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RULE PROPOSALS
VOLUME 42, ISSUE 18
ISSUE DATE: SEPTEMBER 20, 2010
LAW AND PUBLIC SAFETY
DIVISION OF CONSUMER AFFAIRS
NEW JERSEY BOARD OF DENTISTRY

Proposed Readoption with Amendments: N.J.A.C. 13:30

Proposed New Rules: N.J.A.C. 13:30-8.5, 8.18, 8.23 and 8.24

Rules

Authorized By: Jonathan Eisenmenger, Executive Director, New Jersey State Board of Dentistry.
Authority: N.J.S.A. 45:1-15.1 and 45:6-1 et seq.
Calendar Reference: See Summary below for explanation of exception to calendar requirement.

Proposal Number: PRN 2010-215 .
Submit comments by November 19, 2010 to:
Jonathan Eisenmenger, Executive Director
New Jersey State Board of Dentistry
P.O. Box 45005
Newark, NJ 07101

The agency proposal follows:

Summary

The New Jersey State Board of Dentistry (the Board) is proposing to readopt N.J.A.C. 13:30 with amendments and new rules. These rules are scheduled to expire on August 16, 2010, pursuant to N.J.S.A. 52:14B-5.1 and Executive Order No. 66 (1978). Because this notice of readoption has been filed prior to August 16, 2010, the expiration date of the rules in Chapter 30 is extended by 180 days, to February 12, 2011, pursuant to N.J.S.A. 52:14B-5.1c.

In compliance with Executive Order No. 66 (1978), and in light of Executive Order No. 2 (2010), the Board undertook a thorough review of the existing provisions of N.J.A.C. 13:30 in order to clarify existing provisions, and to delete or amend rules that are unnecessary or inconsistent with the Common Sense Principles enumerated in Executive Order No. 2 (2010). The Board believes that the rules proposed for readoption, as amended, are necessary, reasonable, understandable and responsive to the purposes for which they were promulgated.

The following is a summary of the existing rules of Chapter 30 that the Board proposes to readopt with amendments, as well as a summary of proposed new rules.

Subchapter 1 outlines the rules applicable to candidates seeking licensure to practice dentistry in New Jersey. N.J.A.C. 13:30-1.1, which sets forth the purpose and scope of the rules contained in Chapter 30, is proposed to be readopted without change. N.J.A.C. 13:30-1.2 concerns the qualification of applicants. The Board is proposing several amendments to the rule in order to provide applicants with greater flexibility in meeting the Board's licensure requirements. Specifically, the Board is proposing an amendment to N.J.A.C. 13:30-1.2(d)4, which currently provides that applicants must submit evidence of having successfully completed the New Jersey Jurisprudence examination within one year of the date of application, to provide that the examination must be taken within two years of applying for licensure. The Board is proposing a similar amendment in N.J.A.C. 13:30-1.2(e)6 for applicants for licensure by credentials. The Board is also proposing to amend the provisions of N.J.A.C. 13:30-1.2(e) that an applicant for licensure by credentials must demonstrate that he or she actively practiced dentistry in another state or jurisdiction for at least five years prior to applying to the Board for a New Jersey license. The proposed amendment clarifies that such practice may include time spent working as a dental resident. The Board is proposing an additional amendment to the requirement in N.J.A.C. 13:30-1.2(e)5, which currently provides that an applicant for licensure by credentials must submit evidence of having completed a clinical examination that is comparable to the North East Regional Board (NERB) examination. The proposed amendment allows an applicant to submit evidence of having passed an examination that was considered comparable to NERB at the time the applicant took the examination.

The Board is proposing to amend N.J.A.C. 13:30-1.3, concerning resident permits, to clarify that a student who is enrolled in a post-graduate program to obtain a Certificate of Advanced Graduate Standing or its equivalent, is not required to obtain a resident permit. N.J.A.C. 13:30-1.4 concerns exemptions from licensure. The Board is proposing to amend the rule to exempt from the Board's licensure requirements those dentists who are licensed in other states and who are appearing as instructors or attendees at Board-approved continuing education courses in New Jersey where they will be providing hands-on training or demonstrations on live patients. In order to qualify for this exemption, a dentist must be covered by malpractice insurance. The Board believes that the proposed amendment is necessary to protect the health, safety and welfare of the New Jersey consumers to whom these dentists will be providing services.

N.J.A.C. 13:30-1.5, which concerns requirements for retired and inactive licensure, is proposed to be readopted without change. The Board is also proposing to readopt N.J.A.C. 13:30-1.6 through 1.16, which are currently reserved, without change.

[page=2218] Subchapter 1A concerns the licensure of dental hygienists. N.J.A.C. 13:30-1A.1, which sets forth applicant requirements, is proposed to be readopted without change. N.J.A.C. 13:30-1A.2 delineates the scope of practice of licensed dental hygienists. The Board is proposing several amendments to the rule in order to clarify a licensed hygienist's existing scope of practice. Specifically, the Board is proposing to amend N.J.A.C. 13:30-1A.2(b)20, which currently provides that a dental hygienist may place and remove retraction cords and medication pellets, to clarify that this does not include tissue retraction by way of electrosurgery or laser. A similar clarifying amendment is proposed at N.J.A.C. 13:30-1A.2(b)31, which authorizes a dental hygienist to hold a curing light for dental procedures. The rule currently provides that a curing light does not include a laser capable of altering, cutting, burning or damaging hard or soft tissue. The proposed amendment clarifies that the curing light also does not include use of electrosurgery for tissue retraction purposes.

Similar amendments that prohibit electrosurgery or the use of lasers for tissue retraction purposes are being proposed for the scope of practice for registered dental assistants in N.J.A.C. 13:30-2.4(a)15 and 27, and for the scope of practice for unregistered dental assistants in N.J.A.C. 13:30-2.6(a)9. The Board is also proposing to amend N.J.A.C. 13:30-1A.2(b)34, which currently provides that a dental hygienist may demonstrate home-use bleaching systems, to clarify that a hygienist is also permitted to apply bleaching agents. A similar amendment is being proposed for the scope of practice of registered dental assistants in N.J.A.C. 13:30-2.4(a)30.

The Board is proposing additional amendments to N.J.A.C. 13:30-1A.2(c), to clarify the reference to "hospital setting" in paragraph (c)1. Currently, the rule provides that a hygienist may monitor a patient to whom the supervising dentist has administered nitrous oxide/oxygen inhalation analgesia provided the hygienist has completed a Board-approved course offered in a Commission of Dental Accreditation (CODA) approved college or university clinical setting or in a hospital setting. The proposed amendments clarify that the college or university must be CODA-accredited, not approved, and that the hospital must be one licensed by the Department of Health and Senior Services. The Board is also proposing minor amendments to subsection (e) to clarify, consistent with the existing provisions of the rule, that a dental hygienist operating in an institution may do so only under the supervision of a New Jersey licensed dentist.

The Board is proposing a new requirement in N.J.A.C. 13:30-1A.2(f), which provides that, in an institutional setting, a licensed dentist must review all chart entries within 30 days after the patient was treated by a licensed dental hygienist. The Board believes that the proposed amendment is necessary to ensure appropriate follow up care is provided to patients in institutional settings. The Board is also proposing a technical amendment to subsections (g) and (h) for clarification purposes to provide a cross-reference to the permissible activities in subsection (e). In addition, the Board is proposing to amend subsection (h) to refer to N.J.S.A. 45:1-21, in addition to the existing reference to N.J.S.A. 45:1-25, as both statutory provisions provide for penalties.

N.J.A.C. 13:30-1A.3 provides for the administration of local anesthesia by dental hygienists under the supervision of a licensed dentist. The Board is proposing to amend subsection (c) to provide clarification concerning the types of injections and blocks that hygienists who hold permits to administer local anesthesia may provide. As proposed for amendment, the rule authorizes a hygienist to administer supraperiosteal (infiltration), periodontal ligament (PDL, intraligamentary), intraseptal and block anesthesia. The proposed amendments also clarify that a hygienist may not administer any of the following injections or blocks: a maxillary (second division, V2) nerve block via the high tuberosity approach or the greater palatine approach. In addition, the proposed amendments provide that a hygienist authorized to administer local anesthesia may also administer local anesthetic reversal agents that have been approved by the Federal Food and Drug Administration and the American Dental Association.

The Board is also proposing amendments to the training requirements in subsection (d) to clarify that the Board-approved course must include instruction in injection techniques, minimum and maximum dosages and the administration of reversal agents. The Board is not proposing any amendments to the length of the training course, which remains 20 hours of didactic instruction and 12 hours of clinical instruction. However, the Board is proposing to increase the number of monitored administrations of local anesthesia that must be included in the 12 hours of clinical instruction from 20 to 25. The Board is deleting the requirement that the didactic instruction include a minimum of five monitored administrations in the four listed injections. As amended, the rule provides that the 25 monitored administrations in the didactic component of the course must cover all the injections and blocks permitted under amended subsection (c). The Board believes that the proposed amendments to N.J.A.C. 13:30-1A.3 are necessary to ensure that hygienists who are authorized to provide local anesthesia will do so in a manner that provides the highest quality care to patients. N.J.A.C. 13:30-1A.4 remains reserved.

