N.D. Admin. Code 20-04-01-01

Current through Supplement No. 394, October, 2024

Section 20-04-01-01 - [Effective 10/1/2024] Duties

1. A dental hygienist may perform the following services under the direct supervision of a dentist:

a. Apply resin infiltration.

b. Hold impression trays in the mouth after placement by a dentist (e.g., reversible hydrocolloids, rubber base, etc.).

c. Place and remove matrix bands or wedges.

d. Adjust permanent crowns outside of the mouth.

e. Acid-etch enamel surfaces before direct bonding of orthodontic brackets or composite restorations.

f. Take face bow transfers.

g. Administer emergency medications to a patient in order to assist the dentist.

2. A dental hygienist authorized by permit and under the direct supervision of a dentist may:

a. Place, carve, and adjust amalgam, glass ionomer restorations, or composite restorations with hand instruments or a slow-speed handpiece;

b. Adapt and cement stainless steel crowns; and

c. Place, contour, and adjust composite restorations where the margins are entirely within the enamel with hand instruments or a slow-speed handpiece.

3. A dental hygienist may perform the following services under the indirect supervision of a dentist:

a. Administer local anesthesia as authorized by section 20-04-01-03.

b. Dry root canal with paper points.

c. Place and remove rubber dams.

d. Place retraction cord in the gingival sulcus of a prepared tooth before the dentist taking an impression of the tooth.

e. Monitor a patient who has been inducted by a dentist into nitrous oxide inhalation analgesia.

f. Place orthodontic brackets using an indirect bonding technique by seating the transfer tray loaded with brackets previously positioned in the dental laboratory by a dentist.

g. Assist a dentist authorized by permit as set forth in section 20-02-01-05 as follows:

(1) Sedation procedure preparation and presedation documentation, including date of procedure, nothing by mouth status, availability of responsible adult escort, and allergies.

(2) Emergency equipment and use preparedness.

(3) Monitor a patient discharged by a dentist once the patient is in recovery.

(4) Documentation of patient responsiveness, vital signs, including heart rate, respiratory rate, blood pressure, oxygen saturation, and expired carbon dioxide.

(5) Training must be documented and may be acquired directly by an employer-dentist, by a planned sequence of instruction in an educational institution, or by in-office training.

h. A dental hygienist authorized by permit may administer nitrous oxide analgesia to a patient who has not taken sedative medications before treatment in accordance with section 20-02-01-05.

4. A dental hygienist authorized by permit and under contiguous supervision of a dentist authorized by permit to provide moderate sedation, deep sedation, or general anesthesia may:

a. Initiate and discontinue an intravenous line for a patient being prepared to receive intravenous medications, sedation, or general anesthesia.

b. Adjust the rate of intravenous fluids infusion only to maintain or keep the line patent or open.

c. Prepare anesthesia equipment and perform patient monitoring.

d. Assist with emergency treatment and protocols.

5. A dental hygienist authorized by permit and under direct visual supervision of a dentist authorized by permit to provide moderate sedation, deep sedation, or general anesthesia may:

a. Draw up and prepare medications;

b. Follow instructions to deliver medication into an intravenous line upon verbal command of the supervising dentist;

c. Adjust the rate of intravenous fluids infusion beyond a keep-open rate upon verbal command of the supervising dentist; and

d. Adjust an electronic device to provide medications, such as an infusion pump upon the verbal command of the supervising dentist.

6. A dental hygienist may perform the following services under the general supervision of a dentist:

a. Complete prophylaxis to include removal of accumulated matter, deposits, accretions, or stains from the natural and restored surfaces of exposed teeth. The dental hygienist also may perform root planing and soft tissue curettage upon direct order of the dentist.

b. Polish and smooth existing restorations with a slow-speed handpiece.

c. Apply topical applications of drugs to the oral tissues and anticariogenic caries arresting and desensitizing solutions to the teeth.

d. Take impressions for study casts on a patient of record.

e. Take and record preliminary medical and dental histories for the interpretation by the dentist.

f. Take and record pulse, blood pressure, and temperature.

g. Provide oral hygiene treatment planning after an oral assessment or dentist's diagnosis.

h. Take dental radiographs.

i. Apply therapeutic agents subgingivally for the treatment of periodontal disease.

j. Remove excess cement from inlays, crowns, bridges, and orthodontic appliances with hand instruments or a slow-speed handpiece.

k. Receive removable dental prosthesis for cleaning and repair.

l. Take occlusal bite registration for study casts.

m. Fabricate, adjust, place, recement, or remove a temporary crown, bridge, onlay, or temporary restorative material. This applies only to dentitions actively under treatment for which a permanent restoration is being fabricated.

n. Perform nonsurgical clinical and laboratory oral diagnostic tests for interpretation by the dentist.

o. Apply pit and fissure sealants. Adjust sealants with slow-speed handpiece.

p. Place and remove periodontal dressings, dry socket medications, and packing.

q. Remove sutures.

r. Take impressions for fixed or removable orthodontic appliances, athletic mouth guards, bleaching trays, bite splints, flippers, and removable prosthetic repairs.

s. Preselect and prefit orthodontic bands.

t. Place, tie, and remove ligature wires and elastic ties, and place orthodontic separators.

u. Place and remove arch wires or appliances that have been activated by a dentist.

v. Cut and remove arch wires or replace loose bands, loose brackets, or other orthodontic appliances for palliative treatment.

w. Provide an oral assessment for interpretation by the dentist.

x. Orally transmit a prescription that has been authorized by the supervising dentist.

y. Repack dry socket medication and packing for palliative treatment.

z. Screenings as defined in section 20-01-02-01.

aa. Apply bleaching solution, activate light source, and monitor and remove bleaching materials.

bb. Apply interim therapeutic restorations using the standards and protocols established by an authorizing dentist and after completion of a board-approved course.

cc. Adjust a temporary denture or partial for dentitions actively under treatment for which permanent dentures or partial dentures are being fabricated.

dd. Produce on a patient of record, a final scan by digital capture for review and inspection by the authorizing dentist for a prescriptive fixed or removable appliance.

N.D. Admin Code 20-04-01-01

Effective September 1, 1980; amended effective February 1, 1992; October 1, 1993; May 1, 1996; August 1, 1998; April 1, 2000; July 1, 2004; April 1, 2006; January 1, 2011. .

Amended by Administrative Rules Supplement 2015-355, January 2015, effective 1/1/2015.

Amended by Administrative Rules Supplement 2015-356, April 2015, effective 4/1/2015.

Amended by Administrative Rules Supplement 2017-365, July 2017, effective 7/1/2017.

Amended by Administrative Rules Supplement 2021-380, April 2021, effective 4/1/2021.

Amended by Administrative Rules Supplement 2022-385, July 2022, effective 7/1/2022.

Amended by Administrative Rules Supplement 2022-386, October 2022, effective 10/1/2022.

Amended by Administrative Rules Supplement 2024-394, October 2024, effective 10/1/2024.

General Authority: NDCC 43-20-10

Law Implemented: NDCC 43-20-01.2, 43-20-03, 43-20-11, 43-20-12