iowa dental board

4 0 0 S W 8 t h S T R E E T , S U I T E D , D E S M O I N E S , I A 5 0 3 0 9 - 4 6 8 7

P H O N E : 5 1 5 - 2 8 1 - 5 1 5 7 F A X : 5 1 5 - 2 8 1 - 7 9 6 9 h t t p : / / w w w . d e n t a l b o a r d . i o w a . g o v

KIM REYNOLDS, GOVERNOR ADAM GREGG, LT. GOVERNOR

JILL STUECKER EXECUTIVE DIRECTOR

STATE OF IOWA IOWA DENTAL BOARD

IOWA DENTAL HYGIENE COMMITTEE

MEETING AGENDA August 3, 2018

8:30 AM

The mission of the Iowa Dental Board is to ensure that all Iowans receive

professional, competent, and safe dental care of the highest quality.

Location: Iowa Dental Board, 400 SW 8th St., Suite D, Des Moines, Iowa Members: Mary Kelly, R.D.H., Chair; Nancy Slach, R.D.H., Michael Davidson, D.D.S.

I. CALL MEETING TO ORDER – ROLL CALL

II. 1st OPPORTUNITY FOR PUBLIC COMMENT

III. APPROVAL OF OPEN SESSION MINUTES a. June 8, 2018

IV. EXECUTIVE DIRECTOR’S REPORT

V. ADMINISTRATIVE RULES/ADMINISTRATIVE RULE WAIVERS

a. Review of 2018-2019 Regulatory Plan b. Vote on ARC 3849C, Proposed Adoption and Filing: Amendments to Iowa

Administrative Code 650 - Chapter 10, “General Requirements” and Iowa Administrative Code 650 – Chapter 16, “Prescribing, Administering, and Dispensing Drugs”

c. Update on Expanded Functions Committee / Draft Rules d. Update on Teledentistry Committee / Draft Rules

VI. OTHER BUSINESS

a. Review of Draft Language on Sealants for Expanded Function Trained Dental Assistants

b. Discussion on Settings for Services Provided as Outlined in Iowa Code 153.15 c. Vote to Nominate Examiners to CRDTS

i. Kelli Collins, RDH

Please Note: At the discretion of the chairperson, agenda items may be taken out of order to accommodate scheduling requests of committee members, presenters or attendees; or to facilitate meeting efficiency. If you require the assistance of auxiliary aids or services to participate in or attend the meeting because of a disability, please call the office of the Board at 515/281-5157. 2

ii. Kristen Seybold, RDH

VII. 2nd OPPORTUNITY FOR PUBLIC COMMENT

VIII. CLOSED SESSION AGENDA a. Closed Session Minutes, June 8 2018 (Closed session pursuant to Iowa Code §

21.5(1)(a) “to review or discuss records which are required or authorized by state or federal law to be kept confidential.”

b. New Complaints (Closed session pursuant to Iowa Code § 21.5(1)(d) to discuss whether to initiate licensee disciplinary investigations or proceedings).

IX. ACTION, IF ANY, ON CLOSED SESSION ITEMS a. Closed Session Minutes b. New Complaints

X. ADJOURN

NEXT REGULARLY SCHEDULED MEETING: September 28, 2018

DRAFT

4 0 0 S W 8 t h S T R E E T , S U I T E D , D E S M O I N E S , I A 5 0 3 0 9 - 4 6 8 7

P H O N E : 5 1 5 - 2 8 1 - 5 1 5 7 F A X : 5 1 5 - 2 8 1 - 7 9 6 9 h t t p : / / w w w . d e n t a l b o a r d . i o w a . g o v

KIM REYNOLDS, GOVERNOR ADAM GREGG, LT. GOVERNOR

JILL STUECKER EXECUTIVE DIRECTOR

STATE OF IOWA IOWA DENTAL BOARD

DENTAL HYGIENE COMMITEE

MINUTES June 8, 2018

Conference Room 400 S.W. 8th St., Suite D

Des Moines, Iowa Committee Members June 8, 2018 Mary C. Kelly, R.D.H. Present Nancy A. Slach, R.D.H. Present Monica Foley, D.D.S. Present

Staff Members Jill Stuecker, Phil McCollum, Christel Braness, Dee Ann Argo, Steven Garrison Attorney General’s Office Sara Scott, Assistant Attorney General

I. CALL TO ORDER FOR JUNE 8, 2018 Ms. Kelly called the meeting of the Dental Hygiene Committee to order at 8:30 a.m., Friday, June 8, 2018. Roll Call:

A quorum was established with all members present.

II. 1st OPPORTUNITY FOR PUBLIC COMMENT Ms. Kelly asked everyone to introduce themselves. Ms. Kelly allowed the opportunity for public comment. Mr. Cope, Iowa Dental Hygienists' Association, wanted to address the agenda item related to sealants and dental assistants. The Iowa Dental Hygienists' Association expressed an interest in being an active participant in these discussions. Mr. Cope noted that any amendments in this area would require a statutory change.

Member Kelly Slach Foley Present x x x Absent

DRAFT

Dental Hygiene Committee Meeting – OPEN SESSION – Subject to final approval June 8, 2018 (Draft: 6/19/2018) 2

III. APPROVAL OF OPEN SESSION MINUTES

April 6, 2018 – Quarterly Meeting MOVED by SLACH, SECONDED by FOLEY, to APPROVE the open session minutes

of the April 6, 2018 meeting as submitted. Motion APPROVED unanimously.

IV. EXECUTIVE DIRECTOR’S REPORT Ms. Stuecker reported that the Board scheduled a free jurisprudence course for June 27, 2018. Ms. Stuecker noted that the Board had not anticipated the level of interest expressed to date. There may be some capability to record the webinar, which the Board may explore. Ms. Rodgers asked if the Board would be presenting a course for infection control. Ms. Stuecker stated that there weren’t any current plans to do so. Ms. Stuecker reported that she’d filed the paperwork to become a member of WREB as voted on at the last meeting. Ms. Stuecker had submitted the names of Ms. Kelly and Ms. Slach as examiners. Ms. Stuecker stated that this would be added as a standing agenda items for future updates and reports.

V. ADMINISTRATIVE RULES/ADMINISTRATIVE RULE WAIVERS

Review of 2018-2019 Regulatory Plan Mr. McCollum reported that the committee members were provided the updated regulatory plan. Mr. McCollum provided an update on the most recent Board filings. The Notices of Intended Action to Iowa Administrative Code 650—Chapters 10, 16, 26, and 28 had been filed. Staff were waiting to receive edits back from the code editors. A public hearing has been tentatively set for July 13, 2018. The rules would likely come back for a vote regarding adoption at the August meeting. Update on Expanded Functions Committee / Draft Rules

Mr. McCollum provided an update on the expanded functions committee. This was intended to be a high level discussion, as the committee is still meeting, and changes will continue to be made. The more detailed discussion occurred at the full Board meeting.

VI. OTHER BUSINESS Discussion on Sealants for Expanded Function Trained Dental Assistants

Ms. Stuecker explained that the Expanded Functions Committee recommended allowing Level 2 dental assistants to place sealants. This was not intended as a vote; rather, it was for the

DRAFT


committee’s information, and to get some sense as to whether the Board has an interest in supporting this recommendation. Mr. McCollum stated that if this change were made, he recommended also addressing another portion of the Iowa Acts regarding the removal of material so far as it related to the removal of excess adhesive and restorative materials while performing expanded functions. Ms. Slach inquired as to whether minimal educational standards for dental assistants would require CODA-level training. Ms. Stuecker stated that the next meeting of the expanded functions committee will further discuss the training requirements to provide these services. The committee has not had a chance to full discuss that to date. Dr. Foley stated that increased online access may mitigate some of these issues. I-Smile Reports from IDPH

Ms. Stuecker stated that Ms. Rodgers and Ms. Patterson-Rahn would be presenting information about this at the Board meeting. The reports were included for the committee’s information. Vote to Approve Criteria for Nominating Clinical Board Examiners

Ms. Kelly provided an overview of the criteria, which were established by the Central Regional Dental Testing Service (CRDTS). Ms. Slach asked if references would be checked prior to submitting the names for consideration. Ms. Stuecker stated that Board staff may not be equipped to handle that level of review. MOVED by KELLY, SECONDED by FOLEY, to APPROVE the criteria for appointing

clinical board examiners. Motion APPROVED unanimously. Vote to Nominate Examiners to CRDTS

i. Becky McCarl, RDH MOVED by KELLY, SECONDED by FOLEY, to APPROVE the nomination of Ms.

McCarl as an examiner to CRDTS. Motion APPROVED unanimously.

ii. Holly Hunter, RDH MOVED by KELLY, SECONDED by FOLEY, to APPROVE the nomination of Ms.

Hunter as an examiner to CRDTS. Motion APPROVED unanimously.

iii. Kelli Collins, RDH MOVED by KELLY to APPROVE the nomination of Ms. Collins as an examiner to

CRDTS. Ms. Slach believed that some of the information reported on the Ms. Collins’ work history may not be fully accurate.

DRAFT


Ms. Kelly withdrew her motion, and requested that staff ask for additional information to clarify Ms. Collins’ experience.

iv. Tena Springer, RDH MOVED by KELLY, SECONDED by SLACH, to APPROVE the nomination of Ms.