Subchapter 2 outlines the requirements applicable to dental assistants. N.J.A.C. 13:30-2.1 provides definitions of relevant terms. N.J.A.C. 13:30-2.2 and 2.3 set forth application requirements for dental assistants and limited registered dental assistants in orthodontics, respectively. N.J.A.C. 13:30-30-2.5 sets forth the scope of practice of limited registered dental assistants in orthodontics. The Board is proposing that these rules be readopted without change. Proposed amendments to N.J.A.C. 13:30-2.4 and 2.6, concerning the scope of practice of registered and unregistered dental assistants, respectively, are discussed above. In addition, the Board is proposing a further amendment to the scope of practice of registered dental assistants in N.J.A.C. 13:30-2.4 to authorize registered assistants to provide prophylactic and preventive care, such as applying fluorides and pit and fissure sealants. The Board believes the proposed amendment is reasonable and consistent with a registered dental assistant's education and training.

Subchapter 2A remains reserved. Subchapter 3 contains the rules applicable to applicants seeking a limited teaching certificate to enable them to provide instruction at dental schools. N.J.A.C. 13:30-3.1 sets forth applicant qualifications. N.J.A.C. 13:30-3.2 sets forth teaching certificate application procedures. N.J.A.C. 13:30-3.3 details the limitations of the teaching certificate. N.J.A.C. 13:30-3.4 requires educational institutions to submit the names of all teachers and demonstrators of dentistry practice to the Board. These rules are proposed to be readopted without change.

Subchapter 4 sets forth the rules applicable to industrial or corporate dental clinics. The Board is proposing to readopt the rules in this subchapter without any change. N.J.A.C. 13:30-4.1 defines the term industrial or corporate clinic. N.J.A.C. 13:30-4.2 establishes requirements for industrial or corporate clinic permits. N.J.A.C. 13:30-4.3 sets forth the documentation that must be submitted with an application for a dental clinic permit. N.J.A.C. 13:30-4.4 concerns the transferability of permits. N.J.A.C. 13:30-4.5 requires every dental clinic to obtain a certificate of renewal annually. N.J.A.C. 13:30-4.6 sets forth the changes to the clinic that require Board approval. N.J.A.C. 13:30-4.7 concerns the qualifications of persons entitled to perform services at the dental clinic. N.J.A.C. 13:30-4.8 is reserved. N.J.A.C. 13:30-4.9 establishes the standards of services and facilities that must be provided by clinic permit holders. N.J.A.C. 13:30-4.10 concerns inspections of the clinic and the responsibilities of the clinic director.

Subchapter 5 establishes the Board's continuing education requirements. The Board is proposing to amend the requirements in N.J.A.C. 13:30-5.1 for obtaining credit for papers, publications and scientific presentations and for teaching and research appointments. Specifically, the Board is proposing to amend paragraph (i)2, which currently provides that licensees may obtain credit for the presentation of a paper, essay or formal lecture to a recognized group of fellow professionals, to clarify that such activities will qualify for continuing education credit only if they are provided as part of a course or program that is eligible for Board approval for continuing education credit. The Board is not proposing any amendment to the number of credits that licensed dentists may claim for such activities. Dentists will continue to be able to claim two hours of credit for every hour of presentation for continuing education in this category.

The Board is proposing several amendments to the requirements for teaching and research appointments set forth in paragraph (i)3, in order to provide licensed dentists with greater flexibility in meeting their biennial continuing education obligations. Initially, the Board notes that it is proposing to increase the number of credits that faculty members may claim for their teaching and research activities. Currently, the rule [page=2219] provides that a dentist who holds at least a part-time faculty or research appointment may obtain four continuing education credits annually for a teaching or research assignment that meets one full day or its equivalent per week per academic year, and two credits for such assignments if they meet one half day per week per academic year. As amended, the rule would permit dentists to obtain five credits for each full day teaching or research assignment, and two and one half credits for part-time assignments. Currently, a licensee may obtain a maximum of 20 hours of credit in teaching and research activities. The Board, however, is proposing to decrease this number, and to instead provide that dentists who teach or engage in research assignments that meet one full day per week per academic year may claim a maximum of 10 hours of credit for these activities per biennial period, and that dentists who engage in teaching and research assignments that meet in half day per week increments per academic year may claim a maximum of five hours of credit.

The Board believes that lowering the maximum number of credits that licensees who hold faculty teaching and research appointments may claim for their work is reasonable in light of the additional amendment to the section that the Board is proposing at this time. Specifically, the Board is proposing to delete the current prohibition that precludes such licensees from claiming credit for teaching a course or researching a subject matter that the dentist has previously taught or researched. The Board believes that licensees should be permitted to obtain credit for teaching and research activities, even when the courses or subject areas are not new, because of the amount of preparation required of licensees to effectively engage in such activities. The Board, however, believes that decreasing the maximum number of credits that licensees may obtain in these activities will help to ensure that licensees who hold faculty or research appointments take a sufficient number of continuing education credits in other areas, so as to ensure that their continuing education is comprehensive and well rounded.

The Board notes that it is also proposing amendments to N.J.A.C. 13:30-5.2(c)3 and 5.3(b)3 to permit licensed dental hygienists and registered dental assistants who hold faculty or research appointments to obtain credit for teaching a course or researching a subject area that they have previously taught or researched, to ensure consistency. The maximum number of credits for teaching and research activities is proposed to be decreased from 10 credits to a maximum of four credits for full day teaching or research, and a maximum of two hours of credit for half day teaching or research assignments.

The proposed decrease in the maximum number of credits that dentists, dental hygienists and dental assistants may claim for teaching and research activities may require licensees to make adjustments to their continuing education activities. The Board, however, notes that the current biennial renewal period for licensed dentists expires on October 31, 2011, and on December 31, 2011, for licensed dental hygienists. The Board, therefore, believes that dentists and hygienists will have sufficient time to make any necessary adjustments to their continuing education to ensure compliance with this new requirement. The current biennial renewal period for registered dental assistants, however, expires on December 31, 2010 and, therefore, the new cap on this type of credit will not be imposed on dental assistants until the next biennial renewal period. As a result, dental assistants will be required to ensure compliance with the new requirement by December 31, 2012.

The Board is also proposing amendments to N.J.A.C. 13:30-5.2(a). Subsection (a) currently provides that hygienists must complete 10 hours of continuing education, but that beginning with the biennial period that started on January 1, 2006, and for all subsequent renewal periods, hygienists must complete 20 hours of continuing education. The increase from 10 hours to 20 hours of continuing education was the result of statutory amendments to the Dental Practice Act at N.J.S.A. 45:6-56, which became effective in 2005. The Board is proposing to delete the reference to 10 hours, as well as the reference to the January 1, 2006 biennial renewal date, because currently all hygienists must complete 20 hours of continuing education every two years, consistent with the statutory requirements in N.J.S.A. 45:6-56. The Board is proposing to amend the requirement in subsection (b), which currently provides that an individual who graduates from a dental hygiene program in the first year of the biennial must complete five credits of continuing education for biennial renewal, to require such individuals to complete 10 credits of continuing education. The Board believes this change is reasonable and consistent with the requirement in N.J.A.C. 13:30-5.1(a) that provides that an individual who graduates from dental school and is licensed in the first years of the biennial period must complete one half of the continuing education required for licensed dentists. The Board is also proposing to amend N.J.A.C. 13:30-5.2(d) and 5.3(c) to add the American Academy of Dental Hygiene to the list of approved providers of continuing education courses for dental hygienists and dental assistants.

Subchapter 6 sets forth requirements for advertising. N.J.A.C. 13:30-6.1, which establishes requirements for a licensee to announce his or her practice in a special area of dentistry, is proposed to be readopted without change. N.J.A.C. 13:30-6.2 establishes standards for professional advertising by licensed dentists. The Board is proposing a minor amendment in subsection (i) of the rule to clarify that the current reference to recognized specialty areas of practice in subsection (c) of the rule refers to those areas recognized as specialties by the Board. The Board is also proposing a new subsection (j) that provides that if a dentist advertises that he or she possesses an M.D. or D.O. degree, the advertisement may not imply that the dentist is licensed to practice medicine in New Jersey unless the dentist holds a medical license issued by the State Board of Medical Examiners. The Board believes that this new requirement is necessary to ensure that advertisements that refer to medical credentials held by a licensed dentist are not misleading or deceptive. The remaining subsections of the rule, (j) through (q), are proposed to be recodified as (k) through (r), with amendments to correct all internal cross references accordingly. The Board is also proposing to amend recodified subsection (n), to require that services advertised as complimentary, free of charge or for a discounted fee shall be offered equally to all patients identified as eligible in the advertisement, regardless of the patient's third-party coverage. The Board believes that the proposed amendment is necessary to ensure that advertisements of discounts are not misleading to the public, and will help all consumers make informed decisions regarding dental treatment options.

