Section 216-RICR-40-05-2.3 - DefinitionsA. Wherever used in this Part the following terms shall be construed to mean: 1. "Act" refers to R.I. Gen. Laws Chapter 5-31.1, entitled "Dentists and Dental Hygienists". Also known as the Dental Practice Act.2. "Adult" means a person thirteen (13) years of age or older.3. "Advisory consultants" means those individuals appointed by the Board to serve as advisory consultants to the Board in determining compliance with the statutory and regulatory provisions of this Part, of applicants seeking a permit to administer or to permit the administration of general anesthesia/deep sedation, moderate sedation, minimal sedation or nitrous oxide sedation. Such consultants may be Diplomates of the American Board of Oral and Maxillofacial Surgery, Members or Fellows of the American Association of Oral and Maxillofacial Surgeons, or Diplomates of the National Dental Board of Anesthesiology or the American Dental Society of Anesthesiology, and may include a Board Certified Anesthesiologist and a licensed dentist with experience in the administration of general anesthesia/deep sedation, moderate sedation, minimal sedation or nitrous oxide sedation.4. "Analgesia" means the diminution or elimination of pain.5. "Biennial" means occurring every second (2nd) year.6. "Board" refers to the Board of Examiners in Dentistry, or any committee or subcommittee thereof, established in the Rhode Island Department of Health pursuant to the provisions of the Act.7. "Competency" means displaying special skill or knowledge derived from training and experience.8. "Continuous" means prolonged without any interruption at any time.9. "DAANCE-certified maxillofacial surgery assistant" means a person currently certified by the American Association of Oral and Maxillofacial Surgeons to provide supportive anesthesia care.10. "DANB-certified assistant" means a person currently certified by the Dental Assisting National Board, Inc. (DANB), or its successor agency, holding the certified Dental Assistant (CDA) certification in general dental assisting duties or another DANB certification in a specific area of advanced or specialty practice, and employed for the purpose of assisting a dentist in the performance of procedures/duties related to dental care in accordance with the provisions of this Part.11. "Dental administrator" means the Administrator of the Rhode Island Board of Examiners in Dentistry.12. "Deep sedation" means a drug-induced depression of consciousness during which patients cannot be easily aroused but respond purposefully following repeated or painful stimulation. The ability to independently maintain ventilatory function may be impaired. Patients may require assistance in maintaining a patent airway, and spontaneous ventilation may be inadequate. Cardiovascular function is usually maintained.13. "Dental assistant" means a person not currently certified by the Dental Assisting National Board, Inc. (DANB) holding the certified Dental Assistant (CDA) certification in general dental assisting duties or another DANB certification in a specific area of advanced or specialty practice, and employed for the purpose of assisting a dentist in the performance of procedures/duties related to dental care in accordance with the provisions of this Part.14. "Dental auxiliary personnel" refers to a dental hygienist, a public-health dental hygienist, a DANB-certified assistant, a DAANCE-certified maxillofacial surgery assistant or a dental assistant.15. "Dental hygienist" means an individual licensed under the provisions of the Act to practice dental hygiene.16. "Dental office or facility" means a place, however named, where a dentist actively, regularly, and personally practices dentistry, pursuant to the provisions of R.I. Gen. Laws § 5-31.1-1(16).17. "Dentist" means an individual licensed under the provisions of the Act to practice dentistry in Rhode Island.18. "Dentistry" means the evaluation, diagnosis, prevention and/or treatment (non-surgical, surgical or related procedures) of diseases, disorders and/or conditions of the oral cavity, cranio-maxillofacial area and/or the adjacent and associated structures and their impact on the human body, including any service or product that may change the anatomy, appearance or arrangement of teeth provided by a dentist, within the scope of his or her education, training and experience, in accordance with the ethics of the profession and applicable law.19. "Department" means the Rhode Island Department of Health.20. "Digital scan" means a virtual computer generated replica of the hard and soft tissue of the mouth using lasers or other optical scanning devices.21. "Director" means the Director of the Rhode Island Department of Health.22. "Enteral" means any technique of administration in which the agent is absorbed through the gastrointestinal tract.23. "General anesthesia" means a drug-induced loss of consciousness during which patients are not arousable, even by painful stimulation. The ability to independently maintain ventilatory function is often impaired. Patients often require assistance in maintaining a patent airway, and positive pressure ventilation may be required because of depressed spontaneous ventilation or drug-induced depression of neuromuscular function. Cardiovascular function may be impaired.24. "Homebound" means an individual confined to his or her home if the individual has a condition, due to illness or injury, that restricts the ability of the individual to leave his or her home except with the assistance of another individual or the aid of a supportive device or if an individual has a condition such that leaving his or her home is medically contraindicated. While an individual does not have to be bedridden to be considered "confined to his home", the condition of the individual should be such that there exists a normal inability to leave home and that leaving home requires a considerable and taxing effort by the individual and/or others.25. "Immediately available" means on site in the facility and available for immediate use.26. "Impression" means an imprint or negative likeness of teeth and/or other tissues of the oral cavity from which a positive reproduction may be made.27. "Infection control" refers to policies and procedures used to minimize the risk of spreading infections, within the dental healthcare setting. Compliance is based on conformance with current recommendations developed by the Centers for Disease Control and Prevention (CDC) and published in the document entitled "Guidelines for Infection Control in Dental Health-Care Settings" and incorporated in this Part.28. "Inhalation" means a technique of administration in which a gaseous or volatile agent is introduced into the lungs and whose primary effect is due to the absorption through the gas/blood interface.29. "License", as used in this Part, is not synonymous with "registration."30. "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.31. "Minimal sedation" means a state of sedation in which the patient is at a minimally depressed level of consciousness. This