dentin™ | FLORIDA DENTAL LAWS & RULES EXAM
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dentin™ | FLORIDA DENTAL LAWS & RULES EXAM
TABLE OF CONTENTS EXAM STEPS & DESCRIPTION .................................................................................................. 4 DELEGATED TASKS & SUPERVISION FOR AUXILLARIES Irremediable Tasks........................................................................................................................ 4 Remediable Tasks ........................................................................................................................ 4 Direct Supervision ......................................................................................................................... 5 Indirect Supervision ...................................................................................................................... 5 General Supervision ...................................................................................................................... 5 Remediable Supervision Chart ..................................................................................................... 6 Emergency Treatment On Patients of Record .............................................................................. 8 Hygiene Prescription & Health Access Setting ............................................................................. 9 ANESTHESIA, CONSCIOUS SEDATION, N2O ........................................................................ 10 General Anesthesia ..................................................................................................................... 12 Deep Sedation ............................................................................................................................ 14 Conscious Sedation & Pediatric Conscious Sedation ................................................................ 15 Nitrous Oxide Analgesia ............................................................................................................. 17 Local Anesthesia......................................................................................................................... 18 Analgesia & Minimal Sedation (Anxiolysis) ................................................................................. 19 Adverse Occurrence ................................................................................................................... 19 CONTINUING EDUCATION ...................................................................................................... 20 Biennium Requirements.............................................................................................................. 20 Proof of CE ................................................................................................................................. 20 Standard for Approved Providers ............................................................................................... 22 Licenses & Renewal Requirements ............................................................................................ 23 CE Approved Subject Matter ...................................................................................................... 23 Licensee Exempt from CE .......................................................................................................... 25 CHAPTER 466 (DENTAL PRACTICE ACT) .............................................................................. 25 ADVERTISING ............................................................................................................................ 29 NOTIFYING THE BOARD OF DENTISTRY (BOD) ................................................................... 32
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dentin™ | FLORIDA DENTAL LAWS & RULES EXAM
DENTAL LABORATORY............................................................................................................ 34 STERILIZATION, DISINFECTION, HEPATITIS B ..................................................................... 35 PERMITS & PHARMACY PRESCRIPTIONS ............................................................................ 38 Teaching Permits ........................................................................................................................ 38 Dispensing Controlled Substances & Dispensing Practitioner ................................................... 39 Limited License ........................................................................................................................... 40 Expert Witness ............................................................................................................................ 41 OWNERSHIP OF RECORDS, DENTIST OF RECORD, LICENSE DISPLAY ........................... 42 Split Fee Arrangements .............................................................................................................. 43 Display of Licenses ..................................................................................................................... 43 Malpractice & Electronic Records .............................................................................................. 44 Removing Amalgams .................................................................................................................. 44 BOARD DISCIPLINARY ACTIONS ON LICENSEE .................................................................. 44 no lo contendre, Terms of Fraud, Misdemeanor, & Felony ........................................................ 44 Peer Review & Probable Cause Panel (PCP) .............................................................................. 45 Minor Violations .......................................................................................................................... 46 Grounds for Licensee Denial & Disciplinary Action .................................................................... 46 First Degree Misdemeanors & Third Degree Felonies ................................................................ 48 Aggravating or Mitigating Circumstances .................................................................................. 49 64B5 BOD Disciplinary Guidelines Matrix .................................................................................. 50 Important Test Pearls ................................................................................................................. 61
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dentin™ | FLORIDA DENTAL LAWS & RULES EXAM
FLORIDA DENTAL LAWS & RULES EXAM Steps To Take Exam: Apply to the Florida Board of Dentistry office with all the required documentation and pay the application fee to the Department, then wait to be approved via written notification of eligibility from the Board Office BEFORE scheduling the Laws/Rules Exam at your local computer Testing Center. 90 Minutes for 64 multiple-choice questions: Need 75% to pass and you get the “unofficial” printed results at the end of the computer-based exam at the testing center which covers: Florida Dental Practice Acts Sections 466 & 456 & Florida Dental Board Rules Chapter 64B5, FL Admin Code. Around 40% of the questions are on Supervision/Delegated Tasks to Auxillaries. THE INFORMATION IN THIS BOOK IS EVERYTHING YOU NEED TO EASILY PASS THE FLORIDA LAWS & RULES EXAMINATION.
