SECTION 195:15-1-6.1. Advanced procedures for dental hygienists

(a)   It is the determination of the Board that certain procedures may be performed by a dental hygienist who has satisfactorily completed a course of study regarding the performance of such procedures. Pursuant to 59 O.S., Section 328.34, the Board hereby establishes two (2) advanced procedures for dental hygienists with definitions, requirements, and course guidelines as follows:

(1)   Nitrous Oxide.

(A)   Definition: A dental hygienist authorized by the Board to perform this advanced procedure may administer nitrous oxide.

(B)   Requirement: Satisfactory completion of a course of study in nitrous oxide analgesia, consisting of a minimum of 12 hours, approved by the Board.

(C)   Course Guidelines:

(i)   Minimum standards for courses to train dental hygienists to administer nitrous oxide are as follows:

(I)   The instruction level shall meet level 3 of the Board's Guide to Curriculum Development for Advanced Procedures.

(II)   Instruction shall be provided in a properly equipped setting and under he supervision of an education program approved by the Board.

(III)   The minimum length of the course shall be 12 hours.

(IV)   The faculty-student ratio of not in excess of 1 to 10 for classroom training and 1 to 10 for clinical and laboratory training shall be maintained.

(V)   The course shall train students in basic C.P.R. This requirement may be waived for students with current C.P.R. training.

(VI)   Each student shall be provided at least 15 minutes of contact with each patient during clinical training.

(VII)   Faculty shall be qualified licensed dentists or licensed dental hygienists with at least one year of advanced education in comprehensive pain and anxiety control.

(VIII)   When not medically inappropriate, each student shall be afforded the opportunity to experience the effects of nitrous oxide.

(IX)   The course provider shall create and maintain records on each student, including test score of clinical testing, in the clinical test for a one (1) year period. The director of the educational portion of the program shall sign a statement in the scholastic record attesting to the student's proficiency in advanced procedures.

(ii)   The course shall be designed and conducted to provide each student with a thorough knowledge of nitrous oxide-oxygen inhalation sedation and its use in dentistry. Upon completion of the course, each student shall be able to apply this knowledge to administer nitrous oxide-oxygen inhalation to dental patients as indicated.

(iii)   The course instruction shall include:

(I)   Background information, including:

a. A history of nitrous oxide-oxygen inhalation sedation;

b. Instruction in the philosophy and psychology of nitrous oxide-oxygen inhalation sedation;

c. Instruction in the definitions and descriptions of the physiological and psychological aspects of pain and anxiety;

d. Instruction of the stages of drug-induced central nervous system depression through all levels of consciousness and unconsciousness with special emphasis made in the distinction between the conscious and unconscious state;

e. Instruction on the anatomy and physiology of respiration;

f. Instruction on the pharmacology and physiological effects of nitrous oxide as used as analgesia. This instruction shall include among other things, its physical properties, effects, action, side effects, absorption, excretion, and toxicity;

g. Instruction in the advantages and disadvantages of inhalation sedation with nitrous oxide.

(II)   Students shall be trained in aspects of patients assessment, to include:

a. Taking and reviewing a thorough health history;

b. Taking the patient's vital signs;

c. Evaluating implications of the use of nitrous oxide based upon the patient's health history;

d. Evaluating the indications and contraindications of nitrous oxide.

(III)   Students shall be trained in the proper administration of nitrous oxide, to include:

a. The description and use of inhalation equipment;

b. The introduction of nitrous oxide to a patient;

c. Precautions for the successful introduction of nitrous oxide to a patient;

d. Patient monitoring, with particular attention made to monitoring patient vital signs and reflexes related to consciousness;

e. Determining dosages and needs of a patient;

f. Possible reactions of patients under nitrous oxide;

g. How to return a patient to pre-sedation status and instruction in post-operative care;

h. Hazards of nitrous oxide sedation for the patient and operator;

i. The recognition, prevention and management of complications and life threatening situations involving nitrous oxide;

j. Potential health hazards of trace anesthetics and techniques for the elimination of trace anesthetics.

(IV)   Students shall be instructed in pertinent legal aspects of the administration of nitrous oxide sedation.

(V)   The clinical experience of the course shall include:

a. Assessment of the patient's status;

b. The use of different types of nitrous oxide-oxygen machines;

c. Introduction of sedation to a patient;

d. Monitoring the patient;

e. Returning the patient to pre-sedation status;

f. Post operative care of the patient and instruction to the patient.

(iv)   Upon completion of the course, students shall be evaluated by course presenters by written examination. The examination shall cover both the didactic and clinical portions of the course. The passing grade is set at 70%. Each student's written examination shall be maintained by the course provider for a minimum of one (1) year following the completion of the examination. Each course provider shall, prior to beginning a course, allow a member of the Board or its designee to review the examination.

(v)   Each course provider shall, within thirty (30) days after completion of a course, submit to the Board a list of the names of each student at the course and each student's final grade in the course.

(vi)   Courses offered pursuant to this rule are subject to unannounced audits by the Board. Any Board member or designee of the Board shall be provided full access to course materials or the classroom or clinic during instruction. Failure to provide access pursuant to this provision may subject the provider to invalidation of course results.

(2)   Local Anesthesia.

(A)   Definition: A dental hygienist authorized by the Board to perform this advanced procedure may administer local anesthesia.

(B)   Requirement: Satisfactory completion of a course of study in local anesthesia, consisting of a minimum of 20 ½ hours, approved by the Board.

