New Mexico Register / Volume
XXXIV, Issue 10 / May 31, 2023
TITLE 16 OCCUPATIONAL
AND PROFESSIONAL LICENSING
CHAPTER 5 DENTISTRY
(DENTISTS, DENTAL HYGIENISTS, ETC.)
PART 17 DENTISTS
AND DENTAL HYGIENISTS, COLLABORATIVE PRACTICE
16.5.17.1 ISSUING
AGENCY: New Mexico Board of Dental Health Care.
[16.5.17.1 NMAC - Rp,
16.5.17.1 NMAC, 5/31/2023]
16.5.17.2 SCOPE: The
provisions of 16.5.17 NMAC apply to all dentists, dental hygienists and dental
assistants who work in a collaborative practice arrangement.
[16.5.17.2 NMAC - Rp,
16.5.17.2 NMAC, 5/31/2023]
16.5.17.3 STATUTORY
AUTHORITY: 16.5.17 NMAC is promulgated pursuant to the
Dental Health Care Act, Section 61-5A-4 NMSA 1978.
[16.5.17.3 NMAC - Rp,
16.5.17.3 NMAC, 5/31/2023]
16.5.17.4 DURATION: Permanent.
[16.5.17.4 NMAC - Rp,
16.5.17.4 NMAC, 5/31/2023]
16.5.17.5 EFFECTIVE
DATE: May 31, 2023, unless a different date is
cited at the end of a section.
[16.5.17.5 NMAC - Rp,
16.5.17.5 NMAC, 5/31/2023]
16.5.17.6 OBJECTIVE: To
regulate the collaborative practice of dental hygiene in New Mexico.
[16.5.17.6 NMAC - Rp,
16.5.17.6 NMAC, 5/31/203]
16.5.17.7 DEFINITIONS:
A. “Acting
consulting dentist” means a dentist who meets the qualifications of a
consulting dentist who agrees to act as the consulting dentist when that
dentist will be away from his/her practice for more than two weeks. An approved collaborative agreement shall be
signed by the acting consulting dentist and the licensed dental hygienist prior
to the consulting dentist leaving.
B. “Collaborative
practice agreement” means a written agreement between a dentist who meets
the qualifications of 16.5.17.9 NMAC to be a consulting dentist as defined in
16.5.17 NMAC of these rules, and a collaborative practice dental
hygienist. This agreement shall follow
the format as determined by the board and committee. A new agreement shall be signed and submitted
to the board for approval each renewal period.
C. “Collaborative
practice of dental hygiene” means the science of the prevention and
treatment of oral disease through the provision of educational, assessment,
preventive, clinical and other therapeutic services as specified in Subsection
B of Section of 61-5A-4 NMSA 1978, in a cooperative working relationship with a
consulting dentist but without general supervision, as set forth by the rules
jointly established by the board and committee.
D. “Consulting
(collaborative) dentist” means a dentist who meets the qualifications
specified in 16.5.17.9 NMAC of this rule and who agrees to serve or continues
to serve as a patient's dentist of record in collaboration and consultation
with the practice dental hygienist as specified in the rules.
E. “Non-participating
dentist” is a dentist who does not wish to collaborate with a collaborative
practice dental hygienist.
F. “Standard
collaborative practice protocols” is the protocol to be used by the
collaborative practice dental hygienist to treat a patient, as specified in
16.5.17.13 NMAC of this part.
G. “Verbal
prescription or orders” means instructions not communicated in written
form, shall be recorded in the patient's record or the protocol agreement by
both the collaborative hygienist and the consulting dentist when given.
H. “Written
prescription orders” means instructions from the consulting dentist to the
collaborative hygienist to perform those allowable treatments requiring
diagnosis and treatment plan, subject to the limitations of 16.5.17.12 NMAC of
these rules, or directions written to modify the standard collaborative
practice protocols, or the collaborative practice agreement.
[16.5.17.7 NMAC - Rp,
16.5.17.7 NMAC, 5/31/2023]
16.5.17.8 CERTIFICATION
FOR TE COLLABORATIVE PRACTICE OF DENTAL HYGIENE: The
board, based on the recommendation of the dental hygienists committee, will
certify qualified dental hygienists for collaborative practice.
A. Prerequisite
requirements for certification. Each
applicant for certification as a collaborative practice dental hygienist shall
possess the following qualifications:
(1) possess
a current New Mexico dental hygiene license in good standing;
(2) have
been engaged in the active practice of dental hygiene as defined in Subsection
B of Section 61-5A-4 NMSA1978 of the act for not less than:
(a) 2400
hours of active practice for the past 18 months; or
(b) a
total of 3,000 hours of active practice and has been engaged in active practice
for two of the past three years;
(3) meet
the educational criteria for licensure in Subsection A of Section 61-5A-13 NMSA
1978 of the act; and
(4) have
15 hours of continuing education in clinical dental hygiene in the 12 months
prior to certification, which includes courses in infection control and medical
emergencies.
