Illinois General Assembly - Full Text of SB2957
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Full Text of SB2957  97th General Assembly




State of Illinois
2011 and 2012


Introduced 2/1/2012, by Sen. Donne E. Trotter


225 ILCS 25/4  from Ch. 111, par. 2304
225 ILCS 25/18  from Ch. 111, par. 2318

    Amends the Illinois Dental Practice Act. Provides that a dental hygienist may be employed or retained by a health care facility, program, or nonprofit organization to perform dental hygiene services without the patient first being examined by a licensed dentist if the dental hygienist (i) has engaged in active practice of clinical dental hygiene for a minimum of 2,400 hours in the past 18 months or a career total of 3,000 hours, (ii) has entered into a collaborative agreement with a licensed dentist, (iii) had documented participation in course in infection control and medical emergencies, and (iv) maintains current CPR certification. Authorizes the dental hygienist to perform limited specified services. Provides that a licensed dentist may not have a collaborative agreement with more than 2 dental hygienist unless otherwise authorized by the Board. Provides that the collaborative agreement must (i) include certain provisions and it must be signed and maintained by the dentist, the dental hygienist, and the facility, program, or organization, (ii) be reviewed yearly, and (iii) be made available to the Board upon request. Effective immediately.

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SB2957LRB097 18307 CEL 63533 b

1    AN ACT concerning regulation.
2    Be it enacted by the People of the State of Illinois,
3represented in the General Assembly:
4    Section 5. The Illinois Dental Practice Act is amended by
5changing Sections 4 and 18 as follows:
6    (225 ILCS 25/4)   (from Ch. 111, par. 2304)
7    (Section scheduled to be repealed on January 1, 2016)
8    Sec. 4. Definitions. As used in this Act:
9    (a) "Department" means the Illinois Department of
10Professional Regulation.
11    (b) "Director" means the Director of Professional
13    (c) "Board" means the Board of Dentistry established by
14Section 6 of this Act.
15    (d) "Dentist" means a person who has received a general
16license pursuant to paragraph (a) of Section 11 of this Act and
17who may perform any intraoral and extraoral procedure required
18in the practice of dentistry and to whom is reserved the
19responsibilities specified in Section 17.
20    (e) "Dental hygienist" means a person who holds a license
21under this Act to perform dental services as authorized by
22Section 18.
23    (f) "Dental assistant" means an appropriately trained



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1person who, under the supervision of a dentist, provides dental
2services as authorized by Section 17.
3    (g) "Dental laboratory" means a person, firm or corporation
5        (i) engages in making, providing, repairing or
6    altering dental prosthetic appliances and other artificial
7    materials and devices which are returned to a dentist for
8    insertion into the human oral cavity or which come in
9    contact with its adjacent structures and tissues; and
10        (ii) utilizes or employs a dental technician to provide
11    such services; and
12        (iii) performs such functions only for a dentist or
13    dentists.
14    (h) "Supervision" means supervision of a dental hygienist
15or a dental assistant requiring that a dentist authorize the
16procedure, remain in the dental facility while the procedure is
17performed, and approve the work performed by the dental
18hygienist or dental assistant before dismissal of the patient,
19but does not mean that the dentist must be present at all times
20in the treatment room.
21    (i) "General supervision" means supervision of a dental
22hygienist requiring that the patient be a patient of record,
23that the dentist examine the patient in accordance with Section
2418 prior to treatment by the dental hygienist, and that the
25dentist authorize the procedures which are being carried out by
26a notation in the patient's record, but not requiring that a



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1dentist be present when the authorized procedures are being
2performed. The issuance of a prescription to a dental
3laboratory by a dentist does not constitute general
5    (j) "Collaborative agreement" means a written agreement
6between a licensed dental hygienist and a collaborating
7licensed dentist.
8    (k) (j) "Public member" means a person who is not a health
9professional. For purposes of board membership, any person with
10a significant financial interest in a health service or
11profession is not a public member.
12    (l) (k) "Dentistry" means the healing art which is
13concerned with the examination, diagnosis, treatment planning
14and care of conditions within the human oral cavity and its
15adjacent tissues and structures, as further specified in
16Section 17.
17    (m) (l) "Branches of dentistry" means the various
18specialties of dentistry which, for purposes of this Act, shall
19be limited to the following: endodontics, oral and
20maxillofacial surgery, orthodontics and dentofacial
21orthopedics, pediatric dentistry, periodontics,
22prosthodontics, and oral and maxillofacial radiology.
23    (n) (m) "Specialist" means a dentist who has received a
24specialty license pursuant to Section 11(b).
25    (o) (n) "Dental technician" means a person who owns,
26operates or is employed by a dental laboratory and engages in