Springer as an examiner to CRDTS. Motion APPROVED unanimously. Discussion on Iowa Department of Corrections Request on Public Health Supervision

Mr. McCollum provided a short overview about a similar request received in the past. At the time, it was determined that the dental hygienists could operate under general supervision since most, if not all, of the prisons employed a dentist on staff. Ms. Kelly believed that this request was a little different from the earlier request. Mr. McCollum stated that not all of the prisons currently have a dentist on staff. Ms. Scott reported speaking with the Assistant Attorney General for the IDOC when the previous request was received. Ms. Scott indicated that this still may not address the policies established by the Iowa Department of Corrections (IDOC), unless those policies have changed. Ms. Kelly asked if the rules could be changed to assist with this request. Ms. Scott stated that part of the previous discussion was a request for proposed rulemaking, which would have potentially eliminated certain public health settings. Ms. Scott noted that Dr. Greenfield may not have been employed by the IDOC at the time, and may be unfamiliar with the concerns. Ms. Scott stated that she can discuss this with the IDOC’s Assistant Attorney General to bring them into the discussion. Amber Daughenbaugh, Application for RDH License

Ms. Scott stated this would be discussed in closed session.

VII. 2nd OPPORTUNITY FOR PUBLIC COMMENT Ms. Kelly allowed the opportunity for public comment. No comments were received.

VIII. CLOSED SESSION MOVED by KELLY, SECONDED by FOLEY, to go into CLOSED SESSION in

compliance with the following requirements: a. Closed Session Minutes, April 6, 2018 (Closed session pursuant to Iowa Code §

21.5(1)(a) “to review or discuss records which are required or authorized by state or federal law to be kept confidential…”, specifically to review or discuss information that is confidential under Iowa Code § 21.5(4)).

DRAFT


b. New Complaints (Closed session pursuant to Iowa Code § 21.5(1)(d) to discuss whether to initiate licensee disciplinary investigations or proceedings and pursuant to Iowa Code § 21.5(1)(a) to review or discuss records which are required or authorized by state or federal law to be kept confidential, specifically information that is confidential under Iowa Code § 272C.6(4)).

c. Additional Information on Previous Complaints (Closed session pursuant to Iowa Code § 21.5(1)(d) to discuss whether to initiate licensee disciplinary investigations or proceedings and pursuant to Iowa Code § 21.5(1)(a) to review or discuss records which are required or authorized by state or federal law to be kept confidential, specifically information that is confidential under Iowa Code § 272C.6(4)).

d. Application for Licensure (Closed session pursuant to Iowa Code § 21.5(1)(a) to review information required by state or federal law to be kept confidential).

Roll Call:

Motion APPROVED by ROLL CALL. The Dental Hygiene Committee convened in closed session at 9:09 a.m. MOVED by KELLY, SECONDED by FOLEY, to RETURN to OPEN session. Motion

APPROVED unanimously. The Dental Hygiene Committee reconvened in open session at 9:37 a.m. OPEN SESSION

IX. ACTION, IF ANY, ON CLOSED SESSION AGENDA ITEMS MOVED by SLACH, SECONDED by FOLEY, to APPROVE the closed session minutes

from the April 6, 2018 meeting as submitted. Motion APPROVED unanimously. MOVED by KELLY, SECONDED by FOLEY, TO APPROVE the license application for

Ms. Daughenbaugh. Motion APPROVED unanimously. MOVED by KELLY, SECONDED by FOLEY, TO CLOSE case file #16-0093. Motion

APPROVED unanimously. MOVED by KELLY, SECONDED by FOLEY, to KEEP OPEN complaint #17-0100.

Motion APPROVED unanimously. X. ADJOURN

Member Kelly Slach Foley Yes x x x No

DRAFT


MOVED by KELLY, SECONDED by SLACH, to ADJOURN. Motion APPROVED unanimously.

The meeting of the Dental Hygiene Committee adjourned at 9:38 a.m. on June 8, 2018. NEXT MEETING OF THE COMMITTEE The next meeting of the Dental Hygiene Committee is scheduled for August 3, 2018, in Des Moines, Iowa. These minutes are respectfully submitted by Christel Braness, Program Planner 2, Iowa Dental Board.

*Tentative Date Scheduled

IAC 650 Ch. Chapter Title Description of Proposed Action, Reason Legal Basis for Proposed Action Schedule for Action Date of NoIA

Public Hearing Date

Date Board Vote

Final Outcome

Effective Date Comments

1 "Administration"Update definition of "overpayment" to

coincide with definition of "fee" in ch. 15.

147.1(2), 147.13, 147.30, 147.76,

147.80, 153.13, 15315, 272C Adopted 1/26/2108 4/24/2018 6/8/2018 APPROVED 9/19/2018

11"Licensure to Practice Dentistry or Dental Hygiene"

Update requirments for application by

foreign‐trained dentists to match previously‐

approved rule waivers

147.2, 147.33, 153.13, 153.21,

153.33A Adopted 1/26/2018 4/24/2018 6/8/2018 APPROVED 9/19/2018

10, 16 "General Requirements" & "Prescribing"

Strike ownership language, Add use of SDF in

a public health setting, Clarify requirements

for submitting changes of names and

addresses

147.8, 147.9, 149.9, 147.55,

153.13, 153.15, 153.16, 153.17,

153.33, 153.33A, 272C.10 In Process 4/6/2018 7/13/2018 8/3/2018

11 & 20"Licensure to Practice Dentistry or Dental Hygiene" & "Dental Assistants"

Update references for the additional review

of applications for licensure and registration

147.2, 153.15A, 153.21, 153.33B,

153.39 In Process 4/6/2018 7/13/2018 9/28/2018*

Pending clarification of Notice of

Intended Action from Code Editor's

Office. NOIA filed 5/2/18; ARC # not

assigned 7/17/2018

26 & 28 "Advertising" & "Designation of Specialties"Address legal concerns with specialty

avertising 153.13 In Process 4/6/2018 7/13/2016 9/28/2018*

27"Standards of Practice and Principles of Professional Ethics" Create teledentistry rules 153.13, 153.15, 153.33, 153.38 Ongoing Discussion

29"Sedation and Nitrous Oxide Inhalation Analgesia"

Review requirements for allowing sedation

in dental offices by CRNAs or MDs, and

related requirements. 147.76, 153.33 Ongoing Discussion

16"Prescribing, Administering and Dispensing Drugs"

Update rules to match requirements of 2018

legislation, DEA and Iowa Board of Pharmacy 153.2 Ongoing Discussion

10 "General Requirements" Review and update expanded function rules 153.15 Ongoing Discussion

20 "Dental Assistants" Review, update expanded functions rules 153.38, 153.39 Ongoing Discussion

20 "Dental Assistants" Review, update remediation 153.38, 153.39 January 2019*

22 "Dental Assistant Radiography Qualification

Review and update requirements for

obtaining and reinstating a qualification in

dental radiography.

153.38, 153.39, 147.10, 147.11,

272C.2 January 2019*

10 "General Requirements"

Discussion/update regarding the use of

lasers by dental hygienists. Currently, the

board references a position statement

issued in the past. Due to ongoing

questions, the rules ought to be updated to

clarify use and requirements. 153.15, 153.33A, November 2018*

27 "Discontinuation of Practice" Update to eliminate confusing language 153.33(8), 153.34, 147.76 September 2018*

13 "Special Licenses"Review/Update resident/faculty application

requirements 153.22, 153.37 November 2018*35 "Iowa Practitioner Review Committee" Review program eligibility 153, 272C November 2018*

Iowa Dental Board Annual Regulatory Plan 2018‐2019

DRAFTDENTAL BOARD [650]

Adopted and Filed

Pursuant to the authority of Iowa Code 147.76 and 153.33, the Dental Board hereby

adopts and filed amendments to Chapter 10, “General Requirements” and Chapter 16

“Prescribing, Administering, and Dispensing Drugs.”

The amendments eliminate the prohibition against ownership of a dental practice by a

dental hygienist, update protocols for a licensed dental hygienist to work in a public health

setting and clarify the use of silver diamine fluoride, and implement clearer requirements for

reporting changes of name and address.

The amendments remove the restriction against ownership of a dental practice by a dental

hygienist. The amendments would focus on the level of supervision under which a dental

hygienist must work, rather than practice ownership.

The amendments reduce the number of years of clinical experience required for a

licensed dental hygienist to work in a public health setting. Current rules allow a dental

hygienist to work under public health supervision after having completed three years of clinical

practice. The amendments reduces this requirement to one year, which is consistent with the

requirement for registered dental assistants.

The amendments permit licensed dental hygienists to use silver diamine fluoride in a

public health setting and set forth parameters for its use.

The amendments would clarify the situations wherein a licensee or registrant would be

required to submit a change of address to the board.

A public hearing was held on July 13, 2018. Two members of the public were in

attendance and were supportive of the amendments. Additionally, 19 written comments were

DRAFTreceived. The majority of comments support the amendments and state they will provide more

oral health care opportunities for underserved Iowans. Four comments expressed concern

regarding the reduction of experience required for a dental hygienist to work in a public health

setting.

The proposed amendments in Chapter 10 are subject to waiver or variance pursuant to

650-chapter 7.

After analysis and review of this rule making, there is a positive impact on jobs for

hygienists who wish to work in a public health setting, because they will be able to do so with

fewer years of experience.