B. Documentation
requirements. Each applicant for
certification as a collaborative practice dental hygiene shall submit a
completed application, the required fees and following documentation:
(1) verification
of a current active license;
(2) proof
of the active practice of dental hygiene as defined in 16.5.17.8 NMAC of this
part; this proof may be in the form of letters from employers, supervisors of
dental clinics of one of the uniformed services of the United States, or
faculty administrators of accredited schools; if this documentation cannot be
obtained, the applicant may request to provide other proof of the required
hours to the committee for consideration;
(3) basic life support (BLS) or cardiac pulmonary resuscitation (CPR): proof of current certification accepted by the American heart association, the American red cross, or the American safety and health institute (ASHI); cannot be a self-study course;
(4) proof
of 15 hours of continuing education related to the clinical practice of dental
hygiene; and
(5) a
copy of a signed collaborative practice agreement between a dental hygienist
and a consulting dentist.
C. Renewal
requirements. Each dental hygienist
certified for collaborative practice shall:
(1) submit
a completed renewal application for certification for collaborative practice,
along with the triennial renewal application for their license, accompanied by
the required fees as defined in 16.5.18 NMAC;
(2) complete
60 hours of continuing education every triennial renewal period; if the initial
certification period is less than three years, the required continuing
education will be prorated at 20 hours per full year of certification; 60 hours
to include:
(a) basic life support (BLS) or cardiac pulmonary resuscitation (CPR): proof of current certification accepted by the American heart association, the American red cross, or the American safety and health institute (ASHI); cannot be a self-study course;
(b) infection
control: as further defined in 16.5.1.16
NMAC, a course in infection control techniques and sterilization procedures per
renewal period; and
(c) medical
emergencies: as for new certification
defined in Paragraph (4) of Subsection A of 16.5.17.8 NMAC;
(3) submit
a current list of all consulting dentists to the board with each renewal
application; and
(4) submit
a copy of the signed collaborative practice agreement(s) and protocols between
a dental hygienist and a consulting dentist per renewal period.
[16.5.17.8 NMAC - Rp,
16.5.17.8 NMAC, 5/31/2023]
16.5.17.9 QUALIFICATIONS
FOR CONSULTING DENTISTS: A consulting dentist shall meet the following
qualifications:
A. possess a
current New Mexico dental license in good standing;
B. maintains an
active clinical general dentistry or public health practice within the state
and within a reasonable referral distance from the collaborative dental hygiene
practice as determined by the board upon recommendation of the dental
hygienists committee.
[16.5.17.9 NMAC - Rp,
16.5.17.9 NMAC, 5/31/2023]
16.5.17.10 RESPONSIBILITIES
OF A CONSULTING DENTIST: The consulting dentist shall:
A. in collaboration
with the dental hygienist, provide for the patient's additional needed dental
care;
B. be available to
provide consultation to the collaborative practice dental hygienist;
C. make provisions
for a qualified acting consulting dentist to act in his/her place should he/she
be away from his practice for more than two weeks;
D. maintain an
appropriate level of contact and communication with the collaborative practice
dental hygienist;
E. in conjunction
with the collaborative practice dental hygienist, be responsible and liable for
acts and omissions in the collaborative dental hygiene practice;
F. assure that each
collaborative practice dental hygienist is duly licensed and certified for
collaborative practice by the board of dental health care;
G. maintain a
separate and distinct collaborative practice agreement with each collaborative
practice dental hygienist for whom he/she serves as a consulting dentist;
H. provide verbal
or written prescriptions to the collaborative practice dental hygienist for
those procedures requiring a diagnosis;
I. provide verbal
or written prescriptions to the collaborative practice dental hygienist when
the consulting dentist deems it appropriate to provide exception to the
standardized protocols;
J. provide a
written prescription within seven business days following a verbal prescription
or order;
K. maintain in the
patients record a duplicate of the written prescriptions or orders as described
in Subsection H through Subsection J of 16.5.17.10 NMAC;
L. provide a
written diagnosis and treatment recommendations from the records provided by
the collaborative practice dental hygienist to the patient and the hygienist
within 30 days of receipt of such records;
M. each
collaborative agreement will be kept on file by the collaborative practice
dental hygienist and the consulting dentist, the basic format of the agreement
will be provided with the application by the board.