(C)   Course Guidelines:

(i)   Minimum standards for courses to train dental hygienists to administer local anesthesia are as follows:

(I)   The instruction level shall meet level 4 of the Board's Guide to Curriculum Development for Expanded Functions.

(II)   Instruction shall be provided in a properly equipped setting and under the supervision of an educational program approved by the Board.

(III)   The course shall train students in basic C.P.R. This requirement may be waived for students with current C.P.R. training.

(IV)   The course provider shall conduct formal clinical testing of the student's ability to perform the advanced procedure involved. A Board proctor shall be allowed by the course provider to attend the course the first time it is offered and at random times, as determined by the Board, thereafter.

(V)   The course provider shall create and maintain records on each student, including test score of clinical testing, in the clinical test for a one (1) year period. The director of the educational portion of the program shall sign a statement in the scholastic record attesting to the student's proficiency in advanced procedures.

(VI)   The minimum length of the course shall be 20 1/2 hours of instruction.

(VII)   Each student in the course shall perform at least 5 patient infiltration and ten mandibular block injections on patients.

(VIII)   When not medically inappropriate, each student shall be afforded the opportunity to experience the effects of local anesthesia.

(IX)   A faculty-student ratio of not in excess of 1 to 6 shall be maintained for clinical instruction.

(X)   Faculty shall be licensed dentists and licensed dental hygienists who are currently employed or have been employed in a dental or dental hygiene school and have experience in teaching this advanced procedure.

(ii)   The course shall be designed and conducted to provide each student with a thorough knowledge of local anesthesia and local anesthetic injection techniques and their uses in dental hygiene. Upon completion of the course, each student shall be able to apply this knowledge to safely administer local anesthetics to dental patients as indicated.

(iii)   Course instruction shall include:

(I)   Background information, including:

a. Introduction and objectives of the course;

b. History of local anesthesia;

c. Instruction in the philosophy and psychology of the use of local anesthesia;

d. A review of the physiology of nerve conduction;

e. A review of regional anatomy;

f. A survey of local anesthetic agents on nerve conduction;

g. A review of the metabolism and excretion of local anesthetics;

h. Instruction on the toxicity of local anesthetic drugs;

i. Instruction on the clinical manifestations of toxic reactions;

j. Instruction on the treatment of toxic reactions;

k. Instruction on allergic reactions to local anesthetic drugs;

l. Instruction on the clinical manifestations of allergic reactions;

m. Instruction on the treatment of allergic reactions to local anesthetics;

n. Instruction regarding vasoconstrictor drugs used in local anesthetics;

o. Instruction on the clinical manifestations of toxic reactions to vasoconstrictor drugs used in local anesthesia;

p. Instruction on the treatment of toxic reactions to vasoconstrictors used in local anesthesia;

q. Instruction on drug interactions related to local anesthesia; and

r. Instruction on the technical aspects of syringe and cartridge care.

(II)   Students shall be trained in aspects of patient status assessment to include:

a. Taking and recording a thorough health history, including vital signs;

b. Assessing the implications of health history problems related to local anesthesia;

c. Evaluating the indications and contraindications for the use of local anesthesia drugs.

(III)   Students shall be trained in the proper administration of local anesthesia, including:

a. The use of syringes;

b. The selection of anesthetic solutions;

c. The identification of anatomic landmarks;

d. The application of proper depth;

e. The insertion of the needle to the proper depth;

f. Performing an aspiration technique;

g. The depositing of the anesthetic solution at the proper rate;

h. Maintaining a sterile field throughout a procedure;

i. Accurately evaluating the effectiveness of an anesthetic;

j. Reinjecting when necessary;

k. Estimating the highest safe dosage of local anesthesia according based upon the weight and/or age of the patient.

(IV)   Students shall be instructed in pertinent legal aspects of the administration of local anesthetics.

(V)   The clinical experience of the course shall include:

a. Evaluating the patient's health status;

b. Taking the patient's vital signs;

c. Administering local anesthetic infiltrations;

d. Administering local anesthetic nerve blocks;

e. Monitoring the patient's physical status while under the effects of local anesthetics;

(VI)   Course work shall be provided in post-anesthetic care.

(iv)   Upon completion of the course, students shall be evaluated by course presenters by written examination. The examination shall cover both the didactic and clinical portions of the course. The passing grade is set at 70%. Each student's written examination shall be maintained by the course provider for a minimum of one (1) year following the completion of the examination. Each course provider shall, prior to beginning a course, allow a member of the Board or its designee to review the examination.

(v)   Each course provider shall, within thirty (30) days of completion of a course, submit to the Board a list of the names of each student at the course and each student's final grade in the course.

(vi)   Courses offered pursuant to this rule are subject to unannounced audits by the Board. Any Board member or designee of the Board shall be provided full access to course materials or the classroom or clinic during instruction. Failure to provide access pursuant to this provision may subject the provider to invalidation of course results.

(b)   An application by a dental hygienist for authorization to perform an advanced procedure shall be made on a form prescribed by the Board.

(c)   The advanced procedures specified in (a) may be performed by a dental hygienist only on a patient of record and only under the direct or indirect supervision of a dentist.

(d)   The advanced procedures specified in (a) may be performed only by a dental hygienist who is authorized by the Board or a dentist.

(e)   Advanced procedures permitted for dental hygienists who graduate from accredited dental hygiene programs in Oklahoma which provide Board approved instruction, will automatically be authorized after licensure.

[Source: Added at 15 Ok Reg 2200, eff 7-1-98; Amended at 20 Ok Reg 2344, eff 7-11-03]