The proposed amendments are intended to implement Iowa Code 147.9, 153.15, 153.16,

153.17, 153.33, 153.33A, and 153.34.

ITEM 2. Amend subrule 650—10.4 as follows:

CHAPTER 10

GENERAL REQUIREMENTS

[Prior to 5/18/88, Dental Examiners, Board of [320]]

650—10.4(153) Unauthorized practice of a dental hygienist. A dental hygienist who assists a

dentist in practicing dentistry in any capacity other than as an employee or independent contractor

supervised by a licensed dentist or who directly or indirectly procures a licensed dentist to act as

nominal owner, proprietor, director, or supervisor of a practice as a guise or subterfuge to enable

such dental hygienist to engage in the practice of dentistry or dental hygiene or who renders

hygiene dental services, except educational services, directly which have not been delegated by a

licensed dentist or which are not performed under the supervision of a licensed dentist as provided

by rule or indirectly on or for members of the public other than as an employee or independent

DRAFTcontractor supervised by a licensed dentist shall be deemed to be practicing illegally.

10.4(1) The unauthorized practice of dental hygiene means allowing a person not licensed in

dentistry or dental hygiene to perform dental hygiene services authorized in Iowa Code section

153.15 and rule 650—10.3(153).

10.4(2) The unauthorized practice of dental hygiene also means the performance of services

by a dental hygienist that exceeds the scope of practice granted in Iowa Code section 153.15.

10.4(3) A dental hygienist shall not provide services, except for educational services, practice

independent from the supervision of a dentist nor shall a dental hygienist establish or maintain an

office or other workplace separate or independent from the office or other workplace in which the

supervision of a dentist is provided.

10.4(43) Students enrolled in dental hygiene programs. Students enrolled in an accredited

dental hygiene program are not considered to be engaged in the unlawful practice of dental hygiene

provided that such practice is in connection with their regular course of instruction and meets the

following:

a. The practice of clinical skills on peers enrolled in the same program must be under the

direct supervision of a program instructor with an active Iowa dental hygiene license, Iowa faculty

permit, or Iowa dental license;

b. The practice of clinical skills on members of the public must be under the general

supervision of a dentist with an active Iowa dental license;

c. The practice of clinical skills involving the administration or monitoring of nitrous oxide

or the administration of local anesthesia must be under the direct supervision of a dentist with an

active Iowa dental license.

This rule is intended to implement Iowa Code sections 147.10, 147.57 and 153.15.

DRAFT[ARC 2592C, IAB 6/22/16, effective 7/27/16]


650—10.5(153) Public health supervision allowed. A dentist who meets the requirements of this

rule may provide public health supervision to a dental hygienist if the dentist has an active Iowa

license and the services are provided in public health settings.

10.5(1) Public health settings defined. For the purposes of this rule, public health settings are

limited to schools; Head Start programs; programs affiliated with the early childhood Iowa (ECI)

initiative authorized by Iowa Code chapter 256I; child care centers (excluding home-based child

care centers); federally qualified health centers; public health dental vans; free clinics; nonprofit

community health centers; nursing facilities; and federal, state, or local public health programs.

10.5(2) Public health supervision defined. “Public health supervision” means all of the

following:

a. The dentist authorizes and delegates the services provided by a dental hygienist to a patient

in a public health setting, with the exception that hygiene services may be rendered without the

patient’s first being examined by a licensed dentist;

b. The dentist is not required to provide future dental treatment to patients served under public

health supervision;

c. The dentist and the dental hygienist have entered into a written supervision agreement that

details the responsibilities of each licensee, as specified in subrule 10.5(3); and

d. The dental hygienist has an active Iowa license with a minimum of three years one year of

clinical practice experience.

10.5(3) Licensee responsibilities. When working together in a public health supervision

DRAFTrelationship, a dentist and dental hygienist shall enter into a written agreement that specifies the

following responsibilities.

a. The dentist providing public health supervision must:

(1) Be available to provide communication and consultation with the dental hygienist;

(2) Have age- and procedure-specific standing orders for the performance of dental hygiene

services. Those standing orders must include consideration for medically compromised patients

and medical conditions for which a dental evaluation must occur prior to the provision of dental

hygiene services;

(3) Specify a period of time in which an examination by a dentist must occur prior to providing

further hygiene services. However, this examination requirement does not apply to educational

services, assessments, screenings, and fluoride if specified in the supervision agreement; and

(4) Specify the location or locations where the hygiene services will be provided under public

health supervision.

(5) Complete board-approved training on silver diamine fluoride if the supervision agreement

permits the use of silver diamine fluoride. The supervision agreement must specify guidelines for

use of silver diamine fluoride, and must follow board-approved protocols.

b. A dental hygienist providing services under public health supervision may provide

assessments; screenings; data collection; and educational, therapeutic, preventive, and diagnostic

services as defined in rule 10.3(153), except for the administration of local anesthesia or nitrous

oxide inhalation analgesia, and must:

(1) Maintain contact and communication with the dentist providing public health supervision;

(2) Practice according to age- and procedure-specific standing orders as directed by the

supervising dentist, unless otherwise directed by the dentist for a specific patient;

DRAFT (3) Provide to the patient, parent, or guardian a written plan for referral to a dentist and

assessment of further dental treatment needs;

(4) Have each patient sign a consent form that notifies the patient that the services that will be

received do not take the place of regular dental checkups at a dental office and are meant for people

who otherwise would not have access to services; and

(5) Specify a procedure for creating and maintaining dental records for the patients that are

treated by the dental hygienist, including where these records are to be located.; and

(6) Complete board-approved training on silver diamine fluoride if the supervision agreement

permits the use of silver diamine fluoride. The supervision agreement must specify guidelines for

use of silver diamine fluoride, and must follow board-approved protocols.

c. The written agreement for public health supervision must be maintained by the dentist and

the dental hygienist and must be made available to the board upon request. The dentist and dental

hygienist must review the agreement at least biennially.

d. A copy of the written agreement for public health supervision shall be filed with the Bureau

of Oral and Health Delivery Systems, Iowa Department of Public Health, Lucas State Office

Building, 321 E. 12th Street, Des Moines, Iowa 50319.

10.5(4) Reporting requirements. Each dental hygienist who has rendered services under public

health supervision must complete a summary report at the completion of a program or, in the case

of an ongoing program, at least annually. The report shall be filed with the bureau of oral and

health delivery systems of the Iowa department of public health on forms provided by the

department and shall include information related to the number of patients seen and services

provided so that the department may assess the impact of the program. The department will provide

summary reports to the board on an annual basis.

DRAFTThis rule is intended to implement Iowa Code section 153.15.

[ARC 7767B, IAB 5/20/09, effective 6/24/09; ARC 0629C, IAB 3/6/13, effective 4/10/13; ARC

2141C, IAB 9/16/15, effective 10/21/15]


650—10.6(147,153,272C) Other requirements.

10.6(1) Change of address or name. Each person licensed or registered by the board must

notify the board, by written correspondence or through the board’s online system, of a change of

legal name or address within 60 days of such change. Proof of a legal name change, such as a

notarized copy of a notarized letter, marriage certificate, or other legal document establishing the

change must accompany the request for a name change.

10.6(12) Change of address. Each person licensed or registered by the board must notify the

board within 60 days, through the board’s online system, of changes in e-mail and mailing

addresses. Address changes shall be submitted as follows:

a. Primary mailing address. Licensees or registrants shall designate a primary mailing address.

The primary mailing address may be a designated work or home address.

b. Practice locations. Licensees or registrants shall report addresses for all practice locations.

Practice locations include full-time and part-time practice locations.

c. E-mail address. Each licensee or registrant shall report, when available, an email address

for the purpose of electronic communications from the board.

10.6(23) Child and dependent adult abuse training. Licensees or registrants who regularly

examine, attend, counsel or treat children or adults in Iowa must obtain mandatory training in child

and dependent adult abuse identification and reporting within six months of initial employment

DRAFTand subsequently every five years in accordance with 650—subrule 25.2(9).

10.6(34) Reporting requirements. Each licensee and registrant shall be responsible for

reporting to the board, within 30 days, any of the following:

a. Every adverse judgment in a professional malpractice action to which the licensee or

registrant was a party.

b. Every settlement of a claim against the licensee or registrant alleging malpractice.

c. Any license or registration revocation, suspension or other disciplinary action taken by a

licensing authority of another state, territory or country within 30 days of the final action by the

licensing authority.

This rule is intended to implement Iowa Code sections 147.9, 232.69, 235B.16 and 272C.9.

[ARC 0265C, IAB 8/8/12, effective 9/12/12]

ITEM 4. Amend subrule 650—16.2(2) as follows:

650—16.2(153) Scope of authority.

16.2(2) A dental examination must be conducted and a medical history taken before a

dentist initially prescribes, administers, or dispenses medication to a patient, except for patients

who receive fluoride or silver diamine fluoride dispensed under protocols approved by the bureau

of oral and health delivery systems of the department of public health. The examination must focus

on the patient’s dental problems, and the resulting diagnosis must relate to the patient’s specific

complaint. The patient’s dental record must contain written evidence of the examination and

medical history.

