Dental Care Access and Regulations in Minnesota, Exams of Dentistry

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MN Dental Jurisprudence Exam *Rules, regulations, and CE requirements* - ____ *can a dentist accept money for making a referral (renumeration = $) to another dentist? - nope *the patient can be terminated for: - - pt failure to comply with treatment or professional advice (ex: advanced perio) - consistent tardiness or failed appts - failure to pay for services rendered - behavior mngmt issues *Can a LDA scale and clean mandibular anteriors on a pediatric patient? - NO The LDA and DDS would both be held accountable *Who could be in trouble by the Board of Dentistry if a DH/LDA practices beyond their scope of practice, even when the DDS did NOT request them to and the DH/LDA acted on their own - both the DDS and DH/LDA Ad: "Our practice specialized in cosmetic dentistry, *promising* *superior* *results* in the quest to achieve your perfect smile" What is wrong w/ the above ad? - DDS cannot say they are SUPERIOR and cannot PROMISE the results of a tx. They are creating a false/unjustified expectation. *Also, cosmetic dentistry is not recognized as a 'specialty' by the ADA* In advertising a dental office, the DDS cannot use terms such as "top" or "best". They cannot make a claim that a survey, ballot, or poll constitutes a ranking for who they are or what they do; ex) "the top 15%" or "voted best.." T/F - true 5 components of CPR training - -AED -Barrier mask or bag for ventilation -Foreign body airway obstruction -Two person rescuer -Adult, child, and infant CPR Good Samaritan Law - a person at the scene of an emergency who knows that another person is exposed to or has suffer harm shall give *reasonable assistance* to the exposed person Criminal law - law that deals with crime and the legal punishment of criminal offenses (crime against society) Civil law - deal with disputes between individuals, organizations, or between the two, in which compensation is awarded to the victim What actions would cause an immediate suspension of a Dental Professional License? - 1. Dependence on alcohol, drugs, or other substances 2. Writing unauthorized prescriptions *How many CE credits does a LDA, DDS, DT and DH need to have in a 2 year period? - 25 for LDA and DH 50 for DDS and DT's fundamental credits - directly related to clinical practice of dentistry *minimum of 15 credits for LDA and DH; 30 for DDS and dental therapists Core Subjects (fundamental credits) - areas of knowledge that relate to public *safety* and professionalism *minimum of 2 different core subjects needed in 2 yrs *what are core subjects?? - -Record Keeping -Ethics -Infection Control -Patient Communication -Management of med. emergencies -Diagnosis and tx. planning (optional for DH/LDA) CPR is a _________ credit - Fundamental; must be updated every 2 yrs *self assessment is a _____ credit - Fundamental; printed from ADA website; usually updated every 2yrs. completed and put in professional portfolio; 1 credit Can all of your credits be earned in the fundamental category? - yes, but they cannot all be in the elective category *elective credits - activities directly related to, or *supportive* of the practice of dentistry; all dental hygiene services must be provided under supervision of a licensed dentist. T or F - True a DH may be employed by a nonprofit organization to preform DH services *without* the pt first being examined by a licensed DDS if the Dental hygienist.... - - has been engaged in active practice of clinical dh for no less than *2400 hours in past 18 mo* or a career total of *3,000 hours* -has entered into a *collaborative agreement* with a licensed DDS that designates authorization for the services provided by dental hygienist -has documented participation in courses in *infection control and med emergencies* within each continuing education cycle - maintains *CPR certificate* from AHA or American red cross dental hygiene services authorized to be performed are: - 1- oral health promotion 2- removal of deposit and stain from surface of teeth 3- application of topical preventive or prophy agents, including fluoride varnish and pit and fissure sealants 4- polishing and smoothing restorations 5- removal of marginal overhangs 6- performance of preliminary charting 7- taking radiographs 8- performance of SRP (all under general supervision) does the dentist need to examine the pt or be present during injection of local anesthesia or nitrous once delegated in collaborative agreement with licensed dds and dh? - no DH collaborative agreement must include.. - 1- consideration for med comp pt and med conditions for which dental eval and treatment plan must occur *prior* to provision of dh services 2- age and procedure specific standard collaborative practice *protocols*, including recommended intervals for the performance of dh services and a period of time in which an exam by dds should occur 3- copies of *consent to treatment form* provide to patient by dental hygienist 4- specific protocols for the placement of *pit and fissure sealants* and requirements for *follow up care* to assure