[16.5.17.10 NMAC - Rp,
16.5.17.10 NMAC, 5/31/2023]
16.5.17.11 RESPONSIBILITIES
OF A COLLABORATIVE PRACTICE DENTAL HYGIENIST: The collaborative practice
dental hygienist shall:
A. refer each
patient for a dental examination every 12 months, as well as anyone who may
require further dental services, to the patient's consulting dentist or to a
dental specialist in the case of an emergency;
B. in conjunction
with the consulting dentist, be responsible and liable for acts and omissions in
the collaborative dental hygiene practice;
C. assure that each
consulting dentist is duly licensed by the board of dental health care; by
verification with the board office;
D. maintain a
collaborative practice agreement with each consulting dentist; and
E. maintain an
appropriate level of contact and communication with the consulting dentist;
F. contact the
patient's dentist of record, if not a consulting dentist, prior to treating the
patient to give the dentist the option of becoming a consulting dentist;
G. offer the
patient a choice of the collaborative practice dental hygienist's consulting
dentists if the patient's dentist of record chooses to be a non-participating
dentist;
H. not to perform
any treatment if the patient does not have an active consulting dentist on
record with the collaborative practice dental hygienist;
I. follow the
standardized protocol unless modified by the consulting dentist by prescription
or order;
J. follow the
verbal and written prescriptions and orders of the consulting dentist for those
treatments requiring a diagnosis;
K. forward all
records and x-rays, or duplicates, to the consulting dentist within 14 days;
L. assure that each
consulting dentist meets the requirements of a consulting dentist as stated in
16.5.17.9 NMAC;
M. a copy of the collaborative agreement shall be on file with the board office; any changes to this agreement shall be filed with the board office within 60 days.
N. the
collaborative dental hygienist shall be subject to provisions of 16.5.58 NMAC.
[16.5.17.11 NMAC - Rp,
16.5.17.11 NMAC, 5/31/2023]
16.5.17.12 COLLABORATIVE
DENTAL HYGIENE PRACTICE AND LIMITATIONS:
A. A dental
hygienist in a collaborative practice may perform the procedures in a dental
hygienist’s scope of practice listed in 16.5.29 NMAC without general
supervision while the hygienist is in a cooperative working relationship with a
consulting dentist, pursuant to rules promulgated by the board and the
committee.
B. A collaborative
practice dental hygienist may have more than one consulting dentist.
C. A dentist shall
have a consulting agreement with no more than three collaborative practice
dental hygienists. The board may grant exception to this limitation for public health settings on a
case-by-case basis.
D. The
collaborative practice dental hygienist may own and manage a dental hygiene
practice, or enter into a contractual arrangement, in
any location or setting in New Mexico.
E. The committee,
through the board, may take any disciplinary action allowed by the Uniform
Licensing Act, against a dental hygienist certified in collaborative practice.
F. Collaborative
dental hygienist can administer local anesthesia under general supervision as
defined in 16.5.28.8 NMAC and 16.5.28.12 NMAC.
G. A collaborative
dental hygienist may assess for pit and fissure
sealants without a dentist’s evaluation as provided in Subsection D of
16.5.29.8 NMAC.
H. A collaborative
dental hygienists may prescribe, administer and
dispense topically applied fluoride and topically applied antimicrobials as
provided for in 16.5.29.11 NMAC.
I. Perform dental
hygiene focused assessment.
J. A collaborative
practice dental hygienist shall not:
(1) administer
local anesthesia except under the general supervision of a dentist; and only if
certified to do so through the committee and ratified by the board;
(2) administer
a drug or medication, except those directly indicated as dental topical
therapeutic or preventive agents; other therapeutic agents may only be
dispensed if the collaborative practice dental hygienist holds a class C clinic
license; any drugs dispensed as a class C clinic (as designated and defined by
the New Mexico board of pharmacy) shall be on the specific individual
authorization of a dentist:
(a) all
non-controlled substance medications requiring a prescription or order from the
dentist may only be dispensed for immediate use in the collaborative practice
dental hygienist office, and only on the specific order or protocol from the
consulting dentist; a log of these dispensing shall be kept and a copy of this
log shall be sent to the corresponding consulting dentist every six months;
collaborative practice dental hygienists may not dispense or administer any
controlled substance;
(b) prescription
drugs, which are kept in bulk at the collaborative practice dental hygienist's
office, to be dispensed or used by the collaborative practice dental hygienist
as in 16.5.17.12 NMAC, shall be purchased on an order or prescription by a
consulting dentist;
(3) diagnose
dental disease, but may advise the patient of suspected pathology and
periodontal status;
(4) perform
oral hygiene procedures on any patient identified as having a significant
health risk from the procedures; unless the patients' current health history
has been reviewed by the patient’s dentist of record or the consulting dentist;
or for patients who reside in residential or long term care facilities, the
patient's dentist or physician;
(5) perform
treatments requiring the diagnosis of a dentist without a prescription/order
from the consulting dentist; such treatments include but are not limited to,
root planing, sealant application in presence of
cavitation, administration of therapeutic agents and other services defined in Subsection
B of Section 61-5A-4 NMSA 1978 as within the scope of dental hygiene practice but which require a dentists diagnosis;
(6) modify
the standard collaborative practice protocol without a prescription or order
from the consulting dentist;
(7) take
impressions for bleaching trays, deliver bleaching materials or provide systems
of home bleaching, or provide instructions to patients on using bleaching
materials unless it is authorized on a case by case basis by prescription from
a consulting dentist;
(8) provide
in office bleaching systems unless under indirect supervision of a consulting
dentist.
