A. The following words and terms when used in this chapter shall have the meanings ascribed to them in § 54.1-2700 of the Code of Virginia:
"Digital scan technician"
"Digital work order"
"Oral and maxillofacial surgeon"
B. The following words and terms when used in this chapter shall have the following meanings unless the context clearly indicates otherwise:
"AAOMS" means the American Association of Oral and Maxillofacial Surgeons.
"ADA" means the American Dental Association.
"Advertising" means a representation or other notice given to the public or members thereof, directly or indirectly, by a dentist on behalf of himself, his facility, his partner or associate, or any dentist affiliated with the dentist or his facility by any means or method for the purpose of inducing purchase, sale, or use of dental methods, services, treatments, operations, procedures, or products, or to promote continued or increased use of such dental methods, treatments, operations, procedures, or products.
"CODA" means the Commission on Dental Accreditation of the American Dental Association.
"Code" means the Code of Virginia.
"Dental assistant I" means any unlicensed person under the direction of a dentist or a dental hygienist who renders assistance for services provided to the patient as authorized under this chapter but shall not include an individual serving in purely an administrative, secretarial, or clerical capacity.
"Dental assistant II" means a person under the direction and direct supervision of a dentist who is registered by the board to perform reversible, intraoral procedures as specified in 18VAC60-21-150 and 18VAC60-21-160.
"Mobile dental facility" means a self-contained unit in which dentistry is practiced that is not confined to a single building and can be transported from one location to another.
"Nonsurgical laser" means a laser that is not capable of cutting or removing hard tissue, soft tissue, or tooth structure.
"Portable dental operation" means a nonfacility in which dental equipment used in the practice of dentistry is transported to and utilized on a temporary basis at an out-of-office location, including patients' homes, schools, nursing homes, or other institutions.
"Radiographs" means intraoral and extraoral radiographic images of hard and soft tissues used for purposes of diagnosis.
C. The following words and terms relating to supervision as used in this chapter shall have the following meanings unless the context clearly indicates otherwise:
"Direct supervision" means that the dentist examines the patient and records diagnostic findings prior to delegating restorative or prosthetic treatment and related services to a dental assistant II for completion the same day or at a later date. The dentist prepares the tooth or teeth to be restored and remains immediately available in the office to the dental assistant II for guidance or assistance during the delivery of treatment and related services. The dentist examines the patient to evaluate the treatment and services before the patient is dismissed.
"Direction" means the level of supervision (i.e., immediate, direct, indirect,
or general, or remote) that a dentist is required to exercise with a dental hygienist, a dental assistant I, a dental assistant II, or a certified registered nurse anesthetist or the level of supervision that a dental hygienist is required to exercise with a dental assistant to direct and oversee the delivery of treatment and related services. For the purpose of supervision of a digital scan technician, direction means the written or electronic instructions provided by a dentist licensed in Virginia to a digital scan technician in the form of a work order for a digital scan of a patient and the dentist's specified availability to consult with the technician while the scan is being taken.
"General supervision" means that a dentist completes a periodic comprehensive examination of the patient and issues a written order for hygiene treatment that states the specific services to be provided by a dental hygienist during one or more subsequent appointments when the dentist may or may not be present. Issuance of the order authorizes the dental hygienist to supervise a dental assistant performing duties delegable to dental assistants I.
"Immediate supervision" means the dentist is in the operatory to supervise the administration of sedation or provision of treatment.
"Indirect supervision" means the dentist examines the patient at some point during the appointment and is continuously present in the office to advise and assist a dental hygienist , a dental assistant, or a certified registered nurse anesthetist who is (i) delivering hygiene treatment, (ii) preparing the patient for examination or treatment by the dentist, (iii) preparing the patient for dismissal following treatment, or (iv) administering topical local anesthetic, sedation, or anesthesia as authorized by law or regulation.
"Remote supervision" means that a supervising dentist is accessible and available for communication and consultation with a dental hygienist during the delivery of dental hygiene services but such dentist may not have conducted an initial examination of the patients who are to be seen and treated by the dental hygienist and may not be present with the dental hygienist when dental hygiene services are being provided. For the purpose of practice by a public health dental hygienist, "remote supervision" means that a public health dentist has regular, periodic communications with a public health dental hygienist regarding patient treatment, but such dentist may not have conducted an initial examination of the patients who are to be seen and treated by the dental hygienist and may not be present with the dental hygienist when dental hygiene services are being provided. For the purpose of supervision of a digital scan technician, remote supervision means that a directing dentist is accessible and available for communication and consultation in the practice of teledentistry.
D. The following words and terms relating to sedation or anesthesia as used in this chapter shall have the following meanings unless the context clearly indicates otherwise:
"Analgesia" means the diminution or elimination of pain.
"Continual" or "continually" means repeated regularly and frequently in a steady succession.
"Continuous" or "continuously" means prolonged without any interruption at any time.
"Deep sedation" means a drug-induced depression of consciousness during which patients cannot be easily aroused but respond purposefully following repeated or painful stimulation. Reflex withdrawal from a painful stimulus is not considered a purposeful response. The ability to independently maintain ventilatory function may be impaired. Patients may require assistance in maintaining a patent airway, and spontaneous ventilation may be inadequate. Cardiovascular function is usually maintained.
"General anesthesia" means a drug-induced loss of consciousness during which patients are not arousable, even by painful stimulation. The ability to independently maintain ventilator function is often impaired. Patients often require assistance in maintaining a patent airway, and positive pressure ventilation may be required because of depressed spontaneous ventilation or drug-induced depression of neuromuscular function. Cardiovascular function may be impaired.
