EFDA. It also places a number of requirements on EFDAs and the dentists that hire them.
Connecticut Requirements to Earn EFDA Status:
- Pass the DANB Certified Dental Assistant or Certified Orthodontic Assistant exam and maintain current certification
- Successfully complete an EFDA education program at an institution of higher education that is accredited by the Commission on Dental Accreditation
- Pass the DANB CPFDA exams (Coronal Polish, Sealants, Topical Anesthetic and Topical Fluoride)
- Pass the DANB CRFDA exams (Anatomy, Morphology and Physiology; Impressions; Isolation; Sealants; Temporaries; and Restorative Functions)
- A dental assistant must meet all the state requirements to earn EFDA status.
The State of Connecticut does not issue a state certificate or certification to dental assistants who have met all EFDA requirements. It is the supervising dentist’s responsibility, before delegating any EFDA functions to any dental assistant, to verify that the dental assistant has met ALL of the state’s EFDA requirements.
Best management practices (BMP’s) replace the October 23, 2003 BMP’s for mercury amalgam and are intended to help dental practitioners comply with the requirements of Sections 22a-616(d) and 22a-622 of the Connecticut General Statutes (CGS) concerning the management of amalgam.
DEEP has also developed a Certification Form on which dental practitioners certify that their practice(s) or clinic(s) is in compliance with the state adopted BMPs.
Amalgam Separator Inspection Form - Dentists in Connecticut, and now across the country, are required to perform inspections and keep records of such inspections for their amalgam separators. There is no prescribed form, you can make up their own, or you can use the sample form below one, or modify it if they choose. At some point in the future, the Department of Energy and Environmental Protection may randomly ask dental practices to submit inspection records as evidence of compliance with best management practices, specifically having and maintaining an amalgam separator. Please Note: This specific form doesn’t ensure compliance with all best management practices and you should become familiar with the DEEP standards.
NEW! Public Act 18-166 prohibits prescribing practitioners from prescribing, dispensing or administering schedule II to IV controlled substances to themselves or immediate family members. An immediate family member is defined as a spouse; parent; child; sibling; parent-in-law; son or daughter-in-law; brother or sister-in-law; step-parent, child or sibling; or other relative residing with the prescriber.
In an emergency, the bill allows prescribers to prescribe, dispense, or administer up to a 72-hour supply of a schedule II to IV controlled substance to themselves or immediate family members, but only if there is no other qualified prescriber available. If prescribing, dispensing or administering to a family member, the prescriber must (1) perform an assessment for the patient’s care and treatment; (2) medically evaluate the patient’s need for the controlled substance; and (3) document the emergency, assessment and patient’s need in the normal course of his or her business. (Effective as of July 1, 2018)
Public Act 17-131 requires various changes to prevent and treat opioid drug abuse. Several of these items can impact dental practices that write prescriptions for opioids, including:
- Requires prescribing practitioners to electronically transmit the controlled substance prescription to a pharmacy (effective January 1, 2018);
- To apply for a waiver, a provider must contact the CT Department of Consumer Protection Drug Control Division directly. They can be reached at (860) 713-6065 or DCP.DrugControl@ct.gov
- Requires practitioners, when prescribing opioids, to discuss with all patients, rather than only minors, the risks associated with opioid drug use;
- Anyone who does not wish to be issued a prescription for an opioid drug may file a “voluntary non-opioid directive” form with a prescribing practitioner. Upon reviewing the form, the prescribing practitioner must document it in the patient’s medical record;
- A prescribing practitioner shall not issue a prescription of an opioid drug to a minor for more than a five-day supply of such drug; and
- By October 1, 2017, the Alcohol and Drug Policy Council (ADPC) is required to develop a one-page fact sheet on opioid drugs. The ADPC must make the fact sheet available on the Department of Mental Health and Addiction Services website. Health care providers are encouraged to disseminate the fact sheet to anyone they provide an opioid drug prescription to.
During the November 2017 CSDA Continuing Education Course, Rodrick Marriott, Director of the Drug Control Division of the State of CT Department of Consumer Protection, spoke to Connecticut Dentists. During the talk Mr. Marriott clarified the new opioid legislation that recently passed, including the new regulation that requires prescribing practitioners to electronically transmit controlled substance prescriptions to a pharmacy (effective January 1, 2018). The video is below for your reference:
Water Fluoridation in Connecticut
Fluoridation became a law in Connecticut on May 18, 1965, initiated by Public Act 156. Public Water Systems (PWSs) serving 50,000 or more were required to begin fluoridation on January 1, 1967, and PWSs serving 20,000 to 49,999 people were required to begin fluoridation on October 1, 1967.
The amount of fluoride in many drinking water supplies is changed to a level to help reduce tooth decay and promote good oral health. Research studies have shown that water fluoridation is safe, effective and the best way to improve oral health in a community.
Infection Control in Dental Practice and Regulatory Response
The Department of Public Health is authorized under Connecticut General Statutes, 19a‐14(10)(11) to investigate complaints against health care practitioners. The Dental Practice Act which is defined in Chapter 379 of the Connecticut General Statutes allows the Department and the Board to seek disciplinary action under Section 20‐114 for “incompetence or negligent conduct toward a patient”.
2016 Legislation Passed: An Act Concerning Various Revisions to the Public Health Statute includes language about Infection Control.
- "Failure to adhere to the most recent version of the National Centers for Disease Control and Prevention guidelines for infection control in dental care settings."