Subchapter 7 remains reserved. Subchapter 8 sets forth provisions of general applicability. The Board is proposing to readopt N.J.A.C. 13:30-8.1, which sets forth the fees charged by the Board, without change. The Board is also proposing to readopt without change N.J.A.C. 13:30-8.1A, which concerns the use of deep sedation, and N.J.A.C. 13:30-8.2 and 8.3, which set forth requirements for parenteral conscious sedation and general anesthesia permit holders, respectively. The Board is proposing to amend N.J.A.C. 13:30-8.4, which sets forth requirements for the use of enteral sedation with single or multiple pharmacological agents, to remove the references to the July 1, 2006 effective date of the rule in subsections (b), (c) and (e) as the references are no longer necessary.

The Board is proposing a new rule at N.J.A.C. 13:30-8.5, which is currently reserved, to codify an existing practice requirement. The new rule requires all licensees and registrants to comply with Occupational Safety and Health Administration (OSHA) regulations concerning exposure to blood or other potentially infectious materials in the provision of dental services, as well as the requirements of the New Jersey Public Employees Occupational Safety and Health (PEOSH) Act, and Centers for Disease Control and Prevention's (CDC) Recommended Infection Control Practices for Dentistry. The OSHA regulations and the CDC guidelines are incorporated by reference in the new proposed rule.

N.J.A.C. 13:30-8.6 establishes procedures for biennial license and registration renewal, the reinstatement of suspended licenses and registrations, the designation of inactive or retired status and the return from inactive status. The Board is proposing an amendment in subsection (b), which currently provides that if a license renewal notice is not sent at least 60 days prior to the license expiration date, no monetary penalties or fines will apply to the holder for failure to renew, to clarify that no monetary penalties will apply during the period following license or registration expiration, not to exceed the number of days short of 60 before the renewal notices were issued. The Board is also proposing clarifying amendments to subsection (g) of the rule, which requires renewal applications to provide licensees and registrants with the option of either active or inactive status. The proposed amendments clarify that a licensee or registrant electing inactive paid status will continue to receive printed information disseminated by the Board to all active licensees and [page=2220] registrants. A licensee or registrant electing inactive unpaid status will not receive this printed information.

N.J.A.C. 13:30-8.7 concerns the maintenance of patient records. Currently, paragraph (a)5 requires the record to include dates of each patient visit and a description of the treatment or services rendered at each visit. The Board is proposing to amend the paragraph to also require the record to reflect all materials used during each office visit. The Board is also proposing to amend paragraph (a)6, which concerns radiographs maintained as part of the record, to require, if radiographs are released, originals or diagnostic copies to be maintained as part of the record. The rule is also being amended to include, in new paragraph (a)8, that the record contain copies of any prescriptions to laboratories for dental prostheses. Existing paragraphs (a)8 through (a)12 are proposed to be recodified as (a)9 through (a)13. A new paragraph (a)14 is also being proposed, which requires all notations in the patient record to be legible, written in ink and to contain no erasures or white-outs. Corrections to patient record information must be made by way of a single, non-deleting line and must be initialed and dated by the licensee on the date that the change is made. The Board believes that proposed amendments to N.J.A.C. 13:30-8.7 are necessary to ensure that the patient record is accurate and contains all relevant and necessary information.

The Board is also proposing an amendment to subsection (e) of the rule, which authorizes licensees to charge for the reproduction of radiographs and other materials within the patient record that cannot be routinely copied or duplicated on a commercial duplicating machine. The Board is aware that the current provision, which provides that the fee be no more than the actual cost of duplication or the fee charge for such duplication, in addition to an administrative charge of $ 10.00 or 10 percent of the cost of reproduction, whichever is less, has generated a great deal of confusion for licensees. In an effort to make the rule easier for licensees to adhere to and to ensure that patients are not charged an excessive amount for the reproduction of radiographs, the Board is proposing to amend the rule to provide that licensees may charge a duplication fee of up to $ 15.00 for up to nine radiographs, and a duplication fee of up to $ 30.00 to reproduce up to 18 radiographs or a panorex.

The Board is also proposing amendments to subsection (h) of the patient record rule, which delineates the situations in which a patient record need not be maintained, to provide that the maintenance of a dental record is not necessary in the case of dental screenings. The Board is also proposing a new subsection (i), providing that services not recorded in the patient record shall be presumed not to have been performed. In such cases, it shall be the responsibility of the licensee to produce evidence to establish that the non-recorded services were actually performed.

N.J.A.C. 13:30-8.8 requires all licensees to report to the Board, within seven days, incidents occurring in dental facilities that required the removal of a patient to the hospital. The Board is proposing to amend the rule to clarify that the obligation to notify the Board of such incidents is triggered only if the removal of the patient to a hospital occurred after dental treatment was initiated. Moreover, the Board has amended the rule to provide that licensees must use forms supplied by the Board, available on the Board's website, to report these incidents, and to comply with the existing requirement to notify the Board of any death that may be related to dental treatment.

N.J.A.C. 13:30-8.9, which concerns the display of names and identifying badges, is proposed to be readopted without change. The Board is proposing to amend N.J.A.C. 13:30-8.10, which concerns the submission of claims to third-party payors for dental services. Currently, the rule prohibits a licensee from submitting any claim or bill that contains any treatment date that does not accurately reflect the date when dental services or procedures were "actually completed" or any description of services that does not accurately reflect the "actual work completed." The Board is proposing to amend the prohibitions in paragraphs (b)1 and 2 to refer to dates and descriptions of dental work performed, rather than completed, to provide clarification for licensees. As amended, the rule provides that licensees may not submit a claim or bill that contains a treatment date that does not accurately reflect the date when the services or procedure were actually performed, or any description of a service or procedure that does not accurately reflect the actual work performed. The Board is also proposing a clarifying amendment to paragraph (b)4, which provides that a licensee shall not include in any claim submission any statement material to the claim that the licensee knows to be false or misleading, to make the prohibition applicable to attachments to the claim as well. As amended, claim submissions shall not include any statement or attachment material to the claim that the licensee knows is false or misleading.

N.J.A.C. 13:30-8.11, which sets forth the rules applicable to the identification of removable prostheses, and N.J.A.C. 13:30-8.12, which concerns a licensee's obligation to notify the Board of a change of address, are proposed to be readopted without amendment. N.J.A.C. 13:30-8.13 concerns permissible business structures and the prohibition on referral fees. The Board is proposing an amendment to subsection (d) of the rule to clarify that the rule's prohibition on referral fees does not preclude the dentist from providing a gift to a patient, or from providing a credit for dental services to a patient, so long as the gift or credit is of nominal value. The proposed amendment provides that such gift or credit cannot exceed $ 25.00 in value. The Board is also proposing an amendment to subsection (e), which prohibits dentists from participating in any arrangement, with anyone other than an associate, where remuneration received by that person in payment for the provision of space, facilities, equipment, personnel, marketing or management services used by the dentist is to be determined or calculated as a fixed percentage of, or otherwise dependent upon, the income or receipts derived from the practice of dentistry. The Board is proposing an amendment to the rule to capture remuneration received in payment for the provision of professional services, in addition to the provision of space, facilities, equipment, personnel, marketing or management services.

The Board is proposing that the remaining rules in Subchapter 8 be readopted without change, with the exception of N.J.A.C. 13:30-8.18, which is currently reserved and proposed as a new rule as discussed below. N.J.A.C. 13:30-8.14 concerns dental x-rays and lead shields. N.J.A.C. 13:30-8.15 concerns the dentist of record and fee reimbursement. N.J.A.C. 13:30-8.16 affords a licensee the right to request an opportunity to be heard prior to any suspension, revocation or refusal to renew a license. N.J.A.C. 13:30-8.17 concerns the delegation of physical modalities to licensed dental hygienists, registered dental assistants, limited registered dental assistants and unregistered dental assistants. N.J.A.C. 13:30-8.19 establishes requirements for dental practice names. N.J.A.C. 13:30-8.20 concerns the administration of nitrous oxide/oxygen inhalation analgesia and the delegation to licensed dental hygienists and registered dental assistants. N.J.A.C. 13:30-8.21 requires disqualified licensees to divest themselves of their interests in a professional corporation. N.J.A.C. 13:30-8.22 concerns the use of diagnostic tests for traumatically induced temporomandibular dysfunction.

The Board is proposing a new rule at N.J.A.C. 13:30-8.18, which is currently reserved, to codify existing requirements concerning the issuance of prescriptions. The proposed new rule requires that a licensee issue written prescriptions only on New Jersey Prescription Blanks (NJPB) that have been secured from an approved vendor and which meet the security requirements of the Division of Consumer Affair's prescription blanks program. The new rule also requires licensees issuing prescriptions for controlled dangerous substances to comply with State and Federal laws concerning the issuance of such prescriptions.

The Board is proposing a new rule at N.J.A.C. 13:30-8.23 to provide that when a dentist is providing services in a dental practice and he or she does not participate in a third-party payor plan in which other providers in the dental office participate, the dentist must clearly disclose this fact to the patient prior to treatment. The Board believes that the proposed new rule is necessary to ensure that consumers have accurate information with which to make informed and reasoned decisions concerning their dental treatment options. The Board is also proposing a new rule to provide guidance to licensees concerning the keeping of animals or pets in dental offices. Proposed new rule N.J.A.C. 13:30-8.24 provides that a licensee may not permit animals or pets in a dental office unless the animals or pets are maintained in an enclosed space that cannot be accessed by patients. The rule does not apply to trained guide or service dogs (or dogs in training) for the disabled, sightless or hearing impaired, [page=2221] consistent with the provisions of the New Jersey Law Against Discrimination.