state is produced through a pharmacological dosage less than or equal to the U.S. FDA maximum recommended dose along with nitrous oxide. Characteristics of minimal sedation include: a. Patient retains the ability to independently and continuously maintain an airway and respond normally to tactile stimulation and verbal command;b. Although cognitive function and coordination may be modestly impaired, ventilatory and cardiovascular functions are unaffected;c. Patients whose only response is reflex withdrawal from repeated painful stimuli would not be considered to be in a state of minimal sedation;d. If more than one enteral drug is administered to achieve the desired effect, with or without the concomitant use of nitrous oxide, the guidelines for moderate sedation must apply.32. "Mobile dental facility" or "MDF" means any self-contained facility where dentistry will be practiced which may be driven, moved, towed, or transported from one location to another. See definition of Portable Dental Operation in § 2.3(A)(39) of this Part.33. "Mobile dental facility (MDF) director" or "Portable dental operation (PDO) director" means a dentist who is currently licensed to practice dentistry in the State of Rhode Island or a public health dental hygienist practicing pursuant to R.I. Gen. Laws § 5-31.1-39 for the purposes of providing dental hygiene services in public health settings who is responsible for dental services provided by the MDF or PDO.34. "Mobile dental facility (MDF) permit holder" or "portable dental operation (PDO) permit holder" means a dentist who is currently licensed to practice dentistry in the State of Rhode Island or a public health dental hygienist in whose name the MDF and/or PDO Facility Permit is issued. Where the MDF or PDO is not wholly owned by a dentist(s) or public health dental hygienist licensed to practice in the State of Rhode Island, the owner(s) shall apply for a license to operate as a healthcare facility unless the entity is exempt from such licensure.35. "Moderate sedation" means a drug-induced depression of consciousness during which patients respond purposefully to verbal commands, either alone or accompanied by light tactile stimulation. No interventions are required to maintain a patent airway, and spontaneous ventilation is adequate. Cardiovascular function is usually maintained.36. "Nitrous oxide sedation" means the administration of nitrous oxide to diminish or eliminate the sensibility to pain in the conscious patient, designating in particular the relief of pain without loss of consciousness. However, consciousness may be moderately impaired.37. "Operating dentist" means the dentist with primary responsibility for providing dental care.38. "Parenteral" means a technique of administration in which the drug bypasses the gastrointestinal (GI) tract [i.e., intramuscular (IM), intravenous (IV), intranasal (IN), submucosal (SC), intraosseous (IO)].39. "Portable dental operation" or "PDO" means any non-facility where dental equipment utilized in the practice of dentistry is transported to and utilized on a temporary basis at an out-of-office location. See related definitions under Mobile Dental Facility (MDF).40. "Public health dental hygienist" or "PHDH" means a registered dental hygienist who holds a valid license to practice in the State of Rhode Island and who has a minimum of three (3) years of full-time or an equivalent four thousand five hundred (4500) hours of clinical experience and who has the fulfilled the necessary training requirements and who works in a public health setting pursuant to a written collaborative agreement with a local or state government agency or institution or a dentist who holds a valid license issued in the State of Rhode Island pursuant to this Part.41. "Public health setting" includes, but is not limited to, residences of the homebound, schools, Head Start programs, nursing homes and long-term care facilities, licensed clinics, community health centers, hospitals, medical facilities, prisons, residential treatment facilities, federal, state or local public health programs, mobile dental facilities and portable dental programs.42. "Qualified dentist" means a dentist providing sedation and anesthesia in compliance with this Part.43. "Qualified provider" means a licensed healthcare provider providing sedation and anesthesia services at a specific dental facility site holding the necessary Facility Host Permit pursuant to § 2.11.4(E) of this Part, in compliance with applicable rules and regulations for their profession.44. "Supervision" includes four (4) types of supervision for all dental auxiliary personnel as follows: a. "Direct supervision" means the dentist is in the dental office, personally diagnoses the condition to be treated, personally authorizes the procedure(s)/duty(ies), remains in the dental office while the procedure(s)/duty(ies) are being performed and examines the patient before his/her dismissal.b. "General supervision" means the dentist has authorized the procedure/duty and such is being carried out in accordance with his/her diagnosis and treatment plan. The dentist does not have to be physically present in the dental office when such treatment is being performed under general supervision.c. "Indirect supervision" means the dentist is in the dental office, personally diagnoses the condition to be treated, personally authorizes the procedure(s)/duty(ies), and remains in the dental office while the procedure(s)/duty(ies) is being performed by the dental auxiliary.d. "Direct visual supervision" means supervision by an oral and maxillofacial surgeon (with a permit to administer deep sedation and general anesthesia) by verbal command and under direct line of sight.45. "Time-oriented anesthesia record" means documentation at appropriate time intervals of drugs, doses and physiologic data obtained during patient monitoring.46. "Titration" means administration of incremental doses of an intravenous or inhalation drug until a desired effect is reached.47. "Transdermal" means a route of administration whereby the active pharmacological ingredients are transmitted across the skin.48. "Unprofessional conduct" shall include, but not be limited to, the provisions of R.I. Gen. Laws § 5-31.1-10, and is further defined as failure to conform to the Category IC recommendations of the Centers of Disease Control Guidelines for Infection Control in Dental Health-Care Settings incorporated by reference at § 2.2(A) of this Part, or its amendments.49. "Written collaborative agreement" or "WCA" means a written agreement that complies with R.I. Gen. Laws § 5 - 31.1-39(c). Written Collaborative Agreement (WCA) with a Public Health Dental Hygienist is between a public health dental hygienist and a local or state government agency or institution or with a licensed dentist who holds a valid Rhode Island license and who agrees to provide the appropriate level of communication and consultation with the public health dental hygienist to ensure patient health and safety.216 R.I. Code R. § 216-RICR-40-05-2.3
Amended effective 4/4/2019