Indiana Jurisprudence and Your Dental Staff

As an Indiana dentist/employer, you are ultimately responsible for the behavior and training of your staff. For that reason, it is helpful to understand Indiana jurisprudence as it relates to dental hygienists and dental assistants.

Regulations for Dental Hygienists

Requirements for Hygienist Administration of Local Anesthetic

According to Indiana Code IC 25-13-1-10.6, a licensed dental hygienist may administer local dental anesthetics, not including nitrous oxide, under the direct supervision of a licensed dentist after receiving a dental hygiene anesthetic permit. In order to receive an anesthetic permit, a hygienist must complete a CODA accredited course in administration of local anesthetics and analgesics as well as board approved training in CPR and emergency care. Training will cover pain control concepts, pharmacology, injection preparation fundamentals, clinical administration of local anesthesia, and managing unexpected scenarios and will include didactic courses as well as laboratory experiences. Two key points to keep in mind with this regulation are:

1. Administration of anesthetics must be done under direct supervision of a licensed dentist. Prescriptive supervision may not be used for the administration of anesthetics by a hygienist.
2. The administration of anesthetics does not include nitrous oxide or similar analgesics

Continuing Education Requirements for Dental Hygienists

Beginning March 2, 2016, Indiana licensed dental hygienists must complete at least nineteen (19) hours of continuing education per licensure period which includes:

• at least nine and half (9.5) hours of CE in the form of live presentations or live workshops
• two (2) hours covering Ethics, Professional Responsibility and the Indiana Statutes and Administrative Rules
• not more than five (5) hours of credits that relate specifically to the area of practice management.

Dental hygienists must also complete an approved course in Basic Cardiac Life Support (BLS). No more than 2 CE credits in BLS may be applied toward the continuing education requirements per licensure period. (Upon written request, a waiver of the BLS requirement may be granted for hygienists with medical conditions or disabilities that prevent the hygienist from complying with the training and are documented with a physician’s statement.)

Hygienists are exempt from the CE requirements if:

• They have been licensed for less than two years.
• They are a current graduate student or enrolled in an approved residency program.
• They have been deemed by the Board as being unable to practice dental hygiene due to a disability.

Each renewal period, hygienists must complete a two-hour program that covers ethics, professional responsibility and the Indiana Statutes and Administrative. There is no exception to this rule.

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Regulations for Expanded Duties Dental Assistants

Education Requirements for Fluoride Application

Dental assistants who meet the following requirements may apply medicaments for the control or prevention of dental caries under the direct supervision of a licensed dentist:

• has been employed in a dental practice for a minimum of one (1) year or has graduated from a CODA accredited program
• has received nine(9) hours of didactic instruction which is CODA accredited or approved by the board and covers:
  • Ethics and jurisprudence.
  • Reasons for fluoride.
  • Systemic fluoride.
  • Topical fluoride.
  • Toxicity of fluoride.
  • Fluoride application.
  • Infection control.
• has completed two (2) hours of laboratory work, including a mannequin and two (2) live patients, in topical fluoride applications.
• has demonstrated clinical competency on a minimum of five (5) patients under the direct observation of a licensed Indiana dentist or dental hygienist and an affidavit certifying the competency has been signed by the supervising dentist and a copy given to the employee.
• has publicly displayed the signed affidavit in the dental office.

Education Requirements for Coronal Polishing

Dental assistants who meet the following requirements may polish the coronal surface of teeth under the direct supervision of a licensed dentist:

• has been employed in a dental practice for a minimum of one (1) year or has graduated from a CODA accredited program
• has received five(5) hours of didactic instruction which is CODA accredited or approved by the board and covers
  • Ethics and jurisprudence.
  • Plaque and material alba.
  • Intrinsic and extrinsic stain.
  • Abrasive agents.
  • Use of a slow speed hand piece, prophy cup, and occlusal polishing brush.
  • Theory of selective polishing.
  • Infection control.
• has completed two (2) hours of laboratory work, including a mannequin and two (2) live patients, in the use of a slow speed hand piece, prophy cup, and occlusal polishing brush and hand dexterity.
• has demonstrated clinical competency on a minimum of five (5) patients under the direct observation of a licensed Indiana dentist or dental hygienist and an affidavit certifying the competency has been signed by the supervising dentist and a copy given to the employee.
• has received a certificate of completion from the educational program which is publicly displayed in the dental office.

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It is the responsibility of the employing dentist to verify that the educational requirements for fluoride application and/or coronal polishing have been met and to display the appropriate documentation in the dental office.

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About the Author

Ms Karen Scharf is the Indiana Dental Association Director of Communications. She can be reached at karen@indental.org.