The Board has provided a 60-day comment period for this notice of proposal; therefore, this notice is excepted from the rulemaking calendar requirement pursuant to N.J.A.C. 1:30-3.3(a)5.

Social Impact

The Board believes that the rules proposed for readoption with amendments and new rules that establish licensure and registration standards and clarify the varied aspects of dental practice, will have a positive impact upon licensees, registrants, permit holders and applicants. The rules continue accepted practice standards for licensees, registrants and permit holders established by the Board, and by so doing, provide them with a clear and comprehensive set of rules to guide them in their professional practice. Licensees, registrants and permit holders will benefit from the readoption as a result of the uniform standards that will be applied throughout the profession.

The Board also believes that the proposed readoption of these rules will have a positive impact upon the public by continuing to safeguard the public's health, safety and welfare by ensuring the maintenance of professional practice standards. These practice standards enable licensees, registrants and permit holders to provide the highest quality dental services to New Jersey consumers.

The Board believes that the proposed amendments to N.J.A.C. 13:30-1.2 will have a positive impact upon applicants for licensure, including applicants applying for licensure by credentials, by extending the window of time during which applicants will have the opportunity to take the required New Jersey Jurisprudence examination prior to licensure to two years, providing applicants with added flexibility with which to schedule and pass this examination. The remaining amendments to N.J.A.C. 13:30-1.2 will positively impact applicants for licensure by credentials by permitting them to include time spent practicing in a dental residency in order to satisfy the Board's five years of dental practice requirement, and will also permit these applicants to present evidence of having passed a NERB-comparable examination, offering these applicants increased flexibility with which to meet the Board's licensing requirements.

The proposed amendments to N.J.A.C. 13:30-1.3 will have a positive impact upon students enrolled in certain post-graduate dental studies by clarifying for these students, and the institutions at which they are pursing their advanced training, that these students need not obtain a resident permit. The proposed amendments to N.J.A.C. 13:30-1.4 will have a positive impact upon dentists licensed in other states who wish to appear as instructors or attendees at Board-approved continuing education courses where they will be providing hands-on services or demonstrations to live patients. These instructors and participants will not be required to obtain a license from the Board to engage in such activities, provided they are covered by malpractice insurance.

The proposed amendments to N.J.A.C. 13:30-1A.2, 2.4 and 2.6 will have a positive impact upon dental hygienists, registered dental assistants and unregistered dental assistants to the extent that the amendments clarify their existing scopes of practice. The proposed amendments to N.J.A.C. 13:30-1A.2 will have a positive impact upon patients receiving dental care from licensed hygienists in an institutional setting. The proposed amendment requiring a licensed dentist to review all chart entries in such situations within 30 days of treatment by a hygienist will help ensure that patients receive appropriate follow-up care.

The proposed amendments to N.J.A.C. 13:30-1A.3 will have a positive impact upon licensed dental hygienists who administer local anesthesia, on the licensed dentists who supervise the provision of this service and on the patients they treat. The Board believes that the proposed amendments to the training requirements and the greater specificity provided in the rule with respect to the types of injections and blocks that may be utilized will help to ensure that hygienists are appropriately trained and may provide the broadest range of services to patients.

The proposed amendments to the continuing education requirements in N.J.A.C. 13:30-5.1, 5.2 and 5.3 will have a positive impact upon dentists, hygienists and dental assistants who hold faculty or research appointments, by permitting them to claim a limited amount of continuing education credit for teaching or research activities in a subject area that they have taught or researched before. In addition, the proposed amendments to N.J.A.C. 13:30-5.2 and 5.3 will have a positive impact upon dental hygienists and dental assistants by permitting them to obtain continuing education credit for attendance at courses offered by the American Academy of Dental Hygiene. These amendments will benefit licensees and registrants by providing them with greater flexibility in obtaining credits to satisfy their continuing education obligations.

The Board believes that the proposed amendments to N.J.A.C. 13:30-6.2 will have a positive impact upon dentists and consumers by providing added clarity to the Board's advertising requirements. The Board believes that the new requirement in the rule, prohibiting licensees who possess medical degrees from implying that they are licensed to practice medicine when such is not the case, will help to ensure that consumers are not mislead as to the services they will be receiving from Board licensees. In addition, the proposed amendment requiring all services advertised as complimentary, free of charge or for a discounted fee, to be offered equally to all patients, irrespective of the patient's insurance coverage, will help ensure that patients may make reasoned and informed decisions concerning their dental treatment options.

Proposed new N.J.A.C. 13:30-8.5 will have a positive impact upon licensees and registrants by clarifying their existing obligations with respect to compliance with Federal standards for minimizing exposure to blood or other potentially infectious materials in the provision of dental services. The proposed amendments to N.J.A.C. 13:30-8.6 may have a positive impact upon applicants seeking to elect inactive status by clarifying the differences between inactive paid and inactive unpaid status, so as to enable them to make informed decisions about their license and registration renewal options.

The proposed amendments to N.J.A.C. 13:30-8.7, including the requirement that the dentist retain radiograph originals or diagnostic copies if the radiographs must be sent out of the office, will benefit licensees and patients by helping to ensure that dental records are as accurate and complete as possible. The Board also believes that the proposed amendment permitting dentists to charge a reasonable, flat fee for the duplication of radiographs will benefit licensees by eliminating the confusion that currently exists with respect to exactly how much a licensee may charge for such reproductions.

The proposed amendments to N.J.A.C. 13:30-8.8, making the incident reports that must be filed with the Board when a patient must be taken to the hospital or when a patient dies, available on-line from the Board office, will positively impact licensees by lessening the administrative burdens associated with submitting such reports. The proposed amendments to N.J.A.C. 13:30-8.10 will have a positive impact upon licensees by clarifying their obligations with respect to submission of dental insurance forms. In addition, the proposed amendment to N.J.A.C. 13:30-8.13 will benefit licensees by clarifying that nominal gifts to patients do no violate the rule's prohibition against referral fees.

Proposed new N.J.A.C. 13:30-8.18 will have a positive impact upon licensees by clarifying their existing obligations to utilize New Jersey Prescription Blanks when issuing written prescriptions and to comply with all State and Federal laws when prescribing controlled dangerous substances. Proposed new N.J.A.C. 13:30-8.23, which requires a dentist providing services in a dental practice who does not participate in a third-party plan in which other providers in the office participate to clearly disclose this fact to patients prior to treatment, will benefit consumers by providing them with relevant information, so they may make informed decisions about their dental treatment.

Proposed new N.J.A.C. 13:30-8.24 will have a positive impact upon dental practices by clarifying for licensees under what circumstances animals or pets may be permitted in the dental office, thereby helping to ensure dental offices are maintained in a safe and sanitary manner.

Economic Impact

The rules proposed for readoption with amendments and new rules will have an economic impact on licensees, registrants, permit holders and applicants. Applicants for a dental license are required to pay the application fee specified in N.J.A.C. 13:30-1.2. In addition, applicants will incur costs to obtain the requisite dental education and training and to submit the required applications and supporting materials to the Board for review. Applicants must also bear the costs associated with passing the NERB and New Jersey Jurisprudence examinations. Applicants for [page=2222] licensure who have graduated from a dental school that is not CODA-approved will incur added costs. These applicants will be required to complete at least two years of education at a CODA-approved school prior to being licensed. Applicants for resident permits will be required to pay the fee imposed under N.J.A.C. 13:30-1.3, and may also incur costs associated with submitting the required application and supporting documentation to the Board. The proposed amendment to N.J.A.C. 13:30-1.3, however, will have a positive economic impact upon students enrolled in post-graduate programs working toward a Certificate of Advanced Graduate Standing. These students will not be required to obtain resident permits.

N.J.A.C. 13:30-1.4 will have a positive economic impact upon persons who are exempt from obtaining a license because such persons will not be required to apply to the Board or to pay licensing fees to perform certain activities. The proposed amendments to the rule further expand the list of exempt individuals to include dentists licensed in other states appearing as instructors or attendees at approved continuing education courses who provide hands-on training or demonstrations on live patients. These dentists are not required to apply to the Board nor are they required to pay the licensing fee, provided they are covered by malpractice insurance. Under N.J.A.C. 13:30-1.5, a retired licensee seeking to resume the active practice of dentistry may incur costs associated with satisfying the competency requirements for return to active practice.

Applicants for licensure as dental hygienists will be required to remit the fees specified in N.J.A.C. 13:30-1A.1, and will incur costs associated with obtaining the required dental hygiene education, and in submitting the application and supporting materials for Board review. Proposed amendments to N.J.A.C. 13:30-5.2 will also have an economic impact upon applicants who have graduated from dental hygiene school more than two years prior to the applying for a license. These applicants must complete 10 credits of continuing education prior to being issued a license.