"Inhalation" means a technique of administration in which a gaseous or volatile agent, including nitrous oxide, is introduced into the pulmonary tree and whose primary effect is due to absorption through the pulmonary bed.
"Inhalation analgesia" means the inhalation of nitrous oxide and oxygen to produce a state of reduced sensation of pain with minimal alteration of consciousness.
"Local anesthesia" means the elimination of sensation, especially pain, in one part of the body by the topical application or regional injection of a drug.
"Minimal sedation" means a drug-induced state during which patients respond normally to verbal commands. Although cognitive function and physical coordination may be impaired, airway reflexes, and ventilator and cardiovascular functions are unaffected. Minimal sedation includes the diminution or elimination of anxiety through the use of pharmacological agents in a dosage that does not cause depression of consciousness and includes "inhalation analgesia" when used in combination with any such sedating agent administered prior to or during a procedure.
"Moderate sedation" means a drug-induced depression of consciousness, during which patients respond purposefully to verbal commands, either alone or accompanied by light tactile stimulation. Reflex withdrawal from a painful stimulus is not considered a purposeful response. No interventions are required to maintain a patent airway, and spontaneous ventilation is adequate. Cardiovascular function is usually maintained.
"Monitoring" means to observe, interpret, assess, and record appropriate physiologic functions of the body during sedative procedures and general anesthesia appropriate to the level of sedation as provided in Part VII (18VAC60-21-260 et seq.) of this chapter.
"Parenteral" means a technique of administration in which the drug bypasses the gastrointestinal tract (i.e., intramuscular, intravenous, intranasal, submucosal, subcutaneous, or intraocular).
"Provide" means, in the context of regulations for moderate sedation or deep sedation/general anesthesia, to supply, give, or issue sedating medications. A dentist who does not hold the applicable permit cannot be the provider of moderate sedation or deep sedation/general anesthesia.
"Titration" means the incremental increase in drug dosage to a level that provides the optimal therapeutic effect of sedation.
"Topical oral anesthetic" means any drug, available in creams, ointments, aerosols, sprays, lotions, or jellies, that can be used orally for the purpose of rendering the oral cavity insensitive to pain without affecting consciousness.
A. A dentist is responsible for conducting his practice in a manner that safeguards the safety, health, and welfare of his patients and the public by:
1. Maintaining a safe and sanitary practice, including containing or isolating pets away from the treatment areas of the dental practice. An exception shall be made for a service dog trained to accompany its owner or handler for the purpose of carrying items, retrieving objects, pulling a wheelchair, alerting the owner or handler to medical conditions, or other such activities of service or support necessary to mitigate a disability.
2. Consulting with or referring patients to other practitioners with specialized knowledge, skills, and experience when needed to safeguard and advance the health of the patient.
3. Treating according to the patient's desires only to the extent that such treatment is within the bounds of accepted treatment and only after the patient has been given a treatment recommendation and an explanation of the acceptable alternatives.
4. Only delegating patient care and exposure of dental x-rays or taking of digital scans to qualified, properly trained and supervised personnel as authorized in Part IV (18VAC60-21-110 et seq.) of this chapter.
5. Giving patients at least 30 days written notice of a decision to terminate the dentist-patient relationship.
6. Knowing the signs of abuse and neglect and reporting suspected cases to the proper authorities consistent with state law.
7. Accurately representing to a patient and the public the materials or methods and techniques to be used in treatment.
B. A dentist is responsible for conducting his financial responsibilities to patients and third party payers in an ethical and honest manner by:
1. Maintaining a listing of customary fees and representing all fees being charged clearly and accurately.
2. Making a full and fair disclosure to his patient of all terms and considerations before entering into a payment agreement for services.
3. Not obtaining, attempting to obtain, or cooperating with others in obtaining payment for services by misrepresenting procedures performed, dates of service, or status of treatment.
4. Making a full and fair disclosure to his patient of any financial incentives he received for promoting or selling products.
5. Not exploiting the dentist-patient relationship for personal gain related in nondental transactions.
A. Any digital scan technician taking intraoral digital scans for any appliance, prothesis, crown, or any other permanent or removable dental device for which a digital work order is required must complete a training program approved by the board. Training certification may be earned by verifiable participation in any course that is relevant to digital scanning which includes programs by any of the following sponsors:
1. Any sponsor listed in subsection C of 18VAC60-21-250; or
2. A training program certified by the manufacturer of the digital scanner.
B. The dentist under whom a digital scan technician is directed to take digital scans shall establish written or electronic protocols for:
1. The practice of teledentistry in compliance with subsection (C) of § 54.1-2711 of the Code of Virginia and any other provisions required by the board; and
2. The performance of digital scans by digital scan technicians in compliance with subsection (B) of §54.1-2708.5 of the Code of Virginia.
C. The dentist under whom a digital scan technician is directed to take digital scans shall be:
1. Licensed by the board to practice dentistry in the Commonwealth;
2. Accessible and available for communication and consultation with the digital scan technician at all times during the patient interaction;
3. Responsible for ensuring that the digital scan technician has a program of training approved by the board for such purpose; and
4. Ultimately responsible for determining with the patient or his representative the specific treatment the patient will receive, which aspects of treatment will be delegated to qualified personnel, and the direction required for such treatment, in accordance with the Regulations Governing the Practice of Dentistry and the Code of Virginia.
D. The directing dentist shall make available to the board any requested:
1. Protocols and procedures;
2. Evidence that a digital scan technician has complied with the training requirements of the board; and
3. All written or electronic work orders used for digital scans.