efficacy of sealants after applications 5- procedure for creating and *maintaining dental records* for the patients that are treated collaborative management agreement between a DDS and a DT must include: - 1. settings where the DT can serve 2. any practice limitations (DT vrs. ADT) with the level of supervision 3. procedure specific protocalls 4. procedure to maintain dental records 5. a plan to manage medical emergencies 6. quality assurance plan (referral, chart review, follow up care) 7. protocalls for administering and dispensing meds 8. supervision criteria for DAs dental hygiene consent to treatment must include statement stating that - dh services provided are not a substitute for dental exam by licensed dds A DT is limited to practicing in settings that serve ______ - low income, uninsured, and underserved patients referal form - for all referrals to pt for further procedures, dh must fill out and *provide a copy* for collaborating dds health care facility or nonprofit organizations are limited to: (for collaborative agreement) - hospital, nursing home, home health agency, group home serving elderly, disabled, or juveniles; state-operated facility licensed by commissioner of human services or commissioner of corrections; and federal, state, or local public health facility, community clinic, tribal clinic, schools what must be on every complete upper and lower denture and removable dental prosthesis? - patients name and social security number if ssn and pt name on prosthesis is not practicable id should be presented as follows: - - ssn of pt may be omitted if name of pt is shown -initials of pt must be shown alone if use of pt name is impracticable - identification marks may be omitted in entirety if none of the forms of id are practicable or clinically safe do you ID mark older prosthesis without this info? - yes applicant must submit new background check if more than ____________ has Relapsed since the applicants last submitted background check to the board - 1 year no license issued to any applicant who refuses to consent to a criminal background check or fails to submit fingerprints within __________ after submission of application for licensure - 90 days how long does a person have to challenge accuracy of a report of background check - 30 days after they get their report back how long does the board give the applicant to challenge the accuracy or completeness of the report - 180 days when temp license is suspended, the regulated person shall be provided with at least _______________ notice of any hearing held pursuant to this section - 10 days if the board has not completed its investigation and final order within _________________ days the temp suspension shall be lifted unless the regulated person requests a delay in disciplinary preceedings for any reason - 30 days self-reporting: when should a regulated person who is diagnosed as infected with HIV, HBV, or HCVreport the info to the commissioner - no more than 30 days after learning of the diagnosis or 30 days after becoming licensed or registered by the state *infection control reporting- a regulated person shall, within _____________, report to the appropriate board personal knowledge of a serious failure or a pattern of failure by another regulated person to comply with accepted and prevailing infection control procedures related to prevention of hiv hbv and hcv transmission - 10 days how long after an infection control report does the designated office have to meet with the board - 30 days of receiving report without hearing, the board may temporarily suspend the right to practice of a regulated person if they find they have refused to submit or comply with monitoring.... - infection control it is unlawful for any person to.. - -enable a unlicensed person to practice dentistry -practice without a license -not go by his or her own name (and degree) regulated person shall be provided with at least ________notice of a hearing under temp suspension infection control - 20 days supervising dds requirements - -board-approved MN licensed dds for at least 5 consecutive years -license shall not be subject to, or pending, corrective or disciplinary action within the previous five years according to NN statutes - acceptable written agreement between limited licensed dds and supervising dds- may only supervise 1 for duration of agreement- written agreement shall include info acknowledgment that limited dds agrees to practice clinical dentistry at least 1,100 hours annual for a period of 3 consecutive years -no more than 2 limited licensed dds are allowed to practice gen dentistry under supervision in one facility -modifications to written agreement must be submitted in writing to board within 7 business days -supervising dds must inform the board in writing about the termination of a written agreement with a limited dds within 7 business day of termination -must inform board in writing about any known disciplinary or malpractice proceedings involving the limited dds w/I 7 business days of proceeding -submit performance eval no earlier than 90 days before completion of limited dds practice period -disciplinary