Maryland Health Occupations Section 4-308

      (a)      A general license to practice dentistry issued under this title authorizes the licensee to practice dentistry while the license is effective.

      (b)      While it is effective, a limited license to practice dentistry issued under this title authorizes the licensee to practice dentistry, including as an intern or a resident:

            (1)      Only for the institution or public health program named on the license; and

            (2)      Only on patients of the institution or public health program named on the license.

      (c)      While it is effective, a retired volunteer dentist's license or a volunteer dentist's license to practice dentistry issued under this title authorizes the licensee to practice dentistry:

            (1)      Only in a dental office, dental clinic, ambulatory care facility, or hospital;

            (2)      Only for an entity providing medical care to the poor, elderly, or handicapped that is operated by:

                  (i)      The State or a local government;

                  (ii)      A bona fide charitable organization; or

                  (iii)      Any other entity authorized under regulations adopted by the Board;

            (3)      If the dentist signs a written statement agreeing to donate at least 100 hours of dental services without compensation in a facility that satisfies the requirements of subsection (d)(1) and (2) of this section;

            (4)      If the dentist provides documentation as required by the Board which evidences that the licensee is covered by malpractice insurance; and

            (5)      If the dentist does not otherwise practice dentistry for profit in Maryland.

      (d)      While it is effective, a teacher's license to practice dentistry issued under this title authorizes the licensee to practice dentistry at only the following institutions:

            (1)      The institution named on the license; and

            (2)      Other affiliated institutions as appropriate because of the specialized nature of the services to be performed.

      (e)      (1)      While it is effective, a general license to practice dental hygiene issued under this title authorizes the licensee to practice dental hygiene:

                  (i)      Under the supervision of a licensed dentist who is:

                        1.      On the premises and available for personal consultation while the services are being performed; or

                        2.      Not on the premises while authorized dental hygiene services are provided when the requirements of subsection (i) of this section have been fully satisfied; and

                  (ii)      Only in a:

                        1.      Dental office;

                        2.      Dental clinic;

                        3.      Hospital;

                        4.      School;

                        5.      Charitable institution; or

                        6.      Health maintenance organization certified by the State Insurance Commissioner.

            (2)      The Board may waive, on a case by case basis only, the supervision requirements of this subsection for:

                  (i)      A dental facility owned and operated by the federal, the State, or a local government;

                  (ii)      A health facility licensed by the Department of Health and Mental Hygiene;

                  (iii)      A facility providing medical care to the poor, elderly, or handicapped that is owned and operated by:

                        1.      The State or a local government; or

                        2.      A bona fide charitable organization; or

                  (iv)      Any other setting authorized under regulations adopted by the Board.

            (3)      The Board may grant a waiver under paragraph (2) of this subsection if:

                  (i)      The facility requesting the waiver has submitted a written application;

                  (ii)      The facility requesting the waiver has submitted a medical emergency plan of action at the time of application; and

                  (iii)      The Board finds that:

                        1.      Good cause exists to justify the granting of the waiver;

                        2.      Adequate facilities and equipment, including portable equipment where appropriate and appropriate armamentarium, are available for the appropriate delivery of dental hygiene services; and

                        3.      Adequate safeguards are present to protect the patient's health and safety.

            (4)      (i)      The Board, upon written request or its own motion, may conduct a public informational meeting on any waiver application.

                  (ii)      The Board shall maintain records of all waiver applications and the criteria and basis for its action on each application.

                  (iii)      The Board shall have the power to inspect or review any facility, location, person, or entity applying for, covered by, or acting under a waiver.

            (5)      (i)      Except as provided under subparagraph (ii) of this paragraph, the Board shall accept or deny a waiver under paragraph (2) of this subsection within 60 calendar days of the receipt of the application for the waiver or it shall be deemed to have been accepted.

                  (ii)      If extraordinary circumstances exist, the Board shall accept or deny a waiver under paragraph (2) of this subsection within 90 calendar days of the receipt of the application for the waiver or it shall be deemed to have been accepted.

            (6)      Any changes in the procedures or personnel of a facility with a waiver granted under this subsection shall be reported to the Board within 15 business days after the change.

      (f)      While it is effective, a retired volunteer dental hygienist's license or a volunteer hygienist's license to practice dental hygiene issued under this title authorizes the licensee to practice dental hygiene:

            (1)      Only in a dental office, dental clinic, ambulatory care facility, or hospital;

            (2)      Only for an entity providing medical care to the poor, elderly, or handicapped that is operated by:

                  (i)      The State or a local government;

                  (ii)      A bona fide charitable organization; or

                  (iii)      Any other entity authorized under regulations adopted by the Board;

            (3)      If the dental hygienist signs a written statement agreeing to donate at least 100 hours of dental hygiene services without compensation in a facility that satisfies the requirements of subsection (g)(1) and (2) of this section;

            (4)      If the dental hygienist provides documentation as required by the Board which evidences that the licensee is covered by malpractice insurance; and

            (5)      If the dental hygienist does not otherwise practice dental hygiene for profit in Maryland.

      (g)      While it is effective, a teacher's license to practice dental hygiene issued under this title authorizes the licensee to:

            (1)      Teach dental hygiene only at the institution named on the license; and

            (2)      Practice dental hygiene under the general supervision of a licensed dentist with the institution named on the license.

