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 1. GENERAL PROVISIONS
R 338.11101 Definitions.
Rule 1101. As used in these rules:
(a) "Act" means 1978 PA 368, MCL 333.1101.
(b) "Analgesia" means the diminution or elimination of pain in the conscious patient.
(c) "Approved course" means a course offered by either a dental, dental hygiene, or dental assisting program accredited by the commission on dental accreditation of the American dental association and approved by the department, or as defined in section 16611 of the act.
(d) "Assignment" means that a dentist has designated a patient of record upon whom services are to be performed by an assistant, registered dental assistant, or registered dental hygienist and has described the procedure to be performed. The dentist need not be physically present in the office or in the treatment room at the time the procedures are being performed.
(e) "Assistant" means a nonlicensed person who may perform basic supportive procedures under the supervision of a dentist as provided in these rules.
(f) "Board" means the Michigan board of dentistry.
(g) "Conscious sedation" means a minimally depressed level of consciousness that retains a patient's ability to independently and continuously maintain an airway and respond appropriately to physical stimulation or verbal command and that is produced by a pharmacological or a non-pharmacological method or a combination of both.
(h) "Combination inhalation-enteral conscious sedation" means conscious sedation using inhalation and enteral agents. Nitrous oxide/oxygen when used in combination with sedative agents may produce conscious or deep sedation or general anesthesia.
(i) "Dental school" means an institution that offers a curriculum that provides a core of required dental education, training, and experience, and includes at least 4 years of academic instruction or its equivalent leading to the degree of doctor of dental surgery or doctor of dental medicine. The dental school is a component of an institution of higher education that is accredited by an agency recognized by the United States department of education and that the American dental association's commission on dental accreditation has accredited as a dental education program.
(j) "Dentist" means a person licensed by the board under the act and these rules.
(k) "Direct supervision" means that a dentist has designated a patient of record upon whom services are to be performed by an assistant, registered dental assistant, or registered dental hygienist and has described the procedures to be performed. The dentist shall examine the patient before prescribing the procedure to be performed and again upon completion of the procedure. The dentist shall be physically present in the office at the time the procedures are being performed.
(l) "Enteral" means any technique of administration in which the agent is absorbed through the gastrointestinal or oral mucosa.
(m) "General anesthesia" means the elimination of all sensations accompanied by a state of unconsciousness and loss of reflexes necessary to maintain a patient airway.
(n) "General supervision" means that a dentist has designated a patient of record upon whom services are to be performed. The dentist shall be physically present in the office at the time the procedures are being performed.
(o) "Licensed" means the possession of a full license to practice, unless otherwise stated.
(p) "Local anesthesia" means the elimination of sensation, especially pain, in one part of the body by the topical application or regional injection of a drug.
(q) "Office" means the building or suite in which dental treatment is performed.
(r) "Parenteral" means a technique of administration in which the drug bypasses the gastrointestinal (gi) tract, such as intramuscular (im), intravenous (iv), intranasal (in), submucosal (sm), subcutaneous (sc), and intraocular (io).
(s) "Patient of record" means a patient who has been examined and diagnosed by a licensed dentist and whose treatment has been planned by a licensed dentist.
(t) "Public health service" means the United States public health service. A person applying for an exemption under this classification shall submit a certified copy of his or her official papers verifying active duty status.
(u) "Registered dental assistant" means a person licensed as such by the board under the act and these rules. A dental hygienist may perform the functions of a registered dental assistant if he or she is licensed by the board as a registered dental assistant.
(v) "Registered dental hygienist" means a person licensed as such by the board under the act and these rules.
(w) "Second pair of hands," as used in R 338.11109, means acts, tasks, functions, and procedures performed by a dental assistant, registered dental assistant, or registered dental hygienist at the direction of a dentist who is in the process of rendering dental services and treatment to a patient. The acts, tasks, functions, and procedures performed by a dental assistant, registered dental assistant, or registered dental hygienist are ancillary to the procedures performed by the dentist and intended to provide help and assistance at the time the procedures are performed. This definition shall not be deemed to expand the duties of the dental assistant, registered dental assistant, or registered dental hygienist as provided by the act and rules promulgated by the board.