actions (dental prosthetic appliances) - a written work order from a DDS (good for 2 years) *non licensed dental assistants: - can be trained ON THE JOB, on site with dentist duties: retract the cheek, suction, transfer instruments, mix cements, help in sterilization, turn rooms around, set up/tear down, set pts, and walk pts out. (general???) a DDS is responsible for ensuring that any DA complies with ... - - completing a *CPR* course and maintaining certificate -compliance with most current *infection control* guidelines *limited licensed dental assistants - non licensed but have taken a course in taking RADIOGRAPHS *Sedation* - ____ Minimal Sedation (Conscious sedation) - -to reduce anxiety -- Anxiolysis -lightest form of sedation -ex: N2O2, oral meds, or IV sedation (need 12 hours of a course with 3 different "practice cases") characterized by moderate impairment to the patient's cognitive function and coordination, but leaves unaffected the patient's ventilator and cardiovascular - minimal sedation Moderate Sedation (still conscious) - relaxed, awake and can still respond ex: N2O2, oral meds, IV sedation (need 60 hours during an extra course with practice) Deep sedation (unconscious) - can only be performed by an anesthesiologist or an oral surgeon (need extra schooling) *means a depressed level of consciousness produced by a pharmacological agent during which the patient cannot be easily aroused but responds purposefully following repeated or painful stimulation - deep sedation *general anesthesia (unconscious) - for extreme cases of dental care *oral and maxillofacial surgeons *Infection Control* - ------ high level disinfection - Elimination of all microorganisms except bacterial spores decontamination - Removal, inactivation, or destruction of HBV and HIV on a surface or item to the point where HBV and/or HIV are *no longer capable of causing infection* and the surface or item is rendered safe for barehanded touching, use or disposal. Disinfection - destroys *most* pathogenic and other microorganisms by physical or chemical means -does not ensure the degree of safety associated with sterilization processes (ex: sanitary wipes used to wipe down the cubicle) sterilization - destroys *all* microorganisms, including substantial numbers of resistant bacterial spores, by heat (steam autoclave, dry heat, and unsaturated chemical vapor) or liquid chemical sterilants *Use surface barriers on ______ to protect, particularly for surfaces that are hard to clean - light switches, radiographic equipment, drawer handles, computers (change barriers between patients) ----still need to use EPA approved wipes to clean after barriers are removed The _______________ regulates *low- and intermediate-level* disinfectants that are used on surfaces - Environmental Protection Agency The ____________ regulates liquid *chemical sterilants/high-level* disinfectants - Food and Drug Administration Any disinfectant used in a dental setting should be registered by the ____________ and be approved for use in health care settings - Environmental Protection Agency (EPA) can you use disinfectant wipes from the grocery store? - no, the are not EPA registered *what does PPE include? - gloves, masks, gowns, and eye protection disposal of liquid and human waste (blood) - all liquid and human waste, including floor wash water, must be disposed of through *trap drains into a public sanitary sewer system* *what type of gloves should you use? - chemical and puncture resistant gloves -even for "household cleaning" of the dentist office use barrier protective coverings as appropriate for noncritical equipment surfaces that are - 1) touched frequently with gloved hands during patient care 2) likely to become contaminated with blood or body substances 3) hard to clean (e.g., computer keyboards). Digital radiography sensors are considered - *semicritical* (they go inside of patients' mouths but don't puncture mucous membranes) -use a barrier then cleaned with high level disinfectant wipes between patients what types of FLOORS are NOT recommended - carpeting *hand pieces and intraoral instruments that can be removed from the air and waterlines of dental units are considered ___ - *semi-critical* -should be heat sterilized between patients -do not just wipe them down!! examples: high-speed, low-speed, electric, endodontic, and surgical handpieces Dental health care personnel should use water that meets environmental protection agency regulatory standards for drinking water - ≤500 colony forming units (CFU)/mL Can contaminated dental unit waterlines transmit disease? - yes *DHCP should receive infection prevention training: - 1. When they are hired 2. When new procedures affect their occupational exposure 3. Annually 4. According to state or federal requirements *dental techs must have a work order from the DDS and will keep their work order on infection control for ____ years - 2 *training should include: - -A description of their exposure risks -Review of prevention strategies and infection prevention policies and procedures -Discussion of how to manage work-related illness and injuries -Review of work restrictions