7/10/2018 State of Iowa Mail - Fwd: Administrative Code 650-Chapters 10 and 16

https://mail.google.com/mail/u/0?ik=987c77d366&view=pt&search=all&permthid=thread-f%3A1605629477861213495&simpl=msg-f%3A16056294778… 1/2

Garrison, Steven <[email protected]>

Fwd: Administrative Code 650-Chapters 10 and 16 2 messages

Jill Stuecker <[email protected]> Tue, Jul 10, 2018 at 1:33 PMTo: Steve Garrison <[email protected]>

can you add this to the file? Jill Stuecker, MPA, MA | Executive DirectorIowa Dental Board | 400 SW 8th St. Suite D | Des Moines, IA 50309Office: 515.281.6935 | Fax: 515.281.7969 | http://www.dentalboard.iowa.gov/

Ensuring that Iowans receive professional, competent, and safe dental care of the highest quality.

We value your feedback! Click here to tell us how we’re doing.

Confidentiality Notice: This e-mail message, including any attachments, is for the sole use of the intended recipient(s), and maycontain confidential and privileged information. Any unauthorized review, use, disclosure or distribution is prohibited. If you are notthe intended recipient(s), please contact the sender by reply e-mail and destroy all copies of the original message.

---------- Forwarded message --------- From: Nancy Adrianse <[email protected]> Date: Sat, Jul 7, 2018 at 8:48 AM Subject: Administrative Code 650-Chapters 10 and 16 To: <[email protected]>, <[email protected]>, <[email protected]> Cc: <[email protected]> July 7, 2018 Ms. Stuecker, Mr. Garrison and Mr. McCollum, I would like to thank the Iowa Dental Board for this opportunity to provide public comments regarding changes to IowaAdministrative Code 650-Chapters 10 and 16. As a long time practicing dental hygienist, I would recommend that theIowa Dental Board approve the following changes: removing the prohibition of ownership of a dental practice by a dentalhygienist; updates to public health supervision requirements for dental hygienists; implementing procedures for the use ofsilver diamine fluoride in public health supervision and updating the requirements for notifying the Board of a change inname or address. I think it is important for the board to consider the collaborative effort by the many stakeholders whoprovided input for these changes. The changes to this rule will allow the dental hygiene workforce more opportunities to serve those who live in theircommunities. Reducing the number of years of work experience from three years to one year for a dental hygienist towork under public health supervision will bring more qualified individuals into the public health supervision workforce. Thechallenges faced by patients for getting into a traditional dental practice setting will be reduced if dental hygienists areable to utilize silver diamine fluoride when working under public health supervision in such places as nursing homes andschool dental health programs. Taking dental services into community setting will reduce the burden of dental disease,provide additional opportunities to educate Iowans on the importance of good oral health and lower the risk of moreexpensive medical and dental care. Your thoughtful consideration of these comments is appreciated. Nancy Adrianse, RDH 3210 SW 33rd Street Des Moines, Iowa 50321

https://maps.google.com/?q=400+SW+8&entry=gmail&source=g

http://www.dentalboard.iowa.gov/

https://www.surveymonkey.com/r/iowadentalboard

mailto:[email protected]





https://maps.google.com/?q=3210+SW+33rd+Street+%0D%0ADes+Moines,+Iowa+50321&entry=gmail&source=g

7/10/2018 State of Iowa Mail - Fwd: Administrative Code 650-Chapters 10 and 16


Steven Garrison <[email protected]> Tue, Jul 10, 2018 at 2:28 PMTo: "Stuecker, Jill" <[email protected]>

Yes will do. [Quoted text hidden]-- Steve Garrison | Program OfficerIowa Dental Board | 400 SW 8th St. Suite D | Des Moines, IA 50309Office: 515.281.3248 | Fax: 515.281.7969 | http://www.dentalboard.iowa.gov/






9943 Hickman Road, Suite 103 | Urbandale, IA 50322 | 515-244-9610 | www.iowapca.org | Facebook/Twitter:

@iowapca

Dental Board Office, Suite D

400 S.W. Eighth Street

Des Moines, Iowa

July 13, 2018

Executive Director Stuecker and Mr. Garrison,

Thank you for the opportunity to provide public comments on the proposed changes to Iowa

Administrative Code 650 - Chapters 10 and 16. On behalf of our thirteen community health centers and

one migrant health center, the Iowa Primary Care Association would recommend that the Iowa Dental

Board approve the following changes, as published in the most current Iowa Administrative Rules

Bulletin:

• removing the prohibition of ownership of a dental practice by a dental hygienist;

• updates to public health supervision requirements for dental hygienists;

• implementing procedures for the use of silver diamine fluoride in public health supervision and

updating the requirements for notifying the Board of a change in name or address.

Our health centers in Iowa provide comprehensive, integrated healthcare, including dental care. The

changes to this rule will allow the dental hygiene workforce more opportunities to serve those who live

in their communities and may not have other access to dental care. Reducing the number of years of

work experience from three years to one year for a dental hygienist to work under public health

supervision will bring more qualified individuals into the public health supervision workforce. The

challenges of getting into a traditional dental practice setting faced by patients will be reduced, and thus

reduce other costly health complications caused by lack of dental care, if dental hygienists are able to

utilize silver diamine fluoride when working under public health supervision in such places as nursing

homes and school dental health programs.

Thank you for your work on this proposed rule and for your consideration of our comments. If you have

questions, please contact Nancy Adrianse at [email protected].

Sincerely,

Theodore J. Boesen, Jr. Chief Executive Officer Iowa Primary Care Association

7/17/2018 State of lowa Mail - Fwd: public comment re IAC 650

Braness, Ghristel <[email protected]>

Fwd: public comment re lAG 6501 message

Phil Mccollum <[email protected]> Mon, Jul 16,2018 at7:20 PMTo: ChristelA Braness <[email protected]>, "Stuecker, Jill IDB]" <[email protected]>

Fonvarded messageFrom: Gaplan, Daniel J <[email protected]>Date: Mon, Jul 16,2018at4:19 PMSubject: public comment re IAC 650To: [email protected] <phil.mccollu [email protected]>CC: Caplan, Daniel J <[email protected]>

Dear Ms. Stuecker, Mr. Garrison, Mr. McCollum, and other interested parties:

On behalf of the Department of Preventive and Community Dentistry at theUniversity of !owa, College of Dentistry, I would like to thank the lowa Dental Boardfor providing this opportunity to comment publicly regarding changes to lowaAdministrative Code 650-Chapters 10 and 16. We would like to recommend that thelowa Dental Board approve the proposed change that would allow ownership of adental practice by a dental hygienist; update the public health supervisionrequirements for dental hygienists; implement appropriate procedures for the use ofsilver diamine fluoride in public health supervision; and update the requirements fornotifying the Board of a change in name or address.

It is our opinion that changes to these rules will permit our state's dental hygieneworkforce to have more opportunities to serue those who live in their communities.Reducing the number of years of work experience from three years to one for dentalhygienists to work under public health supervision will bring more qualifiedindividuals into the public health supervision workforce, and will do it sooner than thepresent laws allow. Challenges faced by patients in accessing care in traditionaldental practice settings will be reduced if dental hygienists are allowed to place silverdiamine fluoride when working under public health supervision, especially in sitessuch as nursing facilities and schools. Taking preventive dental services intocommunities will help reduce the burden of dental disease, provide additionalopportunities to educate lowans on the importance of good oral health, and lowerthe risk of more expensive dental care.

Thank you for considering these changes. They represent a step toward better oralhealth for Iowa's traditionally underserved populations.

httpsJ/mail.google.com/mail/u/0?ik=bb15062aUU*r;"rv=pt&search=all&permthid=thread-f%3A1606194894286996642&simpl=msg-f%3A16061948942... 112

7/17ノ2018 State of lowa Mail - Fwd: public comment re IAC 650

Sincerely,

DanielJ. Caplan, DDS, PhD

Professor and DEO

Department of Preventive & Community Dentistry

University of lowa, College of Dentistry

N339 Dental Science Building

lowa City, lA 52242

Tel: 319-335-7206

Phil McCollum lAssociate Director

lowa Dental Board | 400 SW 8th Street, Suite D I Des Moines, lA 50309

Office: 51 5.281.3739 | Fax: 51 5.281 .7969 | http//www.dentalboard.iowa.gov

Ensuring that lowans receive professional, competent, and safe dental care of the highest qualt$.

We value your feedback! Click here to tell us how we're doing.

Confidentiality Notice: This e-mail message, including any attachmenfs, is for the so/e use of the intended recipient(s), and may

contain confidential and pivileged information. Any unauthorized review, use, disc/osure or distribution is prohibited. lf you are not

the intended recipient(s), please contact the sender by reply e-mail and destroy all copies of the original message.

https://mail.google.com/mail/u/0?ik=bb15062aUU*r;"*=pt&search=all&permthid=thread-f%3,A1606'194894286996642&simpl=msg-f%3A16061948942... 212

Warren County Health Services 301 N Buxton, Suite 203 Indianola IA 50125

https://www.warrencountyia.org/health_services/ 515-961-1074 or 1-877-961-1074

July 17, 2018

To the Iowa Dental Board,

As a local Public Health administrator, I want to take this opportunity to make known my support for the

changes proposed for the public health supervised dental hygienist to be able to apply silver diamine

fluoride to the public health persons they serve. As you are aware silver diamine fluoride has been

shown to be very effective to stop dental decay. The population served by the public health dental

hygienist typically have limited to no history of accessing dental care in a dental office therefore the

treatment with silver diamine fluoride is most important for this population. I am aware dental

hygienists in private practice dental offices are able to apply this for patients and with the appropriate

training, the public health hygienist should be allowed to provide this effective treatment to promote

improved oral health among the public health clients.