(x) "Sedation" means the calming of a nervous, apprehensive individual, without inducing loss of consciousness, through the use of systemic drugs. Agents may be given orally, parenterally, or by inhalation.
(y) "Titration" means the administration of small incremental doses of a drug until a desired clinical effect is observed. In accordance with this definition, titration of oral medication for the purposes of sedation is unpredictable. Repeated dosing of orally administered sedative agents may result in an alteration of the state of consciousness beyond the intent of the practitioner. The maximum recommended dose (mrd) of an oral medication shall not be exceeded. Facilities, personnel and standards for enteral sedation are the same as those for parenteral sedation.
(z) "Treatment room" means the particular room or specific area in which the dental treatment is performed upon a patient.
History: 1984 MR 7, Eff. July 19, 1984; 1989 MR 5, Eff. May 23, 1989; 2006
MR 11, Eff. June 9, 2006.
R 338.11103 Applicability of rules.
Rule 1103. These rules apply to dentists, registered dental assistants, and registered dental hygienists.
History: 1984 MR 7, Eff. July 19, 1984.
R 338.11105 Rescinded.
History: 1984 MR 7, Eff. July 19, 1984; 1997 MR 1, Eff. February 15, 1997.
R 338.11107 Signs; disclosure of names of dentists practicing in an establishment.
Rule 1107. The name of the dentist actually practicing dentistry within an establishment shall be clearly disclosed by means of a sign or letting on or near a door, window, or wall of the establishment. If more than 1 dentist practices in a single establishment, the names of all the dentists practicing at the establishment shall be listed.
History: 1984 MR 7, Eff. July 19, 1984.
R 338.11109 Second pair of hands.
Rule 1109. A person, while assisting a licensed dentist who at the time is actively performing services in the mouth of a patient, may function as a second pair of hands for the dentist.
History: 1984 MR 7, Eff. July 19, 1984.
R 338.11115 Assessment of fines.
Rule 1115. (1) When a fine has been designated as an available sanction for a violation of sections 16221 to 16226 of the act, in the course of assessing a fine, the board shall take into consideration the following factors without limitation:
(a) The extent to which the licensee obtained financial benefit from any conduct comprising part of the violation found by the board.
(b) The willfulness of the conduct found to be part of the violation determined by the board.
(c) The public harm, actual or potential, caused by the violation found by the board.
(d) The cost incurred in investigating and proceeding against the license.
(2) A fine shall not exceed the sum of $50,000.00 for each violation found to have been committed by the licensee.
History: 1989 MR 5, Eff. May 23, 1989.
R 338.11117 Violations of the act.
Rule 1117. All of the following activities are violations of the act:
(a) Abandonment of dental treatment of a patient of record without advising the patient of the necessity of immediate dental or medical treatment when needed and without advising the patient to seek treatment from another health professional is a violation of section 16221(a) of the act.
(b) Performance of dental treatment without the patient's express or implied consent or the express or implied consent of the patient's guardian is a violation of section 16221(a) of the act.
(c) Practicing or offering to practice professional responsibilities which the licensee knows or has reason to know he or she is not competent to perform is a violation of section 16221(a) and (b)(i) of the act.
(d) Practicing or offering to practice, without adequate supervision, professional services which the licensee is authorized to perform only under the supervision of a licensed dentist as provided for in these rules, except in an emergency situation where a person's life or health is in immediate danger, is a violation of section 16221(a) and (b)(i) of the act.
(e) Delegating or assigning professional responsibilities to a person when the licensee delegating or assigning such responsibilities knows or has reason to know that such person is not qualified by training, by experience, or by licensure to perform them is a violation of section 16221(a) and (b)(i) of the act.
(f) Failure to be present in the office as needed to supervise, or failure to provide needed level of supervision of, the work of an assistant, registered dental assistant, registered dental hygienist, or other employee not licensed as a dentist under the act is a violation of section 16221(a) of the act.
(g) Failure to provide the same level of emergency care at all offices or facilities is a violation of section 16221(a) of the act.
