Dear Ms. Reen and Members of the Virginia Board of Dentistry:

I write to you on behalf of the American Association of Orthodontists (AAO) in response to the Notice of Intended Regulatory Action (NOIRA) published in the Virginia Register on March 1, 2021 to take regulatory action regarding infection control for dental assistants I. We appreciate the opportunity to submit public comment at this time.

The AAO is the nation’s largest dental specialty organization and represents more than 19,000 orthodontists in the United States and abroad.  We have 396 members who are residents of, or licensed to practice dentistry in, the Commonwealth of Virginia. 

Currently, the Virginia Board of Dentistry’s (“Board”) Guidance Document 60-15 (updated December 15^th, 2018) titled, “Standards for Professional Conduct in The Practice of Dentistry,” indicates that it is the practitioner’s responsibility to, “Follow the applicable CDC infection control guidelines and recommendations. See https://www.cdc.gov/oralhealth/infectioncontrol/index.html.”

Furthermore, the Centers for Disease Control and Prevention (CDC) states that:

“Education on the basic principles and practices for preventing the spread of infections should be provided to all dental health care personnel (DHCP). DHCP include dentists, dental hygienists, dental assistants, dental laboratory technicians (in-office and commercial), students and trainees, contractual personnel, and other persons not directly involved in patient care but potentially exposed to infectious agents (e.g., administrative, clerical, housekeeping, maintenance, or volunteer personnel). Training should include both DHCP safety (e.g., Occupational Safety and Health Administration bloodborne pathogen and patient safety, emphasizing job- or task-specific needs.”

See, “Education and Training.” Centers for Disease Control and Prevention: Oral Health, https://www.cdc.gov/oralhealth/infectioncontrol/faqs/education-training.html

If the Board’s current Guidance is to follow the CDC guidelines, the AAO believes that necessary regulations should defer to the CDC or replicate CDC guidelines. The CDC also offers “Key Recommendations for Education and Training in Dental Settings”. Those recommends are as follows:

1.Provide job- or task-specific infection prevention education and training to all DHCP.

2. Provide training on principles of both DHCP safety and patient safety.

3. Provide training during orientation and at regular intervals (e.g., annually).

4. Maintain training records according to state and federal requirements.

See,” Administrative Measures and Infection Prevention Education Training.” Centers for Disease Control and Prevention: Oral Health, https://www.cdc.gov/oralhealth/infectioncontrol/summary-infection-prevention-practices/administrative-measures.html

The CDC guidance supports the notion of job-or task- specific education that can be done annually. Therefore, we feel that any infection control education and training required for dental assistants I should not create unnecessary burdens for dental offices given the limited scope of practice of a dental assistant I and the existing annual required Occupational Safety and Health Administration (OSHA) training. Requiring additional training would seemingly only be beneficial if the training includes some specific element related to the tasks of a dental assistant I that are not covered by OSHA training and CDC guidelines. Due to the limited scope of a dental assistant I, there does not seem to be any other task-specific infection control training that is not covered in guidance and training modules offered by OSHA or the CDC.

In summary, any DHCP in Virginia is already required to follow CDC and OSHA requirements, that additional regulation on infection control education and training required for dental assistants I should not create unnecessary burdens for dental offices given the limited scope of practice of a dental assistant I and the existing annual required OSHA training. Thus, the AAO advises against creating this additional regulation.

Thank you in advance for your consideration of these comments. Please do not hesitate to contact the AAO if we can be of any further assistance to the Board in its consideration of these issues.

Sincerely,

Trey Lawrence

Vice President, Advocacy and General Counsel

American Association of Orthodontists