I also support the changes of allowing dental hygienists with one year of experience, rather than only

those with three or more years of experience, to pursue a career in public health. The hygienist would

continue to be under the supervision of a DDS and would be vetted through the interview process by

the community agency and supervising dentist to be qualified to provide care in the public health

setting. This change could create a larger pool of dental hygienists for public health and community

agencies to choose from to help assure the best qualified dental hygienist is chosen for the job.

Experience is valuable but a professional with less experience yet a heightened passion for the job is also

valuable.

Thank you for this opportunity to provide my comments.

Jodene DeVault BSN RN

Administrator

Warren County Health Services

301 N Buxton, Suite 203

Indianola, IA 50125

[email protected]

https://www.warrencountyia.org/health_services/


June 27, 2018

The following is comment on proposed changes to 10.5(2)d.

I would like to make a public comment on the proposed change to the public supervision for

dental hygienists. I am speaking as a public health hygienist. I have been working in public

health for about 14 years. I had 4 years of clinical experience before I started doing dental

screenings, fluoride varnishes and dental sealants. I have been lucky to have worked with many

very good dentists that showed me any aspects of dentistry that I would not normally see.

These dentists gave me the information to help me as I work alone in the public health settings.

I see conditions that I would not see in a private office because the patients that I see may not

see the dentist regularly if they have never seen a dentist. I believe that hygienists need to have

enough experience before they go out into public health clinics and work by themselves. It is

stated that a hygienist needs three years of experience before they can get a public health

supervision agreement. I believe that if any changes to this requirement are made it should be

made by the number of clinical hour they have worked. If a hygienist works a forty hour week

for 50 weeks a year, they would have 2000 hours of clinical experience. If you have a hygienist

working one half day a week for 50 weeks, they would only have 200 hours of experience. Both

would have the one year experience. Which hygienist would have more experience? I feel that

if I did not have the experience that I had before going into public health, I would not have the

knowledge of what I was seeing in the mouth of some of my patients. Without having

experience, it is much harder to deciding if something is normal or an abnormality. I am always

trying to educate the assistant that is working with me. If I see something that is usual or out of

the ordinary, I try to show them so they can be better educated. I feel that a dental hygienist

needs to have at least 2000 hours before being able to have a public health supervision

agreement to work doing dental screenings, fluoride varnishes, prophies and dental sealants.

You need the experience to be able to handle any situation that comes up. You must be

confident in your ability to handle any situation. I believe that if you have a number of provable

clinic hours then you insure that the patients are having services done by someone with clinical

knowledge. Public health is not like your typical office setting.

I would like to add that sometimes the dental hygienists may not be doing dental screenings,

fluoride varnishes, prophies or sealants but working as dental assistants. These hygienists

should be able to work in the assistant role with the same requirements that a dental assistant.

One year with no amount of hours worked in an office. I have had hygienists work with me as

assistants. They had to have 3 years’ experience just to hand instruments, use the suction, and

clean up and set up. I have assistants that only had 1 year experience. Did one do a different

job? No. Was one better that the other? No. I hope that you would consider having a provision

for dental hygienists to work as dental assistant who would only need one year of some kind of

experience. This would be a way for dental hygienists to see what it is like to do public health. It

would also help in finding a person to help in public health clinics when there is a shortage of

dental assistants.

I would like to thank you for letting me make this comment to you for your consideration. If you

have any questions, about what is involved working in the public health please let me know. I

would more than gladly answer them or come and talk with you.

Dawn T. Doore, RDH, CDA

7/16/2018 State of Iowa Mail - Written testimony



Written testimony 2 messages

Tonya <[email protected]> Mon, Jul 16, 2018 at 8:41 AMTo: "[email protected]" <[email protected]>

Ms. Stuecker, Mr. Garrison and Mr. McCollum, I would like to thank the Iowa Dental Board for this opportunity to provide public commentsregarding changes to Iowa Administrative Code 650-Chapters 10 and 16. I/we would recommendthat the Iowa Dental Board approve the following changes: removing the prohibition of ownershipof a dental practice by a dental hygienist; updates to public health supervision requirements fordental hygienists; implementing procedures for the use of silver diamine fluoride in public healthsupervision and updating the requirements for notifying the Board of a change in name or address.I/we think it is important for the board to consider the collaborative effort by the many stakeholderswho provided input for these changes. The changes to this rule will allow the dental hygiene workforce more opportunities to serve thosewho live in their communities. Reducing the number of years of work experience from three yearsto one year for a dental hygienist to work under public health supervision will bring more qualifiedindividuals into the public health supervision workforce. The challenges faced by patients forgetting into a traditional dental practice setting will be reduced if dental hygienists are able to utilizesilver diamine fluoride when working under public health supervision in such places as nursinghomes and school dental health programs. Taking dental services into community setting willreduce the burden of dental disease, provide additional opportunities to educate Iowans on theimportance of good oral health and lower the risk of more expensive medical and dental care. Your thoughtful consideration of these comments is appreciated.

Tonya

Tonya R. Enright, CDA, RDH, BSDH, MEd, EdD(c)2018-2019 President, Iowa Dental Hygienists' AssociationDental Hygiene Faculty, Hawkeye Community CollegeBHS-DH Program Director, Allen College

Steven Garrison <[email protected]> Mon, Jul 16, 2018 at 8:43 AMTo: [email protected]

Thank you Ms. Enright. I'll include these with the public comments. Sincerely, [Quoted text hidden]-- Steve Garrison | Program OfficerIowa Dental Board | 400 SW 8th St. Suite D | Des Moines, IA 50309Office: 515.281.3248 | Fax: 515.281.7969 | http://www.dentalboard.iowa.gov/


7/16/2018 State of Iowa Mail - Written testimony






7/18/2018 State of lowa Mail - Fwd: IDHA written testimony

Jackson, Amy <[email protected] ov>

Fwd: IDHA written testimony1 message

Jill Stuecker <[email protected]>To: Amy Jackson <[email protected]>

Wed, Jul 18,2018 at 9:31 AM

Forwarded messageFrom: Steven Garrison <[email protected]>Date: Wed, Jul 18, 20'18 at 9:14 AMSubject: Fwd: IDHA written testimonyTo: Stuecker, Jill <[email protected]>

To members of the lowa Denta! Board:

On behalf of the lowa Dental Hygienists' Association, thank you for the opportunity to offer

comments on the changes to lowa Administrative Code 650-Chapter 10 contained in ARC

3849C.

This rule makes the following important changes to the current rules: (1) removing the prohibitionof ownership of a dental practice by a dental hygienist; (2) updates to public health supervisionrequirements for dental hygienists; (3) implementing procedures for the use of silver diaminefluoride in public health supervision and (4) updating the requirements for notifying the Board of achange in name or address.

We support the change to 650-10.4 because the current language no longer reflects the modernrealities of dental practices where the owner of the practice may not be a dentist.

The change to 650-10.5 (2) d. addresses the practice experience requirement for a hygienist tobe employed in a public health setting. We feel that the dentist who supervises and the public

health agency who employs the hygienist are empowered to determine whether a hygienist,whether she/he has one year or multiple years of experience, should be allowed to practice in apublic health setting.

Regarding the change to 650-10.5 (3), we support dental hygienists working under public healthsupervision to be able to apply silver diamine fluoride. lt is another preventive service that this

https://mail.google.com/mail/u/0/?ui=2&ik=886cdaff22&jsver=hlCmByCRTiM."n.96Sl=gmail _le_180711 .12_p1&view=pt&search=inbox&th= 164adcdab. . .

7′ 18′2048 State oflowa Mal‐ Fwd IDHA wntten teslmony

dental hygiene workforce can ofFer which can lower costs and prevent rnore dental disease.

Thank you for your careful consideration of these issues.

Tonya R. Enright, CDA, RDH, BSDH, MEd, EdD(c)2018-2019 President, lowa Dental Hygienists' AssociationDental Hygiene Faculty, Hawkeye Community CollegeBHS-DH Program Director, Allen College

Steve Garrison I Program Officerlowa Dental Board 1400 Sw 8th St. Suite D I Des Moines, lA 50309Otfice: 515.281.3248 | Fax: 515.281.7969 | http://www.dentalboard.iowa.gov/

Ensuring that lowans receive professional, competent, and safe dental care of the highest quality.


Confidentiality Notice: This e-mail message, including any attachments,,s for fh6 so/e use of the intended recipient(s), and maycontain confidential and pivileged information. Any unauthorized review, use, dlsc/osure or dlstribution is prohibited. lf you are notthe intended recipient(s), please contact the sender by reply e-mail and destroy all copies of the original message.

Steve Garrison I Program Officerlowa Dental Board | 400 SW Bth St. Suite D I Des Moines, lA 50309Office: 515.281.3248 | Fax:515.281.7969 lhttp://www.dentalboard.iowa.gov/

Ensuring that lowans receive professional, competent, and safe dental care ofthe highest quality.