(h) It shall be deemed a violation of section 16221(c)(ii) of the act if a dentist allows his or her license to be used by a person who is unlawfully engaged in the practice of dentistry. "Person," as used in this rule, is defined in section 1106 of the act.
History: 1984, MR 7, Eff. July 19, 1984.
R 338.11120 Dental treatment records; requirements.
Rule 1120. (1) A dentist shall make and maintain a dental treatment record on each patient.
(2) The dental treatment records for patients shall include all of the following information:
(a) Dental procedures performed upon the patient, including the charting of all restorations, missing teeth, or other developmental deformities.
(b) The date the procedure was performed.
(c) Identity of the dentist or the dental auxiliary performing each procedure.
(d) The date, dosage, and amount of any medication or drug prescribed, dispensed, or administered to the patient.
(e) Radiographs taken in the course of treatment. If radiographs are transferred to another dentist, the name and address of that dentist shall be entered in the treatment record.
(3) All dental treatment records shall be permanent and shall be maintained for not less than 10 years from the date of the last treatment provided.
History: 1989 MR 5, Eff. May 23, 1989.
R 338.11121 Scheduled controlled substances; inventory record requirements.
Rule 1121. (1) When a controlled substance, as described in article 7 of the act, is stocked in a dental office for dispensing or administering to a patient, an accurate inventory of the drug shall be maintained and include all of the following information:
(a) The date and quantity of the drug purchased.
(b) The amount, dosage, and date dispensed or administered.
(c) The name of the patient to whom it was dispensed or administered.
(2) The inventory record shall be available for inspection for not less than 10 years.
(3) The inventory record shall be in addition to the dental treatment records required by R 33 8.11120.
History: 1989 MR 5, Eff. May 23, 1989.
R 338.11199 Rescission.
Rule 1199. R 338.4101 to R 338.4555 of the Michigan Administrative Code, appearing on pages 2672 to 2693 of the 1979 Michigan Administrative Code, are rescinded.
History: 1984, MR 7, Eff. July 19, 1984.
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 1. GENERAL PROVISIONS
R 338.11101 Definitions.
Rule 1101. As used in these rules:
(a) "Act" means 1978 PA 368, MCL 333.1101.
(b) "Analgesia" means the diminution or elimination of pain in the conscious patient.
(c) "Approved course" means a course offered by either a dental, dental hygiene, or dental assisting program accredited by the commission on dental accreditation of the American dental association and approved by the department, or as defined in section 16611 of the act.
(d) "Assignment" means that a dentist has designated a patient of record upon whom services are to be performed by an assistant, registered dental assistant, or registered dental hygienist and has described the procedure to be performed. The dentist need not be physically present in the office or in the treatment room at the time the procedures are being performed.
(e) "Assistant" means a nonlicensed person who may perform basic supportive procedures under the supervision of a dentist as provided in these rules.
(f) "Board" means the Michigan board of dentistry.
(g) "Conscious sedation" means a minimally depressed level of consciousness that retains a patient's ability to independently and continuously maintain an airway and respond appropriately to physical stimulation or verbal command and that is produced by a pharmacological or a non-pharmacological method or a combination of both.
(h) "Combination inhalation-enteral conscious sedation" means conscious sedation using inhalation and enteral agents. Nitrous oxide/oxygen when used in combination with sedative agents may produce conscious or deep sedation or general anesthesia.
(i) "Dental school" means an institution that offers a curriculum that provides a core of required dental education, training, and experience, and includes at least 4 years of academic instruction or its equivalent leading to the degree of doctor of dental surgery or doctor of dental medicine. The dental school is a component of an institution of higher education that is accredited by an agency recognized by the United States department of education and that the American dental association's commission on dental accreditation has accredited as a dental education program.
(j) "Dentist" means a person licensed by the board under the act and these rules.
(k) "Direct supervision" means that a dentist has designated a patient of record upon whom services are to be performed by an assistant, registered dental assistant, or registered dental hygienist and has described the procedures to be performed. The dentist shall examine the patient before prescribing the procedure to be performed and again upon completion of the procedure. The dentist shall be physically present in the office at the time the procedures are being performed.