DELEGATED TASKS & SUPERVISION FOR AUXILLARIES The number of full-time hygienists or assistants a dentist can employ depends on however many the Board of Dentistry limits him/her to, but NO SPECIFIC NUMBER IS STATED IN THE LAW. There is NO LIMIT of hygienists by the Board in the Department of Children and Family Services, and the Board CANNOT limit the number of auxillaries in State or Federal institutions.
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BOARD can limit BOTH the number of hygienists or assistants (auxillaries) depending on if they perform expanded duties/functions requiring direct or indirect supervision (not based on formal or informal training). BOD CANNOT limit the number of dentists in a multi-dentist office.
IRREMEDIABLE TASKS –only performed by the dentist (ex: anesthesia other than topical anesthesia). Intra-oral tasks that are IRREVERSIBLE & CREATE UNALTERABLE CHANGES in the oral cavity or contiguous structures, or cause increased patient risk. Ex: anesthetic by jet spray or by aerosol CANNOT be delegated to an assistant or hygienist. IRREMEDIABLE TASK can only be delegated WHEN ALLOWED BY LAW. REMEDIABLE TASKS- intra-oral tasks that ARE REVERSIBLE and DO NOT CREATE UNALTERABLE CHANGES in the oral cavity or contiguous structures, nor cause increased patient risk (ex: fluoride treatment). Ex: Placing or removing periodontal or surgical dressings is a remediable emergency
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dentin™ | FLORIDA DENTAL LAWS & RULES EXAM
task. A dentist may delegate remediable tasks that pose no patient risk and are defined by law to a dental hygienist or assistant. •
Remediable task -is reversible and is AKA “expanded function” or “expanded duty”.
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Rule 64B5-16 describes remediable tasks delegable to hygienists/assistants.
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IMPORTANT: Many assistant tasks require a supervision level a higher than hygienists.
FORMAL TRAINING for expanded duties for assisting or hygiene requires DENTAL ASSISTING OR HYGIENE NATIONAL BOARDS and credentials. A course sponsored by the Board at a Department recognized school, or ADA-recognized course is NOT ACCEPATABLE. Before taking an expanded duties course, a dental assistant does NOT need 6-months of OJT, but 3 months of OJT under direct supervision of the dentist followed by certified dental assisting course. DIRECT SUPERVISION-supervision where a dentist diagnosis the condition/case to be treated, authorizes the procedure/work/treatment to be performed, remains on premises while the procedures are performed, and APPROVES THE COMPLETED TREATMENT PERFORMED BEFORE patient dismissal. Direct supervision DOES NOT involve writing work authorizations (prescriptions) to a commercial laboratory. INDIRECT SUPERVISION-supervision where a dentist examines, diagnosis the condition to be treated, authorizes the procedure/treatment to be performed, REMAINS ON PREMISES while procedures are performed, but DOES NOT NEED TO APPROVE treatment at completion. Ex: dental assistant retracting lips, cheek, and tongue under indirect supervision. Major difference between direct and indirect supervision, is the dentist does not need to approve treatment at completion with indirect supervision, but must approve treatment with direct supervision. GENERAL SUPERVISION-dentist diagnosis condition to be treated, authorizes procedure/treatment, BUT DOES NOT NEED BE ON PREMISES WHEN THE AUTHORIZED PROCEDURE IS PERFORMED and does not need to approve work at completion. The authorized procedure may also be performed at a place other than the dentist’s usual place of practice. Ex: a dental intern or residency program hygienist or dentist will work under the GENERAL supervision of at least one licensed dentist. •
Authorized procedures under General Supervision may also be performed at a place other than the dentist’s usual place of practice. Ex: A hygienist working in the Public Health Department or Juvenile Justice Department works under GENERAL supervision.
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dentin™ | FLORIDA DENTAL LAWS & RULES EXAM
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An INTERN serving in a non-profit corporation/organization/institution works WITHOUT FEE OR COMPENSATION except for earning a SALARY and under general supervision.