- Of particular interest is the addition of the sterilization of hand pieces in-between patients. This and other requirements can be found in the National Centers for Disease Control and Prevention guidelines, which was updated in September 2016.
Checklists from the "CDC Summary of Infection Prevention Practices in Dental Settings: Basic Expectations for Safe Care":
Patient Access to Medical Records (PDF)
Frequently Asked Questions on Patient Access to Medical Records according to the provisions of the Connecticut General Statutes.
State Inspections of Dental Facilities and X-ray Machines
The CT Department of Energy and Environmental Protection (DEEP) has shared this information regarding their state inspection process of dental x-ray operations. The information is provided in hopes that the DEEP, in tandem with the CSDA, can enhance mutual effectiveness, communicate regulatory requirements, and maintain low dose and high quality dental imaging. If you have any additional questions, please feel free to contact the CT DEEP Radiation Division at 860.424.3029.
Permit to Administer Dental Anesthesia and Conscious Sedation
Connecticut Department of Public Health guidelines for obtaining dental anesthesia and conscious sedation permit.
Prescription Monitoring Program
The prescription monitoring program collects prescription data for Schedule II through Schedule V drugs into a central database, the Connecticut Prescription Monitoring and Reporting System (CPMRS), which can then be used by providers and pharmacists in the active treatment of their patients.
Backflow Prevention and the Connecticut Dental Office (PDF Version)
The Connecticut Department of Public Health (DPH) requires all Connecticut dental offices to have backflow prevention devices installed. Furthermore, those devices can (and have been) the subject of inspections by local water utility companies. It is important for you as a Connecticut dentist to understand what is required prior to being inspected.
What is a backflow prevention device? Quite simply, a backflow prevention device is used to use to prevent back-siphon age of contaminated fluids into the public water supply.
What specifically does Connecticut require? The CT DPH Fact Sheet on Backflow Prevention at Dental offices (link below) provides information on State requirements. However, it is important to note that a local water utility always has the option of having policies that are more stringent than the State's requirements.
How can I find out what's required in my area? If you are unsure about the backflow prevention device requirements in your area, please contact your local water utility company. The links to some of the larger water utilities in the State are listed below.
Various CT Water Utility Companies (yours may not be listed):
Mobile Dental Providers
In response to questions regarding the credentials of mobile dental programs offering to provide oral health services to children in school settings, the CSDA and the Department of Public Health have reissued a letter to school administrators highlighting questions to be asked in order to assess the appropriateness of protocols in place by the mobile dental program. Click here to review the letter sent to school superintendents, principles, and school nurses in Connecticut.
In 2011, the Connecticut General Assembly passed a non-covered services legislation that prohibits most insurance providers from dictating the rates that dentists can charge to their patients for any services or procedures that are not covered under their dental plans. While self-funded and collectively bargained (i.e. union) insurance plans were not covered under this new law, it does apply to all other dental provider contracts that are signed, renewed or amended after January 1, 2012.
The law also requires that dentists post a notice in their office to inform patients that not all dental services may be covered under their insurance plans. Click on the links below to access and print the notice for your practice.
Section 1557 of the Patient Protection and Affordable Care Act
The Office for Civil Rights has issued a final rule that prohibits health care entities that receive certain federal financial assistance, including Medicaid and CHIP, from discriminating based on race, color, national origin, sex, age or disability. According to ADA’s Health Policy Institute, 42% of dentists across the country were enrolled in Medicaid programs in 2014, and will therefore be subject to this rule.
The rule, went into effect July 18, 2016 and implements Section 1557 of the Affordable Care Act, required the affected parties by October 16, 2016 to post taglines in multiple languages and nondiscrimination notices in their offices, on their websites and in significant publications and communications. The ADA provides a number of resources, including a checklist, Q&A and sample documents for dental practices, free of charge only to ADA members to help them comply with this rule at success.ada.org. Read more in ADA News.
Recommended Infection Control Practices for Dentistry
Developed by CDC staff in collaboration with a working group of infection control experts, the document contains a review of the scientific evidence regarding dental infection control issues as well as consensus, evidence-based recommendations.
Checklists from the "CDC Summary of Infection Prevention Practices in Dental Settings: Basic Expectations for Safe Care":
Click here for State of Connecticut Infection Control in a Dental Practice Regulations.
OSHA Guide for Medical & Dental Offices
State plans establish guidelines and standards to promote worker safety and health that apply to every workplace in the United States, including medical and dental offices. A glimpse of the most frequently found hazards in medical and dental offices.
The Americans with Disabilities Act
The Americans with Disabilities Act of 1990 is a wide-ranging civil rights law that prohibits, under certain circumstances, discrimination based on disability. This link will take you to the American Dental Association's Americans with Disabilities Act Q&A. It is important to note that ALL practicing dentists are affected by this law, since dental offices are considered public accommodations under the Act
Electronic Health Records HIPAA
An electronic health record (EHR) is a digital version of a paper chart that contains all of a patient’s medical history from one practice. An EHR is mostly used by providers for diagnosis and treatment.
The Office for Civil Rights enforces the HIPAA Privacy Rule, which protects the privacy of individually identifiable health information; the HIPAA Security Rule, which sets national standards for the security of electronic protected health information; the HIPAA Breach Notification Rule, which requires covered entities and business associates to provide notification following a breach of unsecured protected health information; and the confidentiality provisions of the Patient Safety Rule, which protect identifiable information being used to analyze patient safety events and improve patient safety.