Confidenriality Notice: This e-mail message, including any attachments, is for the sole use of the intended recipient(s), and may

contain confidential and privileged information. Any unauthoized revieL use, disclosure or distribution is ptohibited. lf you are not

the intended recipient(s), please contact the sender by reply e-mail and destroy all copies of the otiginal message.

httpsJ/mait.google.com/maiUu/O/?ui=2&ik=886cdaff22&jsver=hlCmByCR'IilV,en,&cbl=!mail-fe_1807'11.12i1&view=pt&search=inbox&th=164adcdab...2/2

7/13/2018 State of Iowa Mail - support



support 1 message

Dawn Ericson <[email protected]> Thu, Jul 12, 2018 at 3:58 PMTo: "[email protected]" <[email protected]>

To whom it may concnern,

I am full support of the changes to Iowa Administrative Code 650-Chapter 10 & 16. The changes in the code will help thePublic Health Sector provide care and education for those in greatest need. Removing restriction to for a dental hygienistto own a dental practice will also provide a new avenue to provide care and have some investment in a business in Iowa.

Dawn Ericson, RDH BS

WIC/MCH I-Smile Coordinator

Mid-Sioux Opportunity Incorporated

400 Central Avenue NW Suite 810

Orange City, Ia 51041

Or

410 Marion Street

Remsen, Ia 51050

[email protected]

712-707-9868

This email message and its attachments may contain confidential information that is exempt from disclosure under Iowa Code chapters 22, 139A, and otherapplicable law. Confidential information is for the sole use of the intended recipient. If you believe that you have received this transmission in error, pleasereply to the sender, and then delete all copies of this message and any attachments. If you are not the intended recipient, you are hereby notified that anyreview, use, retention, dissemination, distribution, or copying of this message is strictly prohibited by law.

https://maps.google.com/?q=400+Central+Avenue+NW+Suite+810+%0D%0A+Orange+City,+Ia+51041&entry=gmail&source=g



https://maps.google.com/?q=410+Marion+Street+%0D%0A+Remsen,+Ia+51050&entry=gmail&source=g

https://maps.google.com/?q=410+Marion+Street+%0D%0A+Remsen,+Ia+51050&entry=gmail&source=g


7/13/2018 State of Iowa Mail - support


7/09/2018

To the Iowa Dental Board,

The Iowa CareGivers www.iowacaregivers.org supports the following rule changes to Iowa

Administrative Code 650-Chapters 10 and 16.

1. Allows a dental hygienist with one year of experience instead of 3 years to apply for a Public

Health Supervision Agreement.

• Would allow a greater number of dental hygienists to qualify as instructors for Mouth Care Matters

(MCM), a one-day oral health training program designed for nurse aides, home care aides, and

other direct care workers (DCWs). The program is also suitable for nurses and other health

professionals. Since most of the hands-on care is provided by DCWs they are critical to older

Iowans and people with disabilities receiving access to daily oral care. Because staff turnover rates

are often high in this sector of the workforce, it is also vitally important that we train as many

DCWs as possible. Dental hygienists are ideal candidates to fill that role.

Those who work in direct care receive very little training in the area of oral care and those

completing the training have stressed the value of the training to increasing their understanding

about the connection between oral care and one’s overall health and well-being. Existing MCM

instructors have the capacity to make a remarkable impact on prevention, enabling Iowans to

remain healthy and independent longer, and enhancing the quality of care for Iowans of all ages

and abilities. For more information about Mouth Care Matters:

http://www.iowacaregivers.org/uploads/pdf/2018-mcmhighlights.pdf

2. Implement procedures for the use of silver diamine fluoride (SDF) in public health supervision.

Allows a dental hygienist with the proper training and a public health supervision agreement to

apply SDF in a public health setting, including nursing facilities.

• Well-documented are the challenges associated with workforce shortages, high staff turnover, and

inadequately trained/prepared staff. Those conditions don’t bode well for older Iowans in nursing

homes and other settings, who as a result, often go without the oral care they need in order to live

healthy lives. Until a system is in place that ensures a stable, well-educated, compensated health

and long-term service and support (LTSS) workforce, it is crucial that we use treatments such as

SDF, proven to be effective.

If hygienists are able to provide SDF under public health supervision agreement to the elderly in a

nursing facility setting it will help to arrest and prevent dental caries in those who cannot seek,

tolerate or afford dental treatment. It will help this vulnerable population receive access to better

oral health and quality of life.

Thank you for your consideration of these changes to Iowa Administrative Code 650-Chapters 10 and 16.

Respectfully submitted by

Di Findley, Executive Director

Iowa CareGivers

515-249-0138 [email protected]

7/13/2018 State of Iowa Mail - Iowa Admin Code 650



Iowa Admin Code 650 2 messages

becky hackett <[email protected]> Fri, Jul 13, 2018 at 1:59 PMTo: "[email protected]" <[email protected]>

Dear Mr. Garrison,

My name is Rebecca Hackett-Leas. I am a dental hygienist and have held a license to practicedental hygiene for nearly 30 years. I worked in private practice until October of 2014 when I startedmy career in public health.

I wish to relay to you, while I fully understand the need to increase access to dental care for theunder-served, I believe that it is less than ideal to allow hygienists with less than 3 years ofexperience to obtain a public health supervision agreement. The expertise of the dental hygienistcomes from his/her education but is enhanced and developed by his/her experience. I can attestthat I would not have felt comfortable after one year of experience doing the duties and providingthe assistance to my public health clients that I have done for the past 3-4 years as a public healthdental hygienist, with only a year of clinical experience. Please consider my views when youconsider the changes to the Iowa code.

I also would like you to consider the need for silver diamine fluoride in public health. This is ahighly researched, cost effective, and safe way to arrest decay. Please do what you can to helpthose with active dental decay, who do not have the resources to have a visit with a dentist in theiroffice, to arrest the decay and maintain more of the integrity of their tooth.

Thank you for your service to the State of Iowa.

Smiles, Rebecca Hackett-Leas

Steven Garrison <[email protected]> Fri, Jul 13, 2018 at 2:19 PMTo: [email protected]

Thank you Ms. Hackett-Leas. I'll be sure to include your email with the public comments. [Quoted text hidden]-- Steve Garrison | Program OfficerIowa Dental Board | 400 SW 8th St. Suite D | Des Moines, IA 50309Office: 515.281.3248 | Fax: 515.281.7969 | http://www.dentalboard.iowa.gov/






6t2gl201a State of lowa i/tail - Fwd: comments about Rule Change

Braness, Christel <[email protected]>

Fwd: comments about Rule Changel message

Phil Mccollum <[email protected]> Thu, Jun 28, 2018 at 9:31 AMTo: Christel A Braness <[email protected]>, Steven Garrison <[email protected]>, "Stuecker, Jill IDB|<[email protected]>

Below is second comment I've received. You are lracking these now right Christel ?? Guess I never asked.

Phil Mccollum I Associate Director


Ofiice: 515.281.3739 lFax: 515.28'1.7969 | http://www.dentalboard.iowa.gov

Ensuing that lowans receive professional, competent, and safe dental care of lhe highest quality.


Confidentiality Notice: fhis e-mail message, including any attachments,,s for lhe sole usa of the intended rocipient(s), and maycontain confidential and privileged information. Any unauthorizod review, use, disc/osure or d,stibution is prohibitad. lf you are notthe intended rccipient(s), please contact the sender by reply etnail and destroy all copies of the odginal message.

------ Forwarded message -----From: Meg Hamilton <[email protected]>Date: Wed, Jun 27,2018 al4:44 PMSubject: comments about Rule ChangeTo: [email protected] <[email protected]>

I his nressagc was scr rl secLr ely usrng ZirCorp

Phit,

lwanted to make some comments about the concerns I have with the rule changes. I like that there is a three yearexperience rule in force. As a dental hygienist lworked in a dental setting for 10 years between dental assisting andhygiene. Asagraduateof two dental programs lfeel school is completely different from the real world. The teachers canonly teach you so much in the classroom. For instance, in dental assisting school we took radiographs on manikins. I

remember when lwoked on a patient in a dental office and had totake 18 radiographs. lwas so nervous, unconfident,and sweating!

I understand with any job you have to be willing to learn and grow lt takes a lifetime. Working with new dental hygieniststhey would ask a lot of questions, weren't sure of themselves, and were emotional. My advice would be it could take 2years before you feel comfortable in your position.

A concem that was voiced was there aren't many applicants. I know when we had to our internships for school we onlywent to a private practice. We rarely discussed Public Health.

ln all, I think 3 years of dental hygiene experience or an accumulation of dental assisting and dental hygiene experiencewould be best.

https://mail.google.com/ma;l/ui0?ik=bb15062355&vi6w=pt&search=all&permthid=thread-f%3A1604527126820017 9378simpl=msg-f%3A16045271264...

6D8t2018

Thank you, Meg

State of lowa Mail- Fwd: comments about Rule Chang€

7ltq*ar*rilrir4, ?T*?ril(r. *eakn Da 'al fu4zaiotJohnson County Public Hoalth

855 South Dubuque Street

lowa City, lA 52210

Phone: 319688-5909

Fax:3193396176

[email protected],us

How are we doing? https://www.surveymonkey.com/r/jcphSatisfaciion

www johnson-county.com/health

wwwjohnson-county.com/heallh

EEmail Signature FB logo

Llttp://3835642c2693476aa71744b78efce91b973Obcca72Sc€bb0b37.r51.cfl.rackcdn.com/Multi-_ Color_Logo_thumbnail200.pnglr,]rttps://encrypted-tbn0.gstatic.com/images?

q=tbn:ANdgGcSkVV-ZlMgY69PLbOXSSNVEllD9wzp3924qwbWChiQmZrvGbaMQFnkg

PLEASE BE GREEN, pleasc consider the eavironment bcforc printing this e-mail.

llotlc. of Confid.nilallty: This e-mail and any fi16 transmitted with it may contain conlidenlial or gMleged informaton and is intended solely forthe use of the individual(s) o. entity to whom it is addressed. Any unauthorized review use, disdosure or dlstribution is prohibited. lf you have

received this e-mail in enor, ploasa delete it fiom your syslem.