N.J.A.C. 13:30-1A.2 may have a positive economic impact upon licensed dentists, as the rule permits dentists to utilize the services of dental hygienists to perform certain functions, potentially increasing the number of patients a dentist may treat throughout the day. The proposed amendment to N.J.A.C. 13:30-1A.2, requiring a dentist supervising the provision of care by a dental hygienist in an institutional setting to review all chart entries made by the hygienist within 30 days of treatment, may have an economic impact upon dentists who may need to forgo other activities to complete such chart reviews. The proposed readoption of N.J.A.C. 13:30-1A.3 will continue to have an economic impact upon dental hygienists who desire to administer local anesthesia, as such applicants will be required to undergo advanced training and must also submit a separate application to the Board to provide this service.

The rules in Subchapter 2 impose economic costs upon applicants for registration as dental assistants and limited dental assistants in orthodontics. These applicants must pay the applicable application fees and may incur costs associated with submitting documentation to the Board for review under N.J.A.C. 13:30-2.2 and 2.3. N.J.A.C. 13:30-2.4 and 2.5, establishing the scope of practice of registered dental assistants and limited registered dental assistants in orthodontics, may have a positive economic impact upon dentists by permitting dentists to utilize the services of these assistants to perform certain functions, potentially increasing the number of patients a dentist may treat throughout the day. N.J.A.C. 13:30-2.6 may have a similar impact by permitting dentists to utilize the services of unregistered dental assistants to perform certain activities in a dental office.

Applicants seeking a limited teaching certificate may incur costs associated with submitting the application required under N.J.A.C. 13:30-3.1 and 3.2. Educational institutions that wish to employ limited teaching certificate holders may incur costs to submit the documentation required for Board review under N.J.A.C. 13:30-3.4.

Industrial and corporate agencies seeking a clinic permit must submit an application fee under N.J.A.C. 13:30-4.2. In addition, applicants wishing to operate more than one dental clinic must apply for separate permits for each facility, submitting separate applications and fees for each desired facility. Applicants for clinic permits may also incur costs to submit required documentation for Board review under N.J.A.C. 13:30-4.3. N.J.A.C. 13:30-4.5 requires permit holders wishing to renew their permits to pay an annual renewal fee.

N.J.A.C. 13:30-4.6 may cause clinic permit holders to incur costs associated with notifying the Board of any changes to the clinic's structure and operation. Clinic permit holders may be economically impacted as a result of N.J.A.C. 13:30-4.9, which establishes minimum facility and equipment requirements for dental clinic operations. Industrial and corporate clinic permit holders may incur costs in furnishing the Board with information about the clinic's methods of operation, including information about the clinic's employees under N.J.A.C. 13:30-4.10.

N.J.A.C. 13:30-5.1, 5.2 and 5.3 impose costs on dentists, dental hygienists and dental assistants who must obtain 40, 20 and 10 credit hours of continuing education, respectively, during each biennial renewal period. The proposed amendments to the rule, which relax the requirements for obtaining credit for teaching and research appointments, may result in cost savings for licensees and registrants who may claim credit for teaching and researching activities in subject areas they have previously taught or researched. Licensees and registrants may continue to experience costs associated with maintaining continuing education records. Continuing education sponsors may incur costs associated with applying to the Board for course pre-approval. Licensees and registrants seeking a waiver of continuing education requirements may incur costs in submitting the required documentation for Board review.

A licensed dentist wishing to announce his or her practice as a specialist must apply to the Board for a specialty permit under N.J.A.C. 13:30-6.1, potentially incurring administrative costs. Dentists who advertise their services may incur costs to include required information in the advertisements as required under N.J.A.C. 13:30-6.2. Licensees may also incur costs associated with keeping copies of all advertisements for three years. Licensees may also realize an economic impact in light of the proposed amendment to the rule requiring services advertised as complimentary or free of charge to be offered equally to all patients identified as eligible in the advertisement without regard to a patient's insurance coverage.

The proposed readoption of the Board's fee schedule in N.J.A.C. 13:30-8.1 will continue to have an economic impact upon licensees, registrants, permit holders and applicants, who are required to pay the fees established in the rule. N.J.A.C. 13:30-8.2, 8.3 and 8.4, will impose costs on dentists who wish to administer parenteral conscious sedation, general anesthesia or enteral sedation. Dentists who seek permission to administer these types of sedation must obtain advanced training and may also incur costs in submitting permit applications to the Board for review. These dentists are also required to obtain continuing education in the specified area of sedation.

N.J.A.C. 13:30-8.6 requires licensed dentists, dental hygienists and dental assistants to pay biennial renewal fees. The rule imposes additional costs on those applying late, as well as those seeking reinstatement from a license or registration suspended for failure to renew. These applicants are required to pay late and reinstatement fees. Applicants for reinstatement may also incur costs to complete required continuing education and, in the case of a license or registration that has been suspended for more than five years, the costs associated with retaking the licensing examination.

N.J.A.C. 13:30-8.7 may impose costs on dentists associated with maintaining contemporaneous, permanent patient records as required under the rule. The proposed amendments to N.J.A.C. 13:30-8.7 may have an economic impact upon patients and licensees, to the extent that licensees may charge a reasonable fee for the reproduction of patient records consistent with the amended provisions of the rule. The rule may also have an economic impact on licensees who cease to engage in the practice. These licensees may incur costs associated with publishing a newspaper notice announcing the practice's closing.

N.J.A.C. 13:30-8.8 may impose administrative costs on dentists who are required to notify the Board of any patient incidents or deaths related to dental treatment. The costs associated with notifying the Board, however, may decrease as a result of the proposed amendments to the rule, requiring licensees to utilize Board-supplied forms for the notification that are available on the Board's website. The signage requirements of N.J.A.C. 13:30-8.9 will continue to impose costs on [page=2223] licensed dentists who must ensure that all exterior signs contain the names of the licensees who are responsible for the administration of a dental office. N.J.A.C. 13:30-8.10 may have an economic impact on dentists to the extent that licensees incur administrative costs in maintaining insurance claim records as outlined in the rule. N.J.A.C. 13:30-8.11 will continue to permit dentists to charge a reasonable fee for the permanent marking of dental prostheses. A licensee who changes his or her address may incur costs to notify the Board of the new address under N.J.A.C. 13:30-8.12.

N.J.A.C. 13:30-8.13, concerning permissible business structures and the prohibition of referral fees, will continue to have an economic impact upon licensees to the extent that licensees may choose to organize their professional practices in any form specified in the rule. The rule continues to prohibit licensees from receiving or paying referral fees. The proposed amendments to the rule may impact dentists by permitting licensees to provide gifts or credits for dental service to their patients. The gifts or credits cannot exceed $ 25.00.

N.J.A.C. 13:30-8.15 may have an economic impact upon dentists and dental practices to the extent that the rule provides that any dentist found to have rendered deficient treatment, as well as the owner of the facility in which the deficient treatment was rendered, will be jointly and severally responsible for reimbursing the patient or third-party payor for any fees charged. N.J.A.C. 13:30-8.17 may have an economic impact upon dentists to the extent that delegation of certain physical modalities to dental auxiliaries as authorized under the rule may permit dentists to provide services to more patients.

N.J.A.C. 13:30-8.20 imposes costs on dental hygienists who choose to administer local anesthesia, including costs associated with completing the advanced education and training requirements imposed under the rule. Hygienists may also incur costs associated with applying for a permit. N.J.A.C. 13:30-8.21 will continue to have an economic impact on licensees who are disqualified from the practice of dentistry by Board order. A disqualified licensee must divest his or her interest in a practice within 90 days of the entry of the order. N.J.A.C. 13:30-8.22, concerning the use of diagnostic tests for traumatically induced temporomandibular dysfunction, will continue to have an economic impact upon licensees, to the extent that licensees may only charge patients for tests as outlined in the rule. The rule continues to preclude a licensee from charging a patient, and from billing a third-party payor, for any of the following diagnostic tests: mandibular tracking; surface EMG; sonography; Doppler ultrasound; needle EMG; electroencephalogram; thermograms/thermographs; video fluoroscopy; and reflexology.

Proposed new N.J.A.C. 13:30-8.5, requiring licensees to comply with Federal requirements for minimizing exposure to blood and other infectious materials, and N.J.A.C. 13:30-8.18, requiring licensees to utilize NJPBs when issuing written prescriptions and to comply with existing State and Federals laws when issuing prescriptions for controlled drugs, will not impose any additional costs on licensees as the new rules codify requirements currently imposed under existing Federal and State laws.

Proposed new N.J.A.C. 13:30-8.23 may impose administrative costs on dentists who must make the disclosures mandated under the rule. The rule's disclosures are required only when the dentist providing services in an office does not participate in a third-party plan in which other providers in the office participate.

The administrative costs that will be borne by members of the regulated community as a result of the rules proposed for readoption with amendments and new rules are difficult to ascertain with specificity, and will vary based on costs established by entities beyond the Board's authority to regulate, such as dental schools and examination providers. The Board, however, believes that the costs to licensees, registrants, permit holders and applicants, delineated above, are outweighed by the benefit to the public in protecting the public's health, safety and welfare by ensuring that dental services are provided by qualified professionals consistent with the professional practice standards established in the rules.