(l) "Enteral" means any technique of administration in which the agent is absorbed through the gastrointestinal or oral mucosa.
(m) "General anesthesia" means the elimination of all sensations accompanied by a state of unconsciousness and loss of reflexes necessary to maintain a patient airway.
(n) "General supervision" means that a dentist has designated a patient of record upon whom services are to be performed. The dentist shall be physically present in the office at the time the procedures are being performed.
(o) "Licensed" means the possession of a full license to practice, unless otherwise stated.
(p) "Local anesthesia" means the elimination of sensation, especially pain, in one part of the body by the topical application or regional injection of a drug.
(q) "Office" means the building or suite in which dental treatment is performed.
(r) "Parenteral" means a technique of administration in which the drug bypasses the gastrointestinal (gi) tract, such as intramuscular (im), intravenous (iv), intranasal (in), submucosal (sm), subcutaneous (sc), and intraocular (io).
(s) "Patient of record" means a patient who has been examined and diagnosed by a licensed dentist and whose treatment has been planned by a licensed dentist.
(t) "Public health service" means the United States public health service. A person applying for an exemption under this classification shall submit a certified copy of his or her official papers verifying active duty status.
(u) "Registered dental assistant" means a person licensed as such by the board under the act and these rules. A dental hygienist may perform the functions of a registered dental assistant if he or she is licensed by the board as a registered dental assistant.
(v) "Registered dental hygienist" means a person licensed as such by the board under the act and these rules.
(w) "Second pair of hands," as used in R 338.11109, means acts, tasks, functions, and procedures performed by a dental assistant, registered dental assistant, or registered dental hygienist at the direction of a dentist who is in the process of rendering dental services and treatment to a patient. The acts, tasks, functions, and procedures performed by a dental assistant, registered dental assistant, or registered dental hygienist are ancillary to the procedures performed by the dentist and intended to provide help and assistance at the time the procedures are performed. This definition shall not be deemed to expand the duties of the dental assistant, registered dental assistant, or registered dental hygienist as provided by the act and rules promulgated by the board.
(x) "Sedation" means the calming of a nervous, apprehensive individual, without inducing loss of consciousness, through the use of systemic drugs. Agents may be given orally, parenterally, or by inhalation.
(y) "Titration" means the administration of small incremental doses of a drug until a desired clinical effect is observed. In accordance with this definition, titration of oral medication for the purposes of sedation is unpredictable. Repeated dosing of orally administered sedative agents may result in an alteration of the state of consciousness beyond the intent of the practitioner. The maximum recommended dose (mrd) of an oral medication shall not be exceeded. Facilities, personnel and standards for enteral sedation are the same as those for parenteral sedation.
(z) "Treatment room" means the particular room or specific area in which the dental treatment is performed upon a patient.
History: 1984 MR 7, Eff. July 19, 1984; 1989 MR 5, Eff. May 23, 1989; 2006
MR 11, Eff. June 9, 2006.
R 338.11103 Applicability of rules.
Rule 1103. These rules apply to dentists, registered dental assistants, and registered dental hygienists.
History: 1984 MR 7, Eff. July 19, 1984.
R 338.11105 Rescinded.
History: 1984 MR 7, Eff. July 19, 1984; 1997 MR 1, Eff. February 15, 1997.
R 338.11107 Signs; disclosure of names of dentists practicing in an establishment.
Rule 1107. The name of the dentist actually practicing dentistry within an establishment shall be clearly disclosed by means of a sign or letting on or near a door, window, or wall of the establishment. If more than 1 dentist practices in a single establishment, the names of all the dentists practicing at the establishment shall be listed.
History: 1984 MR 7, Eff. July 19, 1984.
R 338.11109 Second pair of hands.
Rule 1109. A person, while assisting a licensed dentist who at the time is actively performing services in the mouth of a patient, may function as a second pair of hands for the dentist.
History: 1984 MR 7, Eff. July 19, 1984.
R 338.11115 Assessment of fines.