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1making, providing, repairing or altering dental prosthetic
2appliances and other artificial materials and devices which are
3returned to a dentist for insertion into the human oral cavity
4or which come in contact with its adjacent structures and
6    (p) (o) "Impaired dentist" or "impaired dental hygienist"
7means a dentist or dental hygienist who is unable to practice
8with reasonable skill and safety because of a physical or
9mental disability as evidenced by a written determination or
10written consent based on clinical evidence, including
11deterioration through the aging process, loss of motor skills,
12abuse of drugs or alcohol, or a psychiatric disorder, of
13sufficient degree to diminish the person's ability to deliver
14competent patient care.
15    (q) (p) "Nurse" means a registered professional nurse, a
16certified registered nurse anesthetist licensed as an advanced
17practice nurse, or a licensed practical nurse licensed under
18the Nurse Practice Act.
19    (r) (q) "Patient of record" means a patient for whom the
20patient's most recent dentist has obtained a relevant medical
21and dental history and on whom the dentist has performed an
22examination and evaluated the condition to be treated.
23    (s) (r) "Dental emergency responder" means a dentist or
24dental hygienist who is appropriately certified in emergency
25medical response, as defined by the Department of Public



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1    (t) (s) "Mobile dental van or portable dental unit" means
2any self-contained or portable dental unit in which dentistry
3is practiced that can be moved, towed, or transported from one
4location to another in order to establish a location where
5dental services can be provided.
6    (u) "Public health setting" means a hospital; nursing home;
7home health agency; group home serving the elderly, disabled or
8juveniles; State-operated facility licensed by the
9Commissioner of Human Services or the Commissioner of
10Corrections; federal, State, or local public health facility;
11community clinic; school authority; Head start program;
12Maternal and Child Health WIC program; or a program operated by
13a non-profit organization that services individuals who are
14uninsured or who are Illinois health care public program
16(Source: P.A. 97-526, eff. 1-1-12.)
17    (225 ILCS 25/18)   (from Ch. 111, par. 2318)
18    (Section scheduled to be repealed on January 1, 2016)
19    Sec. 18. Acts constituting the practice of dental hygiene;
21    (a) A person practices dental hygiene within the meaning of
22this Act when he or she performs the following acts under the
23supervision of a dentist:
24            (i) the operative procedure of dental hygiene,
25        consisting of oral prophylactic procedures;



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1            (ii) the exposure and processing of X-Ray films of
2        the teeth and surrounding structures;
3            (iii) the application to the surfaces of the teeth
4        or gums of chemical compounds designed to be
5        desensitizing agents or effective agents in the
6        prevention of dental caries or periodontal disease;
7            (iv) all services which may be performed by a
8        dental assistant as specified by rule pursuant to
9        Section 17, and a dental hygienist may engage in the
10        placing, carving, and finishing of amalgam
11        restorations only after obtaining formal education and
12        certification as determined by the Department;
13            (v) administration and monitoring of nitrous oxide
14        upon successful completion of a training program
15        approved by the Department;
16            (vi) administration of local anesthetics upon
17        successful completion of a training program approved
18        by the Department; and
19            (vii) such other procedures and acts as shall be
20        prescribed by rule or regulation of the Department.
21    (b) A dental hygienist may be employed or engaged only:
22        (1) by a dentist;
23        (2) by a federal, State, county, or municipal agency or
24    institution;
25        (3) by a public or private school; or
26        (4) by a public clinic operating under the direction of



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1    a hospital or federal, State, county, municipal, or other
2    public agency or institution.
3    (c) When employed or engaged in the office of a dentist, a
4dental hygienist may perform, under general supervision, those
5procedures found in items (i) through (iv) of subsection (a) of
6this Section, provided the patient has been examined by the
7dentist within one year of the provision of dental hygiene
8services, the dentist has approved the dental hygiene services
9by a notation in the patient's record and the patient has been
10notified that the dentist may be out of the office during the
11provision of dental hygiene services.
12    (d) If a patient of record is unable to travel to a dental
13office because of illness, infirmity, or imprisonment, a dental
14hygienist may perform, under the general supervision of a
15dentist, those procedures found in items (i) through (iv) of
16subsection (a) of this Section, provided the patient is located
17in a long-term care facility licensed by the State of Illinois,
18a mental health or developmental disability facility, or a
19State or federal prison. The dentist shall personally examine
20and diagnose the patient and determine which services are
21necessary to be performed, which shall be contained in an order
22to the hygienist and a notation in the patient's record. Such
23order must be implemented within 120 days of its issuance, and
24an updated medical history and observation of oral conditions
25must be performed by the hygienist immediately prior to
26beginning the procedures to ensure that the patient's health



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1has not changed in any manner to warrant a reexamination by the
3    (e) School-based oral health care, consisting of and
4limited to oral prophylactic procedures, sealants, and
5fluoride treatments, may be provided by a dental hygienist
6under the general supervision of a dentist. A dental hygienist
7may not provide other dental hygiene treatment in a
8school-based setting, including but not limited to
9administration or monitoring of nitrous oxide or
10administration of local anesthetics. The school-based
11procedures may be performed provided the patient is located at
12a public or private school and the program is being conducted
13by a State, county or local public health department initiative
14or in conjunction with a dental school or dental hygiene
15program. The dentist shall personally examine and diagnose the
16patient and determine which services are necessary to be
17performed, which shall be contained in an order to the
18hygienist and a notation in the patient's record. Any such
19order for sealants must be implemented within 120 days after
20its issuance. Any such order for oral prophylactic procedures
21or fluoride treatments must be implemented within 180 days
22after its issuance. An updated medical history and observation
23of oral conditions must be performed by the hygienist
24immediately prior to beginning the procedures to ensure that
25the patient's health has not changed in any manner to warrant a
26reexamination by the dentist.