Federal Standards Statement

A Federal standards analysis is not required because the rules proposed for readoption with amendments and new rules are governed by N.J.S.A. 45:6-1 et seq., and are not subject to any Federal standards or requirements. Although the rules in N.J.A.C. 13:30 are not subject to any mandated Federal requirements or standards, where deemed appropriate, the Board has voluntarily required licensees and permit holders to comply with applicable Federal laws and regulations. Specifically, the Board proposes to readopt N.J.A.C. 13:30-1A.2, concerning the scope of practice of licensed dental hygienists, which allows a dental hygienist to place intrasulcular therapeutic medications, as directed by a dentist, provided that the medications have been approved by the Food and Drug Administration (FDA). In addition, proposed amendments to N.J.A.C. 13:30-1A.3 provide that a licensed dental hygienist who has been issued a permit to administer local anesthesia under the supervision of a New Jersey dentist, may also administer local anesthetic reversal agents approved by the FDA. The Board is also proposing a new rule at N.J.A.C. 13:30-8.5, which requires all licensees and registrants to comply with Federal Occupational Safety and Health Administration (OSHA) regulations and Centers for Disease Control and Prevention (CDC) guidelines concerning infection control practices in the provision of dental services. The proposed readoption of N.J.A.C. 13:30-8.13 continues to require dentists who provide professional services as independent contractors to comply with State and Federal laws regarding such arrangements.

Jobs Impact

The Board does not anticipate that the rules proposed for readoption with amendments and new rules will result in an increase or decrease in the number of jobs in the State.

Agriculture Industry Impact

The Board does not believe that the rules proposed for readoption with amendments and new rules will have any impact upon the agriculture industry in the State.

Regulatory Flexibility Statement

Currently, the Board licenses and/or registers approximately 8,278 dentists with 3,134 branch offices, 5,140 dental hygienists, 3,155 dental assistants and 17 dental clinics. If Board licensees, registrants and permit holders are considered "small businesses," within the meaning of the Regulatory Flexibility Act, N.J.S.A. 52:14B-16 et seq., then the following analysis applies.

The rules proposed for readoption with amendments and new rules will impose various reporting, recordkeeping and compliance requirements upon licensees, registrants and permit holders. These requirements are discussed in the Summary above.

No additional professional services will be needed to comply with the rules proposed for readoption with amendments and new rules. The costs of compliance with the rules proposed for readoption with amendments and new rules are discussed in the Economic Impact statement above. The Board does not believe that there will be any significant, additional economic impact upon licensed dentists, dental hygienists, dental assistants and dental office or clinic permit holders as a result of the rules proposed for readoption with amendments and new rules. The Board believes that the rules proposed for readoption with amendments and new rules should be uniformly applied to all licensees, registrants and permit holders in order to ensure the health, safety and welfare of the general public in the provision of dental services. Therefore, no differing compliance requirements for any licensees, registrants or permit holders are provided based upon the size of the business.

Smart Growth Impact

The Board does not believe that the rules proposed for readoption with amendments and new rules will have any impact upon the achievement of smart growth or upon the implementation of the State Development and Redevelopment Plan.

Housing Affordability Impact

The rules proposed for readoption with amendments and new rules will have an insignificant impact on affordable housing in New Jersey and there is an extreme unlikelihood that the rules would evoke a change in the average costs associated with housing because the rules proposed for readoption with amendments and new rules concern the practice of dentistry.

[page=2224] Smart Growth Development Impact

The rules proposed for readoption with amendments and new rules will have an insignificant impact on smart growth and there is an extreme unlikelihood that the rules would evoke a change in housing production in Planning Areas 1 or 2 or within designated centers under the State Development and Redevelopment Plan in New Jersey because the rules proposed for readoption with amendments and new rules concern the practice of dentistry.

Full text of the rules proposed for readoption may be found in the New Jersey Administrative Code at N.J.A.C. 13:30.

Full text of the proposed amendments and new rules follows (additions indicated in boldface thus ; deletions indicated in brackets [thus]):

SUBCHAPTER 1. LICENSURE TO PRACTICE DENTISTRY

13:30-1.2 Application for licensure to practice dentistry

(a)-(c) (No change.)

(d) A candidate for dental licensure who has successfully completed the North East Regional Board examination five years or more prior to the date of application shall submit a completed application to the Board , which shall contain the following information and materials:

1.-3. (No change.)

4. Results from the successful completion of the New Jersey Jurisprudence examination taken within [one] two year s of the date of application;

5.-8. (No change.)

(e) A candidate for dental licensure by credentials, who is licensed to practice dentistry in another state or jurisdiction, shall submit a completed application to the Board , which shall contain the following information and materials:

1. Evidence demonstrating that the applicant has actively practiced dentistry , which may include practice in a dental residency, in a single state or jurisdiction for at least five years prior to the date of application;

2.-4. (No change.)

5. Results of the successful completion of a clinical examination administered or recognized by another state or jurisdiction that is comparable to the examination recognized by the North East Regional Board [examination] or was comparable at the time the applicant took the examination ;

6. Results from the successful completion of the New Jersey Jurisprudence examination taken within [one] two year s of the date of application;

7.-10. (No change.)

(f) (No change.)

13:30-1.3 Resident permit

(a)-(b) (No change.)

(c) A student who is enrolled in a post-graduate program for the awarding of a Certificate of Advanced Graduate Standing (CAGS) or its equivalent, at a Commission on Dental Accreditation-approved dental school, shall not be required to obtain a resident permit. This individual shall be identified as a student.

13:30-1.4 Exemption from licensure

(a) The following individuals shall not be required to obtain a license to practice dentistry pursuant to N.J.S.A. 45:6-19:

1.-4. (No change.)

5. Licensed dentists of other states or jurisdictions appearing as instructors or attendees at Board-approved continuing education courses in which they will engage in hands-on training or demonstrations on live patients, provided the dentist is covered by malpractice insurance;

Recodify existing 5.-6. as 6.-7. (No change in text.)

13:30-1A.2 Scope of practice of licensed dental hygienist

(a) (No change.)

(b) A licensed dental hygienist practicing under the direct supervision of a licensed dentist may:

1.-19. (No change.)

20. Place and remove retraction cords and medicated pellets . This shall not include electrosurgery or the use of lasers for tissue retraction ;

21.-30. (No change.)

31. Hold a curing light for any dental procedure. Such curing light shall not include a laser capable of altering, cutting, burning or damaging hard or soft tissue or electrosurgery for tissue retraction ;

32.-33. (No change.)

34. Demonstrate home-use bleaching systems and apply bleaching agents ;

35.-37. (No change.)

(c) In addition to the activities set forth in (b) above, a licensed dental hygienist practicing under the direct supervision of a licensed dentist pursuant to N.J.A.C. 13:30-8.20 may monitor a patient to whom the supervising dentist has administered nitrous oxide/oxygen inhalation analgesia, provided that:

1. The licensed dental hygienist has successfully completed a Board-approved course offered in a [CODA (]Commission on Dental Accreditation of the American Dental Association -(CODA ) [approved] accredited college or university [clinical setting] or in a hospital [setting] licensed by the Department of Health and Senior Services, which emphasizes the administration of nitrous oxide simultaneous with the administration of oxygen and safe and effective patient monitoring;

i.-iii. (No change.)

2.-5. (No change.)

(d) (No change.)

(e) A licensed dental hygienist practicing [within an institution subject to] under the supervision of a New Jersey licensed dentist in [the] an institution may:

1.-8. (No change.)

(f) Each licensed dentist may [utilize] supervise no more than three licensed dental hygienists at one time in a dental office. In an institutional setting, a licensed dentist shall review all chart entries within 30 days of treatment of the patient by a licensed dental hygienist.

(g) A licensed dental hygienist who engages in the activities outlined in (b) and (c) above without direct supervision , except as provided in (e) above, shall be deemed to be engaging in the unauthorized practice of dental hygiene and shall be subject to the penalties set forth in N.J.S.A. 45:6-58 and 45:1-25.

(h) A licensed dentist who permits a licensed dental hygienist to engage in the activities outlined in (b) and (c) above without direct supervision , except as provided in (e) above, shall be subject to the penalties set forth in N.J.S.A. 45:1-21 and 45:1-25.

(i) (No change.)

13:30-1A.3 Administration of local anesthesia by licensed dental hygienists

(a)-(b) (No change.)

(c) A licensed dental hygienist who has been issued a permit to administer local anesthesia may do so only under the direct supervision of a New Jersey licensed dentist who shall determine which anesthetic agent shall be administered by the hygienist[. The licensed hygienist may utilize only the following types of injections: infiltration in the maxilla and mandible; mandibular nerve block; mental nerve block; and long buccal nerve block.] and for which procedures the anesthetic agent shall be utilized, consistent with the following:

1. The licensed hygienist may administer supraperiosteal (infiltration), periodontal ligament (PDL, intraligamentary), intraseptal and block anesthesia except as provided in (c)1i below.

i. The licensed dental hygienist shall not administer a maxillary (second division, V2) nerve block via the high tuberosity approach or the greater palatine approach; and

2. The licensed hygienist may administer local anesthetic reversal agents approved by the Federal Food and Drug Administration and the American Dental Association, as determined by the dentist.