Rule 1115. (1) When a fine has been designated as an available sanction for a violation of sections 16221 to 16226 of the act, in the course of assessing a fine, the board shall take into consideration the following factors without limitation:
(a) The extent to which the licensee obtained financial benefit from any conduct comprising part of the violation found by the board.
(b) The willfulness of the conduct found to be part of the violation determined by the board.
(c) The public harm, actual or potential, caused by the violation found by the board.
(d) The cost incurred in investigating and proceeding against the license.
(2) A fine shall not exceed the sum of $50,000.00 for each violation found to have been committed by the licensee.
History: 1989 MR 5, Eff. May 23, 1989.
R 338.11117 Violations of the act.
Rule 1117. All of the following activities are violations of the act:
(a) Abandonment of dental treatment of a patient of record without advising the patient of the necessity of immediate dental or medical treatment when needed and without advising the patient to seek treatment from another health professional is a violation of section 16221(a) of the act.
(b) Performance of dental treatment without the patient's express or implied consent or the express or implied consent of the patient's guardian is a violation of section 16221(a) of the act.
(c) Practicing or offering to practice professional responsibilities which the licensee knows or has reason to know he or she is not competent to perform is a violation of section 16221(a) and (b)(i) of the act.
(d) Practicing or offering to practice, without adequate supervision, professional services which the licensee is authorized to perform only under the supervision of a licensed dentist as provided for in these rules, except in an emergency situation where a person's life or health is in immediate danger, is a violation of section 16221(a) and (b)(i) of the act.
(e) Delegating or assigning professional responsibilities to a person when the licensee delegating or assigning such responsibilities knows or has reason to know that such person is not qualified by training, by experience, or by licensure to perform them is a violation of section 16221(a) and (b)(i) of the act.
(f) Failure to be present in the office as needed to supervise, or failure to provide needed level of supervision of, the work of an assistant, registered dental assistant, registered dental hygienist, or other employee not licensed as a dentist under the act is a violation of section 16221(a) of the act.
(g) Failure to provide the same level of emergency care at all offices or facilities is a violation of section 16221(a) of the act.
(h) It shall be deemed a violation of section 16221(c)(ii) of the act if a dentist allows his or her license to be used by a person who is unlawfully engaged in the practice of dentistry. "Person," as used in this rule, is defined in section 1106 of the act.
History: 1984, MR 7, Eff. July 19, 1984.
R 338.11120 Dental treatment records; requirements.
Rule 1120. (1) A dentist shall make and maintain a dental treatment record on each patient.
(2) The dental treatment records for patients shall include all of the following information:
(a) Dental procedures performed upon the patient, including the charting of all restorations, missing teeth, or other developmental deformities.
(b) The date the procedure was performed.
(c) Identity of the dentist or the dental auxiliary performing each procedure.
(d) The date, dosage, and amount of any medication or drug prescribed, dispensed, or administered to the patient.
(e) Radiographs taken in the course of treatment. If radiographs are transferred to another dentist, the name and address of that dentist shall be entered in the treatment record.
(3) All dental treatment records shall be permanent and shall be maintained for not less than 10 years from the date of the last treatment provided.
History: 1989 MR 5, Eff. May 23, 1989.
R 338.11121 Scheduled controlled substances; inventory record requirements.
Rule 1121. (1) When a controlled substance, as described in article 7 of the act, is stocked in a dental office for dispensing or administering to a patient, an accurate inventory of the drug shall be maintained and include all of the following information:
(a) The date and quantity of the drug purchased.
(b) The amount, dosage, and date dispensed or administered.
(c) The name of the patient to whom it was dispensed or administered.
(2) The inventory record shall be available for inspection for not less than 10 years.
(3) The inventory record shall be in addition to the dental treatment records required by R 33 8.11120.
History: 1989 MR 5, Eff. May 23, 1989.
R 338.11199 Rescission.
Rule 1199. R 338.4101 to R 338.4555 of the Michigan Administrative Code, appearing on pages 2672 to 2693 of the 1979 Michigan Administrative Code, are rescinded.
History: 1984, MR 7, Eff. July 19, 1984.