REMEDIABLE TASK (REVERSIBLE) RULE 64B5-16 Fabricating temporary crowns and bridges with no occlusal adjustment to crown/bridge or dentition and (cementing with temporary cement) ER Task • Hygienists can cement crown/bridges with temp cement with F/IND Packing/removing retraction cord without EPI or vasoconstrictor Removing or re-cementing properly contoured loose ortho bands NOT permanently attached to any appliance. ER Task Selecting/pre-sizing ortho bands, archwires, and “prescribed” extra-oral ortho appliances by preselection or premeasure. NOT FINAL ADJUSTMENTS. Preparing tooth surfaces for ortho appliances (NOT FOR BRACKETS) by conditioning or placing etch and sealant. Inserting or removing dressings from alveolar sockets in diagnosed post-op osteitis (dry socket) when patient is uncomfortable due to lost dressing. ER Task Securing/unsecuring archwire by attaching or removing fastening device. ER Task Changing internal bleaching pellets of non-vital teeth after rubber dam is placed. (Cannot make initial access preparations) Fabricating temp crown/bridge IN LAB Taking impressions for study casts, passive appliances, ortho retainers, athletic and occlusal guards, space maintainers, take home bleaching trays + delivery, and fluoride, surgical stents for palatal coverage. NO IMPRESSIONS FOR INTRA-ORAL APPLIANCES OR RESTORATIONS. *Hygienists need F/D for ortho retainers Monitoring, adjusting, turning off , NOT inducing or establishing maintenance N2O Removing excess ortho cement on orthodontic appliances & bonding adhesive • Assistants (non-mechanical hand only) • Hygienists (slow-speed, hand, ultrasonics) Removing excess cement on restorations or appliances & place/remove temporary restorations. • Assistants (non-mechanical hand only) • Hygienists (non-mechanical hand or ultrasonic scalers) Preliminary charting existing restorations, missing teeth, visual assessments of existing oral conditions. • *Hygienists can also chart “suspected findings” Polishing restorations and clinical crowns on teeth without changing/altering existing contour with burnishers, slow-speed, rubber cup, bristle brush. NOT HIGH SPEED FLAME BURS. • Assistants cannot user air abrasive polisher • Hygienist can use air abrasive and porte polishers Applying sealants, cavity liners, bases, varnishes, topical fluoride by ADA or FDA • Hygienists place cavity liners, bases, and varnishes with F/IND • *Hygienists place sealants, topical & fluoride varnishes with F/GEN
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Assistant F/D
Hygienist F/D
F/D F/D
F/D F/D
F/D
F/D
F/D
F/D
F/D
F/D
F/IND
F/IND
OJT/D
OJT/D
OJT/GEN
OJT/GEN
F/D
F/IND
F/D
F/IND
OJT/IND
BVL/IND
F/D
F/GEN
F/D
F/GEN
F/D
F/GEN
F/IND
F/IND
dentin™ | FLORIDA DENTAL LAWS & RULES EXAM
HYGIENISTS: if took HIV/AIDS or domestic violence course in the immediately preceeding biennium, a hygienist may take a course in end-of-life care and palliative healthcare as a substitute, or skip these courses every other biennium. Licensees Exempt from CE: new licensees during the first biennium of initial licensure, enrolled FT in post-grad specialty or residency program ADA accredited or FT faculty member at dental school ADA accredited, licensees in the Armed Forces and is not in private practice in Florida, and spouses of Armed Forces members who because of spouses duty, was out of Florida for 6 consecutive months.
CHAPTER 466 DENTAL PRACTICE ACT Legislative Branch purpose for enacting Chapter 466 is to ensure every dentist or hygienist practicing in Florida meets minimum requirements for SAFE practice to PROTECT THE PUBLIC and that dental services are provided only IAW the provision of the statutes and rules and are not delegated to unauthorized individuals. •
Chapter 466.001 Florida Statute chapter explains that dentists and hygienist who fall below minimum competency or who otherwise present danger to the public shall be prohibited from practicing in Florida. Chapter 466 Florida Statutes is the LAW that governs dentistry for the Department of Health. AKA: Dental Practice Act, Safe Practice Act.
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Purpose of Chapter 466 is to PROTECT THE GENERAL PUBLIC and ensure all dentists and auxiliaries meet minimum requirements for safe practice.
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Violations of Chapter 466 or Rules 64B-5 are reported to the DEPARTMENT OF HEALTH (not FDA, Governor, Senate, Board of Dentistry, or PCP).
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People EXEMPT from Chapter 466: (PAACSI) = physicians, anesthetists (giving anesthetic for a dental operation), Armed Forces (graduate dentists in US military, public health, VA), outof-state clinicians at a meeting, FULL-TIME dental/hygiene students and instructors (ex: instructors practicing or teaching dentistry at a dental, hygiene, or assisting school). PART TIME dental post-graduate student teaching research in a Public Health Service or in a school IS NOT EXEMPT.