(d) A licensed dental hygienist applying for a Board permit to administer local anesthesia shall satisfy the following requirements:

1. Successful completion of a Board-approved course in the administration of local anesthesia offered in a dental hygiene program [page=2225] approved by the Commission on Dental Accreditation, or in an accredited college or university, teaching hospital or other training institution or facility approved pursuant to N.J.S.A. 45:6-2.

i. (No change.)

ii. The course shall include instruction in: head and neck anatomy; pharmacology of anesthetic and analgesic agents , including appropriate and efficacious injection techniques and minimum and maximum dosages; administration of reversal agents ; patient pre-evaluation, including medical and dental history considerations; recognition of adverse events, emergency procedures and basic life support; and selection of appropriate armamentarium, agents and techniques.

iii. The course shall consist of 20 hours of didactic training and 12 hours of clinical training. The clinical training shall include [20] 25 monitored administrations of local anesthesia, [with a minimum of five administrations of each of the following injections: infiltrations in the maxilla and mandible, mandibular nerve block, mental nerve block, and long buccal nerve block] including all types of blocks set forth in (c)1 above ; and

2. (No change.)

(e)-(h) (No change.)

13:30-2.4 Scope of practice of registered dental assistant

(a) A registered dental assistant may perform the following duties under the direct supervision of a licensed dentist:

1.-14. (No change.)

15. Place and remove retraction cords and medicated pellets . This shall not include electrosurgery or the use of lasers for tissue retraction ;

16.-26. (No change.)

27. Hold a curing light for any dental procedure. Such curing light shall not include a laser capable of altering, cutting, burning or damaging hard or soft tissue or for electrosurgery for tissue retraction ;

28.-29. (No change.)

30. Demonstrate home-use bleaching systems and apply bleaching agents ;

31. (No change.)

32. Administer a topical treatment on a patient after a licensed dentist or licensed dental hygienist has performed a prophylaxis; [and]

33. Assist a licensed dentist in the administration of nitrous oxide, provided the licensed dentist is physically present in the operatory at all times during the procedure[.] ; and

34. Provide prophylactic and preventive measures, such as the application of fluorides and pit and fissure sealants and other recognized topical agents for the prevention of oral disease or discomfort. This shall not include prophylaxis.

(b)-(e) (No change.)

13:30-2.6 Scope of practice of unregistered dental assistant

(a) A dental assistant who has not obtained a registration from the Board may perform the following duties under the direct supervision of a licensed dentist:

1.-8. (No change.)

9. Hold a curing light in any dental procedure. Such curing light shall not include a laser capable of altering, cutting, burning or damaging hard or soft tissue or for electrosurgery for tissue retraction ;

10.-13. (No change.)

(b) (No change.)

SUBCHAPTER 5. CONTINUING EDUCATION

13:30-5.1 Continuing dental education requirements for dentists

(a)-(h) (No change.)

(i) A licensee may obtain continuing education credits from any of the areas of study listed below. A licensee shall not receive credit for more than the maximum number of hours permitted in each area of study for each biennial period, as set forth in (i)1 through 4 below.

1. (No change.)

2. Papers, publications and scientific presentations:

i.-ii. (No change.)

iii. For each original presentation of a paper, essay or formal lecture to a recognized group of fellow professionals as part of a course or program eligible for Board approval for credit pursuant to this section , a licensee shall receive two hours of continuing education credit for every hour of presentation;

3. Teaching and research appointments:

i. A licensee involved in [new] teaching or research activities at least one full day or the equivalent of one full day per week per academic year and who holds at least a part-time faculty or research appointment shall receive [four] five hours of continuing education credit annually for each full day of teaching or research activity up to a maximum of 10 hours of credit per biennial period or two and one-half hours annually for each half day of teaching or research activity up to a maximum of five hours of credit per biennial period . [For purposes of this section, "new" means a program, course or subject matter which the licensee has not taught or researched before in any educational or practice setting.]

[ii. A licensee may obtain a maximum of 20 hours of continuing education credit in this category in a biennial period.]

4. (No change.)

(j)-(m) (No change.)

13:30-5.2 Continuing education requirements for dental hygienists

(a) All licensed dental hygienists shall submit a certification verifying the completion of [10] 20 hours of continuing education every two years at the time of license renewal, except as provided in (b) and (d) below. No more than one-half of the required continuing education hours in the two-year period may be obtained through written or electronic media distance learning courses. [For the biennial renewal period commencing on January 1, 2006 and thereafter, all licensed dental hygienists shall be required to complete 20 hours of continuing education every two years at the time of license renewal, consistent with the requirements of this section.]

(b) An individual who graduates from a program in dental hygiene in the first year of the biennial period shall complete [five] 10 credits of continuing education for biennial renewal. An individual who graduates from a program in dental hygiene in the second year of the biennial period shall be exempt from continuing education requirements for that biennial period.

(c) The following shall be considered acceptable forms of continuing education:

1.-2. (No change.)

3. Teaching and research appointments:

i. A licensee involved in [new] teaching or research activities at least one full day or the equivalent of one full day per week per academic year and who holds at least a part-time faculty or research appointment shall receive two hours of continuing education credit annually for each full day of teaching or research up to a maximum of four hours of credit per biennial period and one credit annually for each half day of teaching or research up to a maximum of two hours of credit per biennial period . [For purposes of this section, "new" means a program, course or subject matter which the licensee has never taught or researched before in any educational or practice setting.]

[ii. A licensee may obtain a maximum of 10 continuing education credit hours for teaching and research appointments in a biennial period.]

(d) The Board shall recognize as acceptable the courses of study and amount of hours credited in continuing education programs approved by the following, provided that the courses satisfy the minimum requirements set forth in this subchapter:

1.-3. (No change.)

4. The American Dental Assistants' Association and its constituents and components; [and]

5. The American Academy of Dental Hygiene and its constituents and components; and

[5.] 6. (No change in text.)

(e)-(f) (No change.)

13:30-5.3 Continuing education requirements for registered dental assistants and limited registered dental assistants in orthodontics

(a) (No change.)

(b) The following shall be considered acceptable forms of continuing education:

1.-2. (No change.)

[page=2226] 3. Teaching and research appointments:

i. A registrant involved in [new] teaching or research activities at least one full day or the equivalent of one full day per week per academic year and who holds at least a part-time faculty or research appointment shall receive two hours of continuing education credit annually for each full day of teaching or research up to a maximum of four hours of credit per biennial period and one credit annually for each half day of teaching or research up to a maximum of two hours of credit per biennial period . [For purposes of this section, "new" means a program, course or subject matter which the registrant has not taught or researched before in any educational or practice setting.]

[ii. A registrant may obtain a maximum of 10 continuing education credit hours for teaching and research appointments in a biennial period.]

(c) The Board shall recognize as acceptable the courses of study and amount of hours credited in continuing education programs approved by the following, provided that the courses satisfy the minimum requirements set forth in this subchapter:

1.-3. (No change.)

4. The American Dental Assistants' Association and its constituents and components; [and]

5. The American Academy of Dental Hygiene and its constituents and components; and

[5.] 6. (No change in text.)

(d)-(e) (No change.)

SUBCHAPTER 6. ADVERTISING

13:30-6.2 Professional advertising

(a)-(h) (No change.)

(i) If a licensee advertises that he or she has obtained master, member, fellow or diplomate status in any dental organization, the advertisement shall disclose the licensee's status as either a general dentist or as the holder of a specialty permit pursuant to N.J.A.C. 13:30-6.1, the name of the dental organization, and if the advertisement concerns an area of practice not recognized by the Board as a specialty pursuant to N.J.A.C. 13:30-6.1(c), that the services provided are not a recognized dental specialty.

(j) If a dentist advertises that he or she possesses an M.D. or D.O. degree, the advertisement shall not imply in any manner that the dentist is licensed to practice medicine in this State unless he or she holds a license to practice medicine issued by the State Board of Medical Examiners.

Recodify existing (j)-(l) as (k)-(m) (No change in text.)

[(m)] (n) Offers of discounts or fee reductions or free services shall indicate the advertiser's fixed or stated range of fees against which the discount is to be made and/or the value of the free service.

1.-3. (No change.)

4. Services advertised as complimentary, free of charge or for a discounted fee shall be offered equally to all patients identified as eligible in the advertisement (for example "new patients"), regardless of the patient's third-party coverage.

[4.] 5. A licensee who holds a specialty permit, as permitted by N.J.A.C. 13:30-6.1, shall in a manner similar to that in [(m)2] (n)2 above, include a representative list of the most frequently performed services in the advertiser's office.

[(n)] (o) (No change in text.)

[(o)] (p) A licensee shall be presumed to have approved and shall be personally responsible for the form and contents of an advertisement which contains the licensee's name, office address, or telephone number or which is published or caused to be published by an entity to which the licensee has paid a fee or when the licensee has agreed to have his or her name listed as a participant pursuant to [(p)] (q) below. A licensee who employs or allows another to employ for his benefit an intermediary source or other agent in the course of advertising shall be personally responsible for the form and contents of said advertisement.

Recodify existing (p)-(q) as (q)-(r) (No change in text.)

SUBCHAPTER 8. GENERAL PROVISIONS

13:30-8.4 Enteral sedation with single or multiple pharmacological agents

(a) (No change.)

(b) [As of July 1, 2006, no] No dentist shall administer, dispense or prescribe enteral sedation with single or multiple pharmacological agents (hereinafter "enteral sedation") unless the minimum standards of training and procedure set forth in this section are satisfied.