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1    (f) Without the supervision of a dentist, a dental
2hygienist may perform dental health education functions and may
3record case histories and oral conditions observed.
4    (g) The number of dental hygienists practicing in a dental
5office shall not exceed, at any one time, 4 times the number of
6dentists practicing in the office at the time.
7    (h) Notwithstanding subsections (c), (d), (e), or (f) of
8Section 18, a dental hygienist licensed under this Act may be
9employed or retained by a health care facility, program, or
10nonprofit organization to perform dental hygiene services
11described under subsection (i) of this Section without the
12patient first being examined by a licensed dentist if the
13dental hygienist:
14        (1) has been engaged in the active practice of clinical
15    dental hygiene for not less than 2,400 hours in the past 18
16    months or a career total of 3,000 hours, including a
17    minimum of 200 hours of clinical practice in 2 of the past
18    3 years;
19        (2) has entered into a collaborative agreement with a
20    licensed dentist that designates authorization for the
21    services provided by the dental hygienist;
22        (3) has documented participation in courses in
23    infection control and medical emergencies within each
24    continuing education cycle; and
25        (4) maintains current CPR certification from
26    completion of the American Heart Association healthcare



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1    provider course, the American Red Cross professional
2    rescuer course, or an equivalent entity.
3    (i) The dental hygiene services authorized to be performed
4by a dental hygienist under this subsection are limited to:
5        (1) screen and assess oral health conditions;
6        (2) preliminary charting of the oral cavity and
7    surrounding structures to include case histories, perform
8    initial and periodic examinations and assessments to
9    determine periodontal status, and formulate a dental
10    hygiene treatment plan in coordination with a dentist's
11    treatment plan;
12        (3) removal of deposits and stains from the surfaces of
13    the teeth;
14        (4) prescribe, administer, and dispense fluoride,
15    fluoride varnish, antimicrobial solutions, or resorbable
16    antimicrobial agents;
17        (5) apply sealants;
18        (6) polishing and smoothing restorations;
19        (7) removal of marginal overhangs;
20        (8) performance of preliminary charting;
21        (9) taking of radiographs; and
22        (10) performance of scaling and root planing.
23    (j) A collaborating dentist must be licensed under this Act
24and may enter into a collaborative agreement with no more than
252 dental hygienists unless otherwise authorized by the Board.
26The Board shall develop parameters and a process for obtaining



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1authorization to collaborate with more than 2 dental
2hygienists. The collaborative agreement must include:
3        (1) consideration for medically compromised patients
4    and medical conditions for which a dental evaluation and
5    treatment plan must occur prior to the provision of dental
6    hygiene services;
7        (2) age-and procedure-specific standard collaborative
8    practice protocols, including recommended intervals for
9    the performance of dental hygiene services and a period of
10    time that an examination by a dentist should occur;
11        (3) copies of consent to treatment form provided to the
12    patient by the dental hygienist;
13        (4) specific protocols for the placement of pit and
14    fissure sealants and requirements for follow-up care to
15    assure the efficacy of the sealants after application; and
16        (5) a procedure for creating and maintaining dental
17    records for the patients that are treated by the dental
18    hygienist; this procedure must specify where these records
19    are to be located.
20    (k) The collaborative agreement must be (i) signed and
21maintained by the dentist, the dental hygienist, and the
22facility, program, or organization, (ii) reviewed annually by
23the collaborating dentist and dental hygienist, and (iii) made
24available to the Board upon request.
25    (l) Before performing any services authorized under this
26subsection, a dental hygienist must provide the patient with a



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1consent to treatment form that must include a statement
2advising the patient that the dental hygiene services provided
3are not a substitute for a dental examination by a licensed
4dentist. If the dental hygienist makes any referrals to the
5patient for further dental procedures, the dental hygienist
6must fill out a referral form and provide a copy of the form to
7the collaborating dentist.
8    (m) The dental hygienist working under a collaborative
9agreement and the collaborating dentist must agree to maintain
10communication and consultation with each other.
11    (n) The dental hygienist working under a collaborative
12agreement must provide the collaborating dentist opportunities
13to review patient records as requested.
14(Source: P.A. 97-526, eff. 1-1-12.)
15    Section 99. Effective date. This Act takes effect upon
16becoming law.