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dentin™ | FLORIDA DENTAL LAWS & RULES EXAM
BOARD OF DENTISTRY: solely responsible for protecting the public from dentists or hygienist who present a danger to the public. NOT the FDA or Department of Health.
ADLEX: An applicant who fails the FLORIDA BOARDS (ADEX) in 3 attempts is required to take additional educational requirements that the BOD designates. American Dental Licensing Exam (ADLEX) does not have to be taken in Florida. An applicant only has to have passed the NBDE I & NBDE II (it no longer has to be within 10 years of applying to take ADLEX). If an applicant does not pass the ADEX Florida Boards in 3 attempts, he is required before another attempt to take a one (1) year boardapproved educational program. Within 12 months (1 year) the applicant who passed the ADLEX outside of Florida must engage in the FT practice of dentistry within Florida for a minimum of 1,200 hours in the first year after receiving Florida licensure. •
By Florida accepting the ADLEX taken in other states does NOT mean reciprocity exists between Florida and those states.
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Any individual found to engage in conduct that subverts or attempts to subvert the examination process may be ejected from the exam site, have scores on the exam withheld or declared invalid, or may be disqualified from the practice of dentistry. A dentist must take ALL parts of the ADEX within an eighteen (18) month period to qualify for licensure. Failure to complete all parts within 18 months requires retaking the entire exam. Need at least 75% on each part of the ADLEX to pass graded by Florida licensed dentist if taken in the Florida.
Dental Assistant Radiography Training: when an assistant completes a BOARD APPROVED dental radiography class, the certificate must be displayed in a CONSPICUOUS PLACE in the dental office and keep a copy on file with the dentist. Dental assistants may position/expose dental radiographs ONLY if certified by the Department as dental radiographers OR graduated from a Board-approved dental assisting school or program. To obtain radiography certification, an assistant can complete at least 3 months of continuous OJT under DIRECT SUPERVISION of a Florida licensed dentist AND successfully complete a Board-approved course within 12 months AFTER the OJT. Practice Management Services CANNOT attempt to govern the delivery of care to patients nor advise a dentist as to how to perform dentistry or what treatment to offer patients. A dentist can enter into an agreement with a non-dentist for Practice Management services for advice on marketing, office design/layout, staff needs, finances and bookkeeping as long as the dentist controls the scope of patient services, clinical personnel, methods of payment. Only a dentist can exercise
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dentin™ | FLORIDA DENTAL LAWS & RULES EXAM
HEPATITIS “B” SERO-POSITIVE (+) means the person IS INFECTED with HEPATITIS B VIRUS SURFACE ANTIGEN & HEPB-e antigen. If a Florida dentist is infected with HEPATITIS B, the BOARD must be notified within FOURTEEN (14) days in writing after learning of the HEP B infection with the licensees HPSAG test results. A licensee or applicant who is a HEPATITIS B CARRIER must NOTIFY BOARD OF DENTISTRY (BOD). If a dentist infected with HEPATITIS B has an infection control barrier breakage during a dental procedure, patient must be notified immediately, dentist must CALL Board’s Executive Director and local county health department within 24 hours, and WRITE Board’s Executive Director and local county health department within 72 hours.
DOES NOT need to notify Department of Health
(Department) or its Director. Monitoring a dentist office infected with HEPATITIS B includes: reviewing dentist’s appointment book, checking number/types of gloves and masks on hand, and ensuring if heat sterilization is used, type of cold disinfectant, and list of instruments and materials routinely cold sterilized, and is being monitored monthly. Monitoring DOES NOT include checking proper handpiece disinfection or type of handpiece used or patient reminder phone calls. HEPATITIS MONITOR who visits an infected licensee’s office checks for the number and types of exam/surgical GLOVES & MASKS ON HAND. HEPATITIS B INSPECTION FAILURE: A dentist infected with Hepatitis B is MONITORED RANDOMLY at least once per year for first (3) years, then at least TRIANNUALLY afterwards. •
Upon notice that a licensee infected with Hepatitis B has not complied with the criteria to maintain a license, Board’s Executive Director shall request an emergency Probable Cause Panel meeting to determine if the Secretary of the Department should be requested to institute an emergency suspension of the licensee infected with Hepatitis B.