(c) [As of July 1, 2006, no] No dentist shall administer, dispense or prescribe enteral sedation unless such dentist possesses an enteral sedation permit issued by the State Board of Dentistry, except as provided in (d) below, for a specified practice location which shall be renewed biennially. A dentist shall obtain a separate enteral sedation permit for each practice location at which enteral sedation is administered, dispensed or prescribed.

(d) (No change.)

(e) [As of July 1, 2006, no] No dentist may administer, dispense or prescribe any pharmacological agent in a dosage which has the potential to inhibit patient response beyond anxiolysis without the possession of an enteral sedation permit issued pursuant to this section.

(f)-(p) (No change.)

13:30-8.5 [(Reserved)] OSHA and CDC requirements

(a) When providing dental services, all licensees and registrants shall comply with:

1. Occupational Safety and Health Administration (OSHA) regulations set forth at 29 CFR 1910.1030, concerning occupational exposure to blood or other potentially infectious materials, in the provision of dental services, the requirements of the New Jersey Public Employees Occupational Safety and Health (PEOSH) Act, N.J.S.A. 34:6A-25, incorporated herein by reference; and

2. Centers for Disease Control and Prevention (CDC) Recommended Infection Control Practices for Dentistry, incorporated herein by reference, as amended and supplemented, and available at the CDC website, www.cdc.gov , specifically, http://www.cdc.gov/oralhealth/infectioncontrol/guidelines/index.htm .

13:30-8.6 Biennial license and registration renewal; license and registration suspension; reinstatement of suspended license or registration; inactive status; return from inactive status

(a) (No change.)

(b) The Board shall send a notice of renewal to each licensee and registrant at the address of record registered with the Board at least 60 days prior to the expiration of the license or registration. If the notice to renew is not sent at least 60 days prior to the expiration date, no monetary penalties or fines shall apply to the holder for failure to renew during the period following license or registration expiration, not to exceed the number of days short of 60 before the renewal notices were issued .

(c)-(f) (No change.)

(g) Renewal applications shall provide the licensee or registrant with the option of either active or inactive status. A licensee or registrant choosing inactive status shall be provided with the option of choosing either inactive paid or inactive unpaid status. A licensee or registrant electing inactive paid status shall pay the applicable inactive renewal fee set forth in N.J.A.C. 13:30-8.1[and] , which shall entitle the licensee or registrant to obtain all printed information disseminated by the Board to all active licensees and registrants. Inactive paid licensees shall not engage in practice. A licensee or registrant choosing inactive unpaid status shall not be required to pay the inactive renewal fee and shall not receive printed information disseminated by the Board to active licensees and registrants. Inactive unpaid licensees or registrants shall not engage in practice.

(h)-(i) (No change.)

13:30-8.7 Patient records

(a) A contemporaneous, permanent patient record shall be prepared and maintained by a licensee for each person seeking or receiving dental services, regardless of whether any treatment is actually rendered or whether any fee is charged. Licensees also shall maintain records relating to charges made to patients and [third party] third-party carriers for [page=2227] professional services. All treatment records, bills and claim forms shall accurately reflect the treatment or services rendered. Such records shall include, at a minimum:

1.-4. (No change.)

5. The dates of each patient visit and [a] an accurate description of [the] all treatment or services rendered and the materials used at each visit;

6. Radiographs, if any, of a diagnostic quality and a description of all diagnostic models made, identified with the patient's name and the date[;] . If the radiographs are sent out of the dental office, the dentist shall retain the originals or a diagnostic copy of the radiographs in the patient record;

7. (No change.)

8. Copies of any prescriptions to laboratories for dental prostheses;

Recodify existing 8.-10. as 9.-11. (No change in text.)

[11.] 12. A record of any recommendations or referrals for treatment or consultation by a specialist, including those which were refused by the patient; [and]

[12.] 13. The name of the dentist of record consistent with the requirements of N.J.A.C. 13:30-8.15[.] ; and

14. If written notations appear in the patient record, the notations shall be legible, written in ink and contain no erasures or white-outs. If incorrect information is placed in the record, it shall be crossed out with a single non-deleting line and shall be initialed and dated by the licensee on the date the change was made. If additions are made to the record, the additions shall be initialed and dated by the licensee on the date the change was made.

(b)-(d) (No change.)

(e) Licensees shall provide patient records to the patient or the patient's authorized representative or another dentist of the patient's choosing in accordance with the following:

1.-2. (No change.)

3. The licensee may charge a reasonable fee for:

i. (No change.)

ii. The reproduction of radiographs or any other material within a patient record , which cannot be routinely copied or duplicated on a commercial duplicating machine. [That fee shall be no more than the actual cost of the duplication of the materials, or the fee charged to the licensee for duplication. In addition, the licensee may charge an administrative fee of $ 10.00 or 10 percent of the cost of reproduction, whichever is less, to compensate for office personnel time spent retrieving or reproducing the materials and overhead costs.] The fee for duplication for a set of up to nine radiographs shall not exceed $ 15.00. The fee for duplication for a set of up to 18 radiographs shall not exceed $ 30.00. The fee for duplication of a panorex shall not exceed $ 30.00.

4.-5. (No change.)

(f)-(g) (No change.)

(h) Patient records need not be maintained in situations where no patient-dentist relationship exists, such as where the professional services of a dentist are rendered at the behest of a third party for the purposes of examination and evaluation only , [or] at the behest of the Board or for dental screenings .

(i) Services not recorded in the patient record in accordance with the requirements of this section shall be presumed not to have been performed. It shall be the responsibility of the licensee to produce evidence to establish that the non-recorded services were actually performed.

13:30-8.8 Reporting of incidents or deaths

(a) All licensees shall report to the State Board of Dentistry within seven days, in writing, on a form supplied by the Board and available on the Board's website at http://www.njconsumeraffairs.gov/dentistry/ , any incident occurring in a dental office, clinic or any other dental facility after dental treatment has been initiated, which requires the removal of a patient to a hospital for observation or treatment.

(b) All licensees shall report to the Board within seven days, in writing, on a form supplied by the Board and available on the Board's website at http://www.njconsumeraffairs.gov/dentistry/ , any death , which may be related to dental treatment, whether or not the death occurred in a dental office, clinic or other dental facility.

13:30-8.10 Dental insurance forms

(a) (No change.)

(b) No licensee shall submit to a [third party] third-party payor any claim, bill[,] or governmental assistance claim , which contains any of the following:

1. Any treatment date , which does not accurately reflect the date when the service and procedures were actually [completed] performed ;

2. Any description of a dental service or procedure , which does not accurately reflect the actual work [completed] performed ;

3. (No change.)

4. Any statement or attachment material to the claim , which is known to be false or misleading; or

5. (No change.)

(c)-(e) (No change.)

13:30-8.13 Permissible business structures, prohibition on referral fees and fee splitting

(a)-(c) (No change.)

(d) Dentists shall not receive, solicit, offer or pay any remuneration as an inducement to make a referral or as compensation for a referral of a patient for a service, product, drug or device or to purchase, prescribe or recommend a product, drug or device. Nothing contained in this section shall prohibit a licensee from paying the reasonable costs of any advertisement permitted pursuant to N.J.A.C. 13:30-6.1 and 6.2. Nothing contained in this section shall prohibit a dentist from providing a gift to a patient, or from providing a credit for dental services to a patient, provided the gift or credit does not exceed $ 25.00 in value.

(e) Dentists shall not participate in any arrangement or agreement, with any person other than an associate, whereby any remuneration received by that person in payment for the provision of space, professional services, facilities, equipment, personnel, marketing or management services used by the dentist is to be determined or calculated as a fixed percentage of, or otherwise dependent upon, the income or receipts derived from the practice of dentistry. Nothing in this section, however, shall preclude a dentist from entering into a bona fide profit sharing plan or retaining the services of a collection agency.

(f) (No change.)

13:30-8.18 [(Reserved)] Issuance of prescriptions; NJPBs; controlled dangerous substances

(a) A licensee shall issue written prescriptions only on New Jersey Prescription Blanks (NJPB) that have been secured from an approved vendor and which meet the security requirements of the prescription blanks program set forth in N.J.A.C. 13:45A-27. A licensee's NJPB shall include all information required to appear on the blank pursuant to Division of Consumer Affairs rules, set forth at N.J.A.C. 13:45A-27, including the licensee's National Provider Identifier, if one has been obtained.

(b) Licensees issuing prescriptions for controlled dangerous substances shall comply with all State and Federal laws concerning the issuance of such prescriptions, including requirements set forth at N.J.A.C. 8:65.

13:30-8.23 Disclosure of participation in third party payor plans

If a dentist providing services in a dental practice does not participate in a third-party payor plan in which other providers in the dental office participate, the dentist shall clearly disclose this fact to the patient prior to treatment.

13:30-8.24 Animals and pets in dental office

A licensee shall not permit animals or pets in a dental office unless the animals or pets are maintained in an enclosed space that cannot be accessed by patients. This requirement shall not apply to trained guide or service dogs (or dogs in training) for the disabled, sightless or hearing impaired, consistent with the provisions of the Laws Against Discrimination, N.J.S.A. 10:5-29.



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