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Part 4. Delegation, Supervision, Assignment

Michigan Department of Community Health Director's Office

Dentistry Rules - General Rules

(By authority conferred on the director of the department of community health by sections 16145(3) and 16601 of 1978 PA 368, MCL 333.16145(3) and 333.16601 et seq. and Executive Reorganization Order Nos. 1996-1, 1996-2 and 2003-1, MCL 330.3101, 445.2001 and 445.2011)

Part 4. Delegation, Supervision, Assignment

R 338.11401 Delegation or assignment of procedures by dentist to assistant, registered dental assistant, or registered dental hygienist; certain procedures prohibited.
Rule 1401. (1) A dentist shall not delegate or assign the following functions to an assistant or a registered dental assistant unless authorized by these rules or the code:

(a) Diagnosing, or prescribing for, any of the following:

(i) Disease.

(ii) Pain.

(iii) Deformity.

(iv) Deficiency.

(v) Injury.

(vi) Physical condition.

(b) Cutting of hard and soft tissue.

(c) Removal of any of the following:

(i) Accretions.

(ii) Stains.

(iii) Calculus deposits.

(d) Deep scaling.

(e) Root planing.

(f) Any intra-oral restorative procedures.

(g) Administration of any of the following:

(i) Local anesthesia.

(ii) Nitrous oxide analgesia.

(iii) Acupuncture.

(h) Irrigation and medication of root canals, try-in of cones or points, filing, or filling of root canals.

(i) Taking impressions for any purpose other than study or opposing models.

(j) Permanent cementation of any restoration or appliance.

(2) A dentist shall not assign to a registered dental hygienist the procedures described in subrule (1) (a), (b), (f), (g), (h), (i), and (j) of this rule unless authorized by these rules or the code.

History: 1984 MR 7, Eff. July 19, 1984; 1999 MR 9, Eff. Sept. 28, 1999

R 338.11403 Assistant; delegation of intra-oral procedures under general supervision.
Rule 1403. (1) The following intra-oral procedures shall not be delegated to an assistant unless the procedures are performed under general supervision:

(a) Trial sizing of orthodontic bands.

(b) Holding the matrix for anterior resin restorations.

(c) Making impressions for study and opposing models.

(d) Applying of topical anesthetic solutions (nonaerosol).

(e) Instructing in the use and care of dental appliances.

(f) Operating dental radiographic equipment if the assistant has successfully completed a course in dental radiography which is substantially equivalent to a course taught in a program approved by the board pursuant to R 338.11303 or R 338.11307. This subdivision takes effect July 26, 1992.

History: 1984 MR 7, Eff. July 19, 1984; 1989 MR 5, Eff. May 23, 1989; 2006

MR 11, Eff. June 9, 2006.

R 338.11404 Assistant; delegation of intra-oral procedures under direct supervision.
Rule 11404.
(1) The following intra-oral procedures shall not be delegated to an assistant unless the procedures are performed under direct supervision:

(a) Placement and removal of orthodontic separators.

(b) Placement and removal of orthodontic elastics, ligatures, and arch wires.

(2) Except for those procedures described in R 338.11403 and this rule, intra-oral procedures shall not be delegated to an assistant.

History: 2006 MR 11, Eff. June 9, 2006.

R 338.11405 Registered dental assistant; performance of intra-oral procedures under general supervision.
Rule 1405. (1) A dentist shall not assign the intra-oral dental procedures detailed in R 338.11403(1) and the following additional intra-oral procedures to a registered dental assistant unless the procedures are performed under the general supervision of a dentist:

(a) Placing and removing a rubber dam.

(b) Placing and removing a nonmetallic temporary restoration with nonrotary instruments.

(c) Removing excess cement from supragingival surfaces of a tooth with nonrotary instruments.

(d) Applying anticariogenics after oral prophylaxis, when ordered by a licensed dentist.

(e) Inspecting an oral cavity with a mouth mirror, including chartings of lesions, existing restorations, missing teeth, and classification of occlusion.

(f) Sizing of temporary crowns and bands.

(2) A dentist shall not assign the following additional intra-oral procedures to a registered dental assistant unless the registered dental assistant has successfully completed an approved course, as defined in section 16611(12) and (13) of the act. These procedures shall be performed under the general supervision of a dentist:

(a) Performing pulp vitality testing.

(b) Placing and removing matrices and wedges.

(c) Applying cavity liners and bases.

(d) Placing and removing nonepinephrine retraction cords.

(e) Applying desensitizing agents.

(f) Making an impression for orthodontic appliances, mouth guards, bite splints, and bleaching trays.

(g) Drying endodontic canals with absorbent points.

(h) Etching and placing adhesives before placement of orthodontic brackets.

History: 1984 MR 7, Eff. July 19, 1984; 1999 MR 9, Eff. Sept. 28, 1999;

2006 MR 11, Eff. June 9, 2006.

R 338.11405a Registered dental assistant; assignment of intra-oral procedures under direct supervision.
Rule 11405a. (1) A dentist shall not assign to a registered dental assistant the intra-oral dental procedures specified in R 338.11404(1) and the following intra-oral procedures unless the procedures are performed under the direct supervision of a dentist:

(a) Placing and removing periodontal dressings.

