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.
Dental Assistants and the DANB Infection Control Examination
In 2019, the Legislature passed a bill that requires all Connecticut dental assistants to pass the Dental Assistant National Board’s (DANB) Infection Control Examination (ICE) or an infection control competency assessment administered by an institution accredited by the American Dental Association’s Commission on Dental Accreditation. Dental Assistants must successfully complete the DANB ICE or a competency assessment exam by October 1, 2020.* All dental assistants must provide records demonstrating successful completion of the DANB ICE or the infection control competency assessment.
* New Connecticut dental assistants hired after July 1, 2019 have fifteen months from the start of employment to receive on-the-job training by a licensed dentist to prepare for and pass the exam or assessment, if they have not done so already.
Dental Assistants and Continuing Education
Effective January 1, 2018, upon successful completion of the Dental Assisting National Board’s infection control examination or an infection control competency assessment, all dental assistants will be required to complete not less than one hour of training or education in infection control in a dental setting every two years.
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 Practice Act
Connecticut General Statutes: Chapter 379 - Dentistry
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.
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":
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.
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.
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:
Patient Access to Medical Records
Frequently Asked Questions on Patient Access to Medical Records according to the provisions of the Connecticut General Statutes.
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.
Sexual Harassment Training
A new law went into effect on October 1, that establishes new rules and requirements regarding sexual harassment training and education. Employers with three or more employees will now have to:
- Provide all existing employees with two hours of training by October 1, 2020
- Provide to a new employee a copy of information regarding the illegality of sexual harassment and remedies available to victims
- Provide two hours of training and education to new employees hired on or after October 1, 2019 within six months of their start date
- Provide periodic supplemental training not less than every ten years
Employers with fewer than three employees must provide two hours of training and education to all existing supervisory employees by October 1, 2020 or within six months to new supervisory employees.
The Commission on Human Rights and Opportunities has developed a free online training and education video. Click here to view the Commission on Human Rights and Opportunities for further information regarding these new regulations and the training video.
Effective Date: October 1, 2019
Single-Use Plastic Bag Fee
Effective August 1, 2019, retailers making sales in Connecticut of tangible personal property to the public are required to collect a 10 cent fee per single-use plastic checkout bag. “Single-use checkout bag” is defined as a plastic bag with a thickness of less than four mils and is provided by a store to a customer at the point of sale. “Store” is defined as any retailer, as defined in Conn.Gen.Stat 12-407, that maintains a retail store within the state and sells tangible personal property directly to the public. This definition includes any dental office with a sales tax permit.
For example, if a dental office is using a plastic bag to provide their patients with promotional materials or free items, such as a toothbrush and or floss, then the dental office is not required to collect a fee. If, however, a dental office has a sales tax permit and is selling items to their patients, such as an electronic toothbrush and uses a plastic bag with a thickness of less than four mils, to provide the product to the patient, then the dental office is required to collect a 10 cent fee and report that to the State.
For further information, please click here for more from the CT Department of Revenue Services Guidance Sheet Regarding the Single-Use Plastic Bag Fee.
If you have additional questions regarding the plastic bag fee, please contact the CT Department of Revenue Services (DRS) directly. You can email DRS Legal Division at email@example.com or call DRS at (800) 382-9463.
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.
Virtual Credit Cards Payments
Specified health insurance carriers that issue policies covering inpatient or outpatient dental services are required, at least once during the term of a contract, to permit a licensed dentist who provides covered dental services to an insured to refuse to accept reimbursement for such services by way of virtual credit card. Such refusal shall apply to all covered dental services provided by such dentist during the term of such contract. “Virtual credit card” means a single-use credit card exclusively provided in an electronic or digital format.
Effective Date: January 1, 2019
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.
Various CT Water Utility Companies (yours may not be listed):
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
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.
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.
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.