      (h)      (1)      In this subsection, "general supervision" means supervision of a dental hygienist by a dentist, where the dentist may or may not be present when the dental hygienist performs the dental hygiene procedures.

            (2)      While it is effective, a general license to practice dental hygiene issued under this title authorizes the licensee to practice dental hygiene under the general supervision of a licensed dentist in:

                  (i)      A dental facility owned and operated by the federal, the State, or a local government; or

                  (ii)      A public health department of the State or a county.

            (3)      A facility in which a dental hygienist is authorized to practice under the general supervision of a licensed dentist shall ensure that:

                  (i)      The supervising dentist in the facility:

                        1.      Holds an active general license to practice dentistry in the State;

                        2.      Holds a current certificate evidencing health provider level C proficiency, or its equivalent, in cardiopulmonary resuscitation; and

                        3.      Has at least 2 years of active clinical practice in direct patient care;

                  (ii)      Each dental hygienist authorized to practice under the general supervision of a licensed dentist:

                        1.      Holds an active general license to practice dental hygiene in the State;

                        2.      Holds a current certificate evidencing health provider level C proficiency, or its equivalent, in cardiopulmonary resuscitation; and

                        3.      Has at least 2 years of active clinical practice in direct patient care;

                  (iii)      Before the initial treatment of a patient by a dental hygienist practicing under the general supervision of a licensed dentist, the supervising dentist, the patient's dentist, or the treating physician evaluates the patient's medical history and determines its impact on the patient's suitability to receive oral health treatment;

                  (iv)      The supervising dentist diagnoses the patient and approves the treatment plan for the patient;

                  (v)      The supervising dentist authorizes, on a patient by patient basis, a dental hygienist to practice under the general supervision of a licensed dentist;

                  (vi)      A dental hygienist practicing under the general supervision of a licensed dentist ascertains before treating a recall patient that there has been no change in the patient's medical history;

                  (vii)      A dental hygienist consults with the supervising dentist, the patient's dentist, or a treating physician before proceeding with treatment if there is a change in the patient's medical history;

                  (viii)      The facility has a medical emergency plan;

                  (ix)      Adequate facilities and equipment are available for the delivery of dental hygiene services other than fluoride rinse programs; and

                  (x)      A recall patient who has been examined by a dental hygienist practicing under the general supervision of a licensed dentist will be scheduled for an oral examination every 6 months, or as otherwise recommended by the supervising dentist.

            (4)      Before a facility operates under general supervision, the facility shall report to the Board:

                  (i)      That the facility is operating under general supervision; and

                  (ii)      The identity of each supervising dentist and each dental hygienist.

            (5)      A facility operating under general supervision shall report to the Board any changes in the status of the facility's general supervision, any supervising dentist, or any dental hygienist within 30 days after the change.

            (6)      This subsection may not be construed to:

                  (i)      Authorize a dental hygienist to practice dental hygiene independent of a supervising dentist; or

                  (ii)      Prohibit a dentist from being available for personal consultation or on the premises where a dental hygienist is practicing.

      (i)      (1)      In this subsection, "private dental office" means a dental office owned and operated by:

                  (i)      A licensed dentist; or

                  (ii)      A professional corporation, partnership, limited liability company, or limited liability partnership owned and controlled by a licensed dentist.

            (2)      While it is effective, a general license to practice dental hygiene issued under this title authorizes the licensee to practice dental hygiene under the general supervision of a licensed dentist in a private dental office.

            (3)      A private dental office in which a dental hygienist is authorized to practice under the general supervision of a licensed dentist shall ensure that:

                  (i)      The supervising dentist holds an active license to practice dentistry in this State;

                  (ii)      The dental hygienist holds an active license to practice dental hygiene in this State;

                  (iii)      The dental hygienist has at least 1,500 hours of dental hygiene clinical practice in direct patient care; and

                  (iv)      There is a written agreement between the supervising dentist and the dental hygienist practicing under general supervision that clearly sets forth the terms and conditions under which the dental hygienist may practice, including a statement that the dental hygienist may provide dental hygiene services without the supervising dentist on the premises.

            (4)      A dental hygienist may perform authorized dental hygiene services without the supervising dentist on the premises only if:

                  (i)      After the supervising dentist examines and evaluates a patient, the prescribed and authorized treatment to be provided by the dental hygienist is written in the patient's records;

                  (ii)      1.      Treatments authorized by a supervising dentist to be provided by the dental hygienist are rendered no later than 7 months from the date the patient was examined and evaluated by the supervising dentist; and

                        2.      Upon expiration of a prescription or prescribed treatment, the supervising dentist examines and reevaluates the patient before writing a new prescription and authorization for treatment;

                  (iii)      Prior to an appointment, the patient or the custodial parent or legal guardian of a minor or incompetent adult shall:

                        1.      Be informed that a dental hygienist will be providing services previously prescribed by a dentist who will not be on the premises during the appointment; and

                        2.      Consent to receiving the dental hygiene services;

                  (iv)      Written emergency procedures are in place and the dental hygienist is trained to implement the emergency procedures;

                  (v)      A designated licensed dentist is available for consultation with the dental hygienist; and

                  (vi)      The number of unsupervised clinical hours worked by a supervised dental hygienist in any given calendar week is less than 60 percent of the dental hygienist's total hours.

            (5)      A supervising dentist may not employ more than two dental hygienists to work under the dentist's general supervision at any given time.