This message was secured by ZkCorp(R).

4 attachments

image00l jpg

State of lowa Mail - Fwd: comm€nts about Rule Change

image002.png8K

image003.lpg2K

image002.png8K

6n4t2018

EeEltr

https://mail.google.com/maiUu/o?ik=bb15062365&view=p8s6arch=all&permthid=throad-f/3A16U52712ffi20017937&dmpl=msg-fA3A1N45271264...3B

6t28nO1A State of lowa Mail- Fwd: public comment

Braness, Christel <chrlstel,[email protected]>

Fwd: public comment2 messages

Phil Mccollum <[email protected]> Wed, Jun 27, 2018 at 3:44 PMTo: 'Stuecker, Jill !DBl" <[email protected]>, Steven Garrison <[email protected]>, Christel A Braness<christel.braness@iowa. gov>

l'm forwarding this since she has a public comment attached.

I will respond to the nurse PH question.

Phil Mccollum I Associate Directorlowa Dental Board | 4OO SW th Street, Suite D I D€s Moines, lA 50309

Offce: 515.281.3739 | Fax: 515.281.7969 | http://www.dentalboard.iowa.gov

Ensuing that lowans receive professional, competent, and safe dental care ofthe highest quality.

We value you feedback! Click here to tell us how we're doing.

Confidenttality Notlce: This e-mail message, including any attachments, is tor the sole use of the intended recipient(s), and maycontain confidential and privileged information. Any unauthorizod review use, disclosure or didibt,tion is ptohibiled. lf you arc notthe intended rocipient(s), please contact the sender by reply e-mail and destoy a copies of the oMina, message.

----- Forwarded message --From: Dawn Doore <[email protected]>Date: Wed, Jun 27, 2018 at 1: 15 PMSubiect: public commentTo: [email protected] <[email protected]>

Phit,

Thank you for your lurisprudcnce w€binar. lt was informstive. I hgve one queetion. lf a nuB€ ls lvorking aE an a$istant ina dental sealant program, do th€y n6€d to h8\re a dental assistanfs public health supervbion agr€oment? I have alsoattach€d my public comment on changcs to 10.5(2)d that I would liko to trken into oonsideration.

Thanks,

Dswn T. Door€, RDH

Public Health Comment.docx15K

Phil Mccollum <[email protected]\r>To: [email protected]: [email protected]

Wed, Jun 27, 2018 at 3:49 PM

Thanks Oawn

Per our rules, only a DA or DH can work under PH supervision agreements. While a nurse can perform the services of aDA, that does not mean they are a DA. lf a nurse is performing this type of work, they are doing so under their nursinglicense.

https://mail.google.com/mail/u/o?ik=bb'15062365&view=pt&search=all&permthid=threed-fyo3A160,1460010568174211&simpl=msg-F,63A16044600105...

6nu2018 State of loxl6 Mail - Fwd: public commsnl

Phil Mc€ollum I Assodate Diredorlowa Dental Board I 400 SW 8fl Sf€€t, Suite D I Des Moines, lA 50309

Offce: 515.281.3739 | Fax: 515.281.7969 | http:/ uvr,.dentaboe.d.lm.gov

Ensuing that lowans raceive professional, @m,E,tent, aN sab dental care of the highesl quaw

We value your leedbackl Click h€re to tell us lnw we'rc doing.

Confun lalw l{o/t co,' Ihb o-rnar7 rnessagte, itl6;h.ding any sltodnt7p/nfa, is br rrro sob uso ol the irilondod /€(tpbI,/s), aN fiEy@ntain confidantiat ad privilegad intom€tlon. Any unautllotizod lEv,arr, rrso, dist osurE or distriDrrfioD E ptdtbited, lf W a.e nolthe intended recipient(s), p|€,e{E.' @ntad the ean&r by rcply e-mafl aN desboy d @pies ot tlt€ ortglr,s/l rrressago.

Iouored bn hEd€nl

https://mall.googl€.com/mail/u/0?ik=bb15062365&viri=pt&search=all&pem hid+edff63A16M46001056817421l&simpl=rEg-O63A160,1,1600105... 22

June27,2Ol8The following is comment on proposed changes to 10.5(2)d.

I would like to make a public comment on the proposed change to the public supervision fordental hygienists. I am speaking as a public health hygienist. I have been working in public

health for about 14 years. I had 4 years of clinical experience before I started doing dental

screenings, fluoride varnishes and dental sealants. I have been lucky to have worked with many

very good dentists that showed me any aspects of dentistry that I would not normally see.

These dentists gave me the information to help me as I work alone in the public health settings.

I see conditions that I would not see in a private office because the patients that I see may not

see the dentist regularly if they have never seen a dentist. I believe that hygienists need to have

enough experience before they go out into public health clinics and work by themselves. lt isstated that a hygienist needs three years of experience before they can get a public health

supervision agreement. I believe that if any changes to this requirement are made it should be

made by the number of clinical hour they have worked. lf a hygienist works a forty hour week

for 50 weeks a year, they would have 2000 hours of clinical experience. lf you have a hygienist

working one half day a week for 50 weeks, they would only have 200 hours of experience. Both

would have the one year experience. Which hygienist would have more experience? I feel thatif I did not have the experience that I had before going into public health, I would not have theknowledge of what I was seeing in the mouth of some of my patients. Without having

experience, it is much harder to deciding if something is normal or an abnormality. I am always

trying to educate the assistant that is working with me. lf I see something that is usual or out ofthe ordinary, ltry to show them so they can be better educated. I feel that a dental hygienist

needs to have at least 2000 hours before being able to have a public health supervision

agreement to work doing dental screenings, fluoride varnishes, prophies and dental sealants.

You need the experience to be able to handle any situation that comes up. You must be

confident in your ability to handle any situation. I believe that if you have a number of provable

clinic hours then you insure that the patients are having services done by someone with clinical

knowledge. Public health is not like your typical office setting.

I would like to add that sometimes the dental hygienists may not be doing dental screenings,

fluoride varnishes, prophies or sealants but working as dental assistants. These hygienists

should be able to work in the assistant role with the same requirements that a dental assistant.

One year with no amount of hours worked in an office. I have had hygienists work with me as

assistants. They had to have 3 years' experience just to hand instruments, use the suction, and

clean up and set up. I have assistants that only had l year experience. Did one do a differentjob? No. Was one better that the other? No. I hope that you would consider having a provision

for dental hygienists to work as dental assistant who would only need one year of some kind of

experience. This would be a way for dental hygienists to see what it is like to do public health. ltwould also help in finding a person to help in public health clinics when there is a shortage ofdental assistants.

I would like to thank you for lettinS me make this comment to you for your consideration. lf you

have any questions, about what is involved working in the public heahh please let me know. I

would more than gladly answer them or come and talk with you.

Dawn T. Doore, RDH, CDA

6t2at201a State of lowa Mail - Fwd: Letter of Support

Braness, Christel <[email protected]>

Fwd: Letter of Support'| message

Phil Mccollum <[email protected]> Thu, Jun 28, 2018 at 1:26 PMTo: Christel A Braness <[email protected]>, "Stuecker, Jill IDBI" <[email protected]>

another comment for the file

Phil McCollum I Associate Director

lowa Dental Board | 400 SW 8th Street, Suite D I Des Moines, lA 5O3Og

Ofricer 515.281 .3739 | Fax: 515.281 .7969 | http:/tu/ww.dentalboard.iowa.gov

Ensuring that lowans receive professional, competent, and safe dental care of the highest qualu.


Confidentiality Notice: This e-mail message, including any aftachments, is for the so/e use ofthe intended recipient(s), and maycontain conlidential and privileged information. Any unauthorized revisw, usq d,sciosure or drstibution is prohibiled. lf you are notthe intended recipient(s), please contact the sender by reply e-mail and destroy all copies of the oiginal message.

------- Forwarded message -----From: Bob Russell <[email protected]>Date: Thu, Jun 28, 2018 at l2:09 PMSubiect: Letter of SupportTo: Phil Mccollum <[email protected]>Cc: Jill Stuecker <[email protected]>

Phil,

Please flnd attached a letter of support for proposed rules adoption to AC 650-10:16 ARC 3849C.

Thank you!