K. Effective July 1, 2015, a collaborative practice hygienist who owns a dental practice shall register with the board as a non-dentist owner. No additional license or fee is required for this registration. A collaborative practice hygienist who owns a dental practice must notify the board, in writing, if the dental practice has been sold or has closed.
[16.5.17.12 NMAC - Rp,
16.5.17.12 NMAC, 5/31/2023]
16.5.17.13 STANDARD
COLLABORATIVE PRACTICE PROTOCOLS: All protocols will include but
are not limited to:
review of health history charting of existing teeth and restorations,
periodontal charting as necessary, and notations of potential pathology. Protocols
may be amended upon written order of the consulting dentist. Time intervals for these protocols shall be
established in the collaborative practice agreement as provided in Subsection G
of 16.5.17.13 NMAC.
A. Protocols for
children 12 and under:
(1) appropriate
panoramic or occlusal x-rays;
(2) two
bitewing x-rays;
(3) prophylaxis/scaling;
(4) topical
fluoride treatment;
(5) other
radiographs as indicated by consultation with the dentist.
B. Protocols for
teenagers:
(1) appropriate
panoramic or full mouth radiographs;
(2) two
or four bitewing x-rays;
(3) prophylaxis/scaling;
(4) topical
fluoride treatment;
(5) other
radiographs as indicated by consultation with the dentist.
C. Protocols for
adults:
(1) full
mouth or panoramic radiograph;
(2) bitewing
radiographs annually;
(3) complete
periodontal charting;
(4) prophylaxis/scaling
or gross debridement and consultation with the consulting dentist if
periodontal assessment suggests periodontal involvement.
D. All other procedures
not listed in the protocols shall require a prescription from the consulting
dentist as stated in Subsections H and N of 16.5.17.10 NMAC.
E. Guidelines for
patient release forms, to include a disclaimer signed by the patient or legal
guardian that the dental hygiene services rendered do not preclude the need for
routine examinations by a dentist.
F. Both the
consulting dentist and the collaborative practice dental hygienist shall sign a
copy of this or amended protocol and keep on file.
G. Changes to
practice protocol and agreements shall be prescribed in writing by the
consulting dentist and recorded by both the consulting dentist and the
collaborative practice dental hygienist.
[16.5.17.13 NMAC - Rp,
16.5.17.13 NMAC, 5/31/2023]
16.5.17.14 DENTAL
ASSISTANTS IN COLLABORATIVE DENTAL HYGIENE PRACTICE:
Collaborative practice dental hygienists may work with and supervise
dental assistants, including dental assistants certified to perform functions
as defined in 16.5.39 NMAC of these rules.
[16.5.17.14 NMAC - Rp,
16.5.17.14 NMAC, 5/31/2023]
HISTORY OF 16.5.17 NMAC:
Pre-NMAC History: None.
History of Repealed Material:
16.5.17 NMAC,
Dentists and Dental Hygienists, Collaborative Practice, filed 12/1/2000
Repealed effective 5/31/2023.
Other History:
16 NMAC 5.17,
Dentists and Dental Hygienists, Collaborative Practice, filed 1/28/2000;
16 NMAC 5.17,
Dentists and Dental Hygienists, Collaborative Practice, filed 1/28/2000 -
renumbered, reformatted and amended to 16.5.17 NMAC, Dentists and Dental Hygienists,
Collaborative Practice, effective 2/14/2000.
16.5.17 NMAC,
Dentists and Dental Hygienists, Collaborative Practice, filed 12/1/2000
Replaced by 16.5.17 NMAC, Dentists and Dental Hygienists, Collaborative
Practice, effective 5/31/2023.