for the exposure or infection *The infection prevention coordinator - will be responsible for developing and maintaining a written *infection prevention program*; monitoring/evaluating the program; and implementing quality improvement measures as needed. *extracted teeth are infectious and should be disposed in - medical waste containers (but not if it has amalgam in it) -- find out local regulations regarding disposal of amalgam *can we give patients their teeth after extractions? - yes, it is no longer our responsibility once it is handed over extracted teeth for educational purposes must be... - -Cleaned so there is no visible blood or debris. *spore testing* assess by killing highly resistant microbes -best way to tell if sterilizing equipment is working properly -MUST be performed WEEKLY dirty uniforms and lab coats should be _____ at the location where they were used - bagged --must be handled as little as possible --must not be sorted or rinsed if spore test comes back positive.... - indicated that the sterilizer is not working properly and items are NOT sterile -needs to be corrected and temporarily be out of service T/F a tooth with an amalgam filling in it is considered hazardous waste only - false: hazardous and infectious autoclaving = - sterilizing -destroy all microbes what testing should be available to all DHCW for those concerned that they may be infected by HIV - serologic testing how should the amalgam scrap be stored and handled - stored in a closed unbreakable container labled " hazardous "contains mercury" and should be recycled website for more info on infection control - https://www.cdc.gov/oralhealth/infectioncontrol/questions/ *Record Keeping* - ---- *Dental records must include - - pt's name, address, DOB - if minor, need parent's name - name and telephone number of contact person - name of insurance and ID number if applicable - patient's reason for visit - dental and medical history - clinical exam - diagnosis and treatment plan - informed consent - progress note *informed consent consists of... - giving options benefits risks cost patient's approval (signature) *correction of records - notations must be legible, written in ink, no erasures or white outs -if incorrect info is on paper, must cross out with one line and initialed *transfer of records - digital Xrays must be transfered by compact or optical disc, electric communication, or printed on high quality photographic paper -need diagnostic quality using proper exposure settings * T/F: as a request of patient, records must be transferred, even if their bill hasn't been paid - True *when electronic records are kept, a dentist must keep either a _____________ or use an _____________ - duplicate hard copy unalterable electronic record *adults records must be kept for _____ years beyond last time they were seen - 7 A minor (child) records must be kept for ____ years beyond the age of 18 - 7 *can the dentist charge a patient a fee for transferring records? - yes. should original X-rays or forms be sent if requested?? - No, NEVER. diagnostic duplicate X-rays and records must be copied and sent who decides the max. fee a DDS can charge? - Minnesota Department of Health the provider can charge for copies of records - no more than 75 cents per page AND $10 charge for time spent When a pt requests a copy of the pt's record for purposes of reviewing current *medical care* - the provider must *not* charge a fee means an accumulation of written documentation of professional development activites - portfolio each licensee must establish a portfolio for the purpose of: - -record professional development activities -monitor CE -retain acceptable documentaion of professional activities -CPR certificate *Ethics* - --- if a dental therapist, dental hygienist,or a dental assistant performs a services not authorized by the dentist, that behavior is called - conduct of unbecoming a licensee failure to cooperate with the minnesota board dentistry is considered which of the following - conduct unbecoming a licensee fraud upon a patient's or third party payers is called - conduct unbecoming violation of any statues of the dental practice act shall be guilty of ______ ______ - gross misdamenor what is the common tort liability in dentistry - negligence what concept is demonstrated in the philosophy that all patients should recieve the same quality of dental care? - justice what is the term for voluntary standards for behavior established by a professor - code of ethics what does DHCP stand for - dental health care personal which of the following is elected position on the minnesota board of dentistry? -public board member -executive director -secretary -dentist - secretary if a licnesed dental professional fails to report the habitual use of drugs and alcohol by their employing dentist, the licnesed dental professions shall be subject to which of the following? a. civil penalties b. censure c. tort liability d. discrimination - a. civil penalties for a dental therapist to become an advanced dental therpist, the dental therapist must complete how many hours of dental therapy clinical practice? - 2000 hours