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Reasons for an emergency suspension of dentist infected with Hepatitis B includes: a monitor’s report that the infected licensee failed to report any break in barrier technique or the infected licensee failed to follow appropriate sterilization, disinfection, and barrier techniques in a manner that adequately protects the public; failure of the infected licensee to successfully complete the Board approved educational program; a confirmed report that the infected licensee failed to report a break in barrier technique as required.
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dentin™ | FLORIDA DENTAL LAWS & RULES EXAM
64B5 DISCIPLINARY GUIDELINES ISSUED BY BOD VIOLATION Attempting to obtain or renew license by bribery, fraud or Board errors 1st Offense 2nd Offense
MIN PENALTY
Denial + $500.00 fine + referral to State Attorney if not licensed Probation w/conditions + $500.00 fine
VIOLATION Having license revoked, suspended or acted against (including denial) by in another state, territory, country 1st Offense
$1000.00 fine
2nd Offense
Probation + $1000.00 fine
3rd Offense
1 year suspension, probation + $5000.00 fine
VIOLATION Guilty of a crime directly related to practice or ability to practice 1st Offense 2nd Offense 3rd Offense
VIOLATION Advertising, practicing or attempting to practice under someone else’s name 1st Offense 2nd Offense 3rd Offense
MIN PENALTY
MIN PENALTY
$1,000 fine 1 year suspension, probation + $1,0000 fine Revocation + $2500 fine
MIN PENALTY
$1,000 fine Probation + $3,000 fine Probation + $5,000 fine
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MAX PENALTY
Denial/revocation $10,000 fine + referral to State Attorney if not licensed Revocation + $10,000 fine, denial + revocation MAX PENALTY
Suspension/denial until license is active in the jurisdiction where the action was taken or up to 5 years probation + $10,000 fine or revocation. Revocation until license is unencumbered in the jurisdiction where the action was taken + $10,000 fine Revocation and permanent denial + $10,000 fine MAX PENALTY
Denial or 2 year suspension, 2 years probation + $10,000 fine or revocation Denial or revocation + $10,000 fine with conditions Revocation + $10,000 fine
MAX PENALTY
1 year suspension + $10,000 fine Denial or revocation + $10,000 fine Revocation + $10,000 fine
dentin™ | FLORIDA DENTAL LAWS & RULES EXAM
VIOLATION Failing to report a person violating Board or Department rules 1st Offense 2nd Offense 3rd Offense VIOLATION Aiding, assisting, procuring, advising any unlicensed person to practice dentistry or hygiene 1st Offense 2nd Offense 3rd Offense
VIOLATION Being employed by any corporation, organization, person other than a dentist or PC or LLC composed of licensed dentists 1st Offense 2nd Offense 3rd Offense VIOLATION Failing to perform any statuatory or legal obligation placed upon a licensee 1st Offense 2nd Offense 3rd Offense VIOLATION Making/filing a false report, failing to file a report/record required by state/federal law or knowingly impeding or obstructing such filing 1st Offense 2nd Offense
MIN PENALTY
MAX PENALTY
$500.00 fine
1 year probation, + $1,000 fine
1 year probation + $1,000 fine 1 year probation + $3,000 fine
6 month suspension, 1 year probation + $3,000 fine 1 year suspension, 1 year probation + $5,000 fine
MIN PENALTY
$1000 fine 1 year suspension, 2 years probation + $5000 fine 2 year suspension then 2 years probation + $10,000 fine MIN PENALTY
$1,000 fine 1 year probation, reprimand, + $3000 fine 1 year suspension, reprimand, + $5000 fine MIN PENALTY
MAX PENALTY
6 month suspension, 1 year probation + $10,000 fine 2 year suspension, 2 years probation + $10,000 fine Denial/revocation + $10,000 fine
MAX PENALTY
2 years probation up to suspension + $10,000 fine Suspension, 1 year probation + $10,000 fine Revocation + $10,000 fine MAX PENALTY
$500.00 fine 1 year probation + $1,000 fine 2 years probation + $2,000 fine MIN PENALTY
2 years probation + $10,000 fine 2 years probation + $10,000 fine
$1,000 fine
1 year probation, up to suspension + $10,000 fine Suspension, probation + $10,000 fine
1 year probation + $2,500 fine
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1 year suspension + $10,000 fine MAX PENALTY