Thank you for the opportunity to comment on proposed amendments to be implemented for regulations governing the practice of dentistry, dental hygiene, and dental assistants, as identified during the 2022 periodic review of Chapters 21, 25, and 30. We appreciate the Board’s efforts to delete outdated, redundant, or duplicative provisions and clarify others consistent with current practice.

In reviewing the proposal, we strongly support the proposed deletion of the requirement that dental hygienists consent in writing to providing services under general supervision. As the Board correctly points out in the Background Document, “That provision is more akin to an employment document

maintained by a practice and is not necessary to protect the public health, safety, and welfare.” We could not agree more and thank the Board for including this proposed change.

Likewise, we applaud efforts by the Board to remove gender-specific language in the regulations through the use of non-gendered language (e.g., specific terms such as “hygienist,” “dentist,” or “provider”) when possible. This is a welcome change, and we appreciate your including it.

In the context of removing redundant language in 18 VAC-60-21-120(E) and 18 VAC-60-25-60 (C), VDHA encourages the Board to adopt the following:

E. Duties that are delegated to a dental hygienist under general supervision shall only be performed if the following requirements are met:

1. The treatment to be provided shall be ordered by a dentist licensed in Virginia and shall be entered in writing in the record. The services noted on the original order shall be rendered within a specific time period, not to exceed 10 months from the date the dentist last performed a periodic examination of the patient. Upon expiration of the order, the dentist shall have examined the patient before writing a new order for treatment under general supervision.

2. The dental hygienist shall consent in writing to providing services under general supervision.

3. The patient or a responsible adult shall be informed prior to the appointment that a dentist may not be present, that only topical oral anesthetics can be administered to manage pain, and that only those services prescribed by the dentist will be provided.

4. Written basic emergency procedures shall be established and in place, and the hygienist shall be capable of implementing those procedures.

Requiring hygienists to inform patients of the dentist’s absence for a visit of ordered services is unnecessary. Patients generally expect to receive dental hygiene services unless they have scheduled specifically with the dentist, and as such, this eliminates a redundant requirement.

We recognize that the intent of this regulatory action is to identify and amend provisions that are outdated, redundant, or duplicative and to provide clarification where needed so that regulation is consistent with current practice rather than making significant policy changes. With that stated, we would be remiss if we did not identify two areas for consideration, perhaps in future regulatory actions if their inclusion in the current action would go beyond its scope.

We strongly support the removing the limitation of 4 RDH/DAII’s employed by a dentist as well as removal of the 10-month exam requirement for patients under general supervision. These limits and requirements should be determined by the structure and protocols of the individual practice as well as the needs and types of patients being served.

Thank you for the opportunity to provide these comments. Please do not hesitate to contact VDHA if you have any questions.