(b) Temporarily cementing and removing temporary crowns and bands.

(c) Removing sutures.

(d) Polishing specific teeth with a slow-speed rotary hand piece immediately before procedures that require acid etching, for any of the following:

(i) Placing sealants.

(ii) Placing resin-bonded orthodontic appliances.

(iii) Placing direct restorations by the dentist.

(2) Except for the procedures described in this rule, a dentist shall not assign intra-oral procedures to a registered dental assistant.

(3) A dentist shall not assign the following intra-oral procedures to a registered dental assistant unless the registered dental assistant has successfully completed an approved course, as defined in section 16611(11) of the act, followed by a comprehensive clinical experience of sufficient duration that validates clinical competence through a criterion-based assessment instrument. These procedures shall be performed under the direct supervision of a dentist:

(a) Placing, condensing, and carving amalgam restorations.

(b) Making final impressions for indirect restorations.

(4) A dentist shall not assign the assisting and monitoring of the administration of nitrous oxide analgesia by the dentist or registered dental hygienist to a registered dental assistant unless the registered dental assistant has successfully completed an approved course, as defined in section 16611(7) of the act, in the assisting and monitoring of the administration of nitrous oxide analgesia. This procedure shall be performed under the direct supervision of a dentist.

(5) Except for the procedures described in R 338.11405 and this rule, a dentist shall not assign intra-oral procedures to a registered dental assistant.

History: 2006 MR 11, Eff. June 9, 2006.

R 338.11406 Assignment of intra-oral procedures to registered dental hygienist.
Rule 1406. The intra-oral procedures listed in R 338.11405(1)(b) and (f) and shall not be assigned to a registered dental hygienist unless the registered dental hygienist is also licensed as a registered dental assistant under R 338.11235.

History: 1984 MR 7, Eff. July 19, 1984; 2006 MR 11, Eff. June 9, 2006.

R 338.11408 Registered dental hygienist; performance of intra-oral procedures under assignment of dentist.
Rule 1408. (1) A registered dental hygienist shall not perform the following intra-oral dental procedures unless the procedures are performed under the assignment of a dentist as defined in section 16601 of the code:

(a) Removing accretions and stains from the surfaces of the teeth and applying topical agents essential to complete prophylaxis.

(b) Root planing or debridement.

(c) Polishing and contouring restorations.

(d) Applying anticariogenic agents.

(e) Charting of the oral cavity,including all of the following:

(i) Periodontal charting.

(ii) Intra- and extra-oral examining of soft tissue.

(iii) Charting of radiolucencies or radiopacities, existing restorations, and missing teeth.

(f) Preliminary examining that includes both of the following:

(i) Classifying occlusion.

(ii) Testing pulp vitality using an electric pulp tester.

(g) Applying nonaerosol and noncaustic topical anesthetic agents by prescription of the dentist.

(h) Placing and removing intra-coronal temporary sedative dressings.

(i) Taking intra-oral measurements for orthodontic procedures.

(j) Placing and removing postextraction and periodontal dressings.

(k) Removing excess cement from tooth surfaces.

(l) Providing nutritional counseling for oral health and maintenance.

(m) Applying commonly accepted emergency procedures.

(n) Removing sutures.

(o) Placing and removing a rubber dam.

(p) Making impressions for study or opposing models, orthodontic appliances, mouth guards, bite splints, and bleaching trays.

(q) Operating dental radiographic equipment.

(r) Placing subgingival medicaments.

(s) Temporary cementing and removing of temporary crowns and bands.

History: 1984 MR 7, Eff. July 19, 1984; 1999 MR 9, Eff. Sept. 28, 1999;

2006 MR 11, Eff. June 9, 2006.

R 338.11409 Registered dental hygienist; assignment of intra-oral procedures under direct supervision.
Rule 11409. (1) A registered dental hygienist shall not perform the following intra-oral dental procedures unless the procedures are performed under the direct supervision of a dentist as defined in section 16601 of the code:

(a) Performing soft tissue curettage.

(b) Administering intra-oral block or infiltration anesthesia or nitrous oxide analgesia or both to a patient 18 years of age or older and only if the registered dental hygienist has met the following requirements:

(i) Successfully completed an approved course, as defined in section 16611(4) of the act, in the administration of local anesthesia and/or nitrous oxide analgesia.

(ii) Successfully completed a state or regional board administered written examination in local anesthesia within 18 months of completion of the approved course.

(iii) Successfully completed a state or regional board administered written examination on nitrous oxide analgesia, within 18 months of completion of the approved course, if such an examination exists.

(iv) Maintains and provides evidence of current certification in basic or advanced cardiac life support.

(2) A dental hygienist who meets the requirements of this rule may not administer more than 50% nitrous oxide.

History: 2006 MR 11, Eff. June 9, 2006.

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