Bob

Bob Russell, DDS, IVPH, CPM, FACDDental Director & Bureau ChiefOral & Health Delivery Systems Bureau,Division of Health Promotion and Chronic Disease Prevenlion i lowa Department of Public HealthLucas State Office Building / 321 East 12th Streev Des Moines, lowa 50319P: 515-281-4916 F . 515-242-6384'Protecting and lmproving the Health of lowans"

6l FINAL lefter ot IDB Rules Adoption 6.28.2018.docx- 58K

httpsr/mail.google.com/mailiuio?ik=bb'15062365&view=pt&search=all&permthid=thr6ad-f%3A'16045418959'12138206&simpl=msg-f/o3A16045418S59... 1/'1

YIDPHlowa Department of Public HealthProlecting and lmproving the Healtlt of lowans

Gerd W. Clabaugh, MPADirector

Kim ReynoldsGovernor

Adam GreggLt. Govemor

June 28,2018

Phil McCollum, Associate DirectorIowa Dental Board400 SW 8th Street, Suite DDes Moines, IA 50309- 4687

RE: Administrative Code 650-10; 16: ARC 3849C

Dear Mr. McCollum,

The Iowa Department of Public Health (IDPH), as the state organization with a mission to " Support apublic health rr-stem that promotes healthy behaviors, prevention of disease and provides access locare", supports the Iowa Dental Board's proposal to adopt rules related to public health supervision fordental hygienists.

The impact of the proposed changes will increase improve public health preventive care access forunderserved Iowans. The aspect ofthe changes ofmost importance is the addition ofSilver DiamineFluoride, a proven effective arrester ofdental caries. Use ofSilver Diamine Fluoride will allow earlyprevention ofadvancing dental decay when detected. This will further provide time for patient access todentists to provide definitive care when and where needed. Additionally, reducing the time a dentalhygienist has to quali$r to work under Public Health Supervision enhances the ability to field a trainedcompetent oral care tearn for Iowa's neediest communities.

Iowa's network ofdental care coordination, 1-Sz ile, I-Smile Silver which was created and sponsored bythe Iowa Department of Public Health and the Iowa Department of Human Services, partners withIowa's dentists to provide an oral health "safety net" for Iowa's underserved children. The addition oftools to improve prevention and early detection will greatly enhance a system that has served as bestpractice model throughout the USA.

Please consider this letter our endorsement for the proposed rules change. We look forward to furtheropportunities to partner with the Iowa Dental Board in meeting the oral health needs oflowans.

Sincerely,

Gl 7**t4 a'('<"tl,1

Bob Russell, DDS, MPH, CPM FACD

Lucas State Office Building, 321 E. 12th Street, Des Moines, lA 50319-0075 r 515-281-7689 r www. idph.iowa.gov

DEAF RELAY (Hearing or Speech lmpaired) 7l l ot 1400-735-2942

www. deltadentalia. com

July 11, 2018

Mr. Phil McCullomIowa Dental Board400 SW 8th Street, Suite DDes Moines, IA 50309-4686

DearMr. McCullom:

We are writing regarding the board's request for input on ARC 3849C that outlines changes toChapter 10, "General Requirements," and Chapter 16, "Prescribing, Administering, andDispensing Drugs," Iowa Administrative Code. We are in support of ARC3849C andencourage the passage of the proposed rules changes.

We support the reduction of the clinical experience required for a licensed dental hygienist towork in a public health setting understanding that this change brings about consistency withinthe requirements of these dental professionals providing care to underserved Iowans. Inaddition, we support the use of and application of a licensed dental hygienists to use silverdiamine fluoride (SDF) in a public health setting and the setting forth of parameters for itsuse. There is overwhelming evidence that SDF is safe and effective and poses no threat to thesafety of Iowans when utilized in such a public health setting.

We believe the above noted changes are a key component to achieving Delta Dental of IowaFoundation's oral health 2020 goals every Iowa child age 0-l2,living in a households withincomes below 300 percent of the federal poverty level, will be cavity-free; and every Iowanursing home resident and homebound elderly person will have access to oral health care. lnfact, the opportunity to increase care coordination and preventive care in public health settingscan reach a broader underserved population to support and improve their oral health in Iowa.

Sincerely,

η- 'r4#? qdi-,

Do5

Suzanne Heckenlaible, MPAVice President, Public AffairsDelta Dental of Iowa

Dclta I)cntal of lo、va

9000 Northpark D五 vc

Johnston,IA 50131

Tclcphonc 515‐ 261-5600

Toll Frcc 877-983-3582

Facsinlllc 51 5-261-5573

Jeff Chaffin, DDS, MPH, MHAVice President & Dental DirectorDelta Dental of Iowa

WE LOVE TO SEEッ Oνr SMILEQ

A orrn DENTAI

RECEIVEDJllr 1l ?Lll8

711 Jewel DriveIOWA DEN'IAL BOARD

Ames, lowa 50010

July 16,2018

lowa Dental Board

400 5W 8th Street. Suite D

Des Moines, lowa 50309-4686

Dear Members of the lowa Dental Board

I support the proposed lowa Administrative Code 650-Chapter 10 and 16 because I believe it ls

consistent with lowa's need for greater involvement of dental hygienists in attending to the needs oflowans. As you are fully aware, there are many areas in the state where it is very difficult to receive

services. The proposed rule responds to this need.

Sincerely,

7/17/2018 State of Iowa Mail - testimony



testimony 2 messages

Nancy Miller <[email protected]> Tue, Jul 17, 2018 at 1:56 PMTo: [email protected]

Hello Steve, I am including this in the e-mail and attaching it - not sure what format is best. July 17, 2018 Via e-mail to: [email protected] To members of the Iowa Dental Board: Thank you for allowing public comments regarding changes to Iowa Administra�v e Code 650-Chapters 10and 16 contained in ARC 3849C. I am in support of all the changes in Chapter 10 pertaining to dental hygienists: 1) removing theprohibition of ownership of a dental practice by a dental hygienist; (2) updates to public healthsupervision requirements for dental hygienists; (3) implementing procedures for the use of silverdiamine fluoride in public health supervision and (4) updating the requirements for notifying theBoard of a change in name or address. Rule 650-10.4 no longer applies to all dental practices since, for example, a corporation can own adental practice so this change is appropriate to keep up with today’s changing situations. Rule 650-10.5 (1) d. is restrictive on the hiring of dental hygienists who desire to work in publichealth settings. I know the Iowa Dental Board has already granted waivers for those competenthygienists who did not have the three years of practice experience. Our Iowa dental hygieneeducational programs prepare students to work in all practice settings so I support changingthe requirement from three years of practice experience to one year. My comment on Rule 650-10.5 (3) is that I support the application of silver diamine fluorideby dental hygienists who work under public health supervision. Silver diamine fluoride is ideal forpublic health settings where services that are safe, quick to perform, economical, easy, and pain-free for a population that has a high caries rate and is fearful. Its application requires no anestheticand no caries removal. This is another preventive procedure easily performed by a dentalhygienist and may help patients be more accepting of dental procedures.

Your careful consideration of these changes is much appreciated.

Nancy Miller, RDH, BS

7/17/2018 State of Iowa Mail - testimony


.

Testimony for rule changes.docx 27K

Steven Garrison <[email protected]> Tue, Jul 17, 2018 at 1:59 PMTo: Nancy Miller <[email protected]>

Thank you. I’ll add this to the comments we’ve received. [Quoted text hidden]-- Steve Garrison | Program OfficerIowa Dental Board | 400 SW 8th St. Suite D | Des Moines, IA 50309Office: 515.281.3248 | Fax: 515.281.7969 | http://www.dentalboard.iowa.gov/




https://mail.google.com/mail/u/0?ui=2&ik=987c77d366&view=att&th=164a999724386d8f&attid=0.1&disp=attd&realattid=f_jjq20i8s0&safe=1&zw



7/18/2018 State of Iowa Mail - Fwd: Supporting code changes

https://mail.google.com/mail/u/0/?ui=2&ik=886cdaff22&jsver=hICmByCRTiM.en.&cbl=gmail_fe_180711.12_p1&view=pt&search=inbox&th=164adcdfff3… 1/2

Jackson, Amy <[email protected]>

Fwd: Supporting code changes 1 message

Jill Stuecker <[email protected]> Wed, Jul 18, 2018 at 9:31 AMTo: Amy Jackson <[email protected]>

On Tue, Jul 17, 2018 at 9:54 PM Kara Parcher <[email protected]> wrote:

TO: [email protected]

FROM: Kara L. Parcher RDH

DATE: July 15, 2018

RE: testimony in support of rule changes to Iowa Administrative Code 650 – 10.4, 10.5

Thank you for the opportunity to express my support for the following rule changes:

1) Eliminate the prohibition against ownership of a dental practice by a dental hygienist.

2) Reduction of the number of years of clinical practice experience required for a licensed

dental hygienist to be employed in a public health setting.

3) To allow dental hygienists who work under public health supervision to apply silver

diamine fluoride according to board-approved protocols.

4) To implement clearer requirements for reporting changes of name and address.

I appreciate the many hours the members of the Dental Board have spent working on the wording of these changes taking into consideration

the input from other interested entities.

In rule 10.4, focus is on the level of supervision under which a dental hygienist must work, rather than practice ownership.

Regarding the changes in rule 10.5, the qualifications of the dental hygienist seeking employment in the public health arena should be the

main consideration, not the years of clinical practice. It is important to keep these important positions filled to meet the needs of the many

clients served through the public health agencies. Since the inception of the I-SMILE program in 2005, 80% more Medicaid enrolled children

had dental visits due to the diligent efforts of the dental hygienist coordinators. Allowing dental hygienists working under public health

supervision to apply silver diamine fluoride is one more preventive service that these coordinators can perform to lower costs and prevent

more dental disease.

Thank you for your careful consideration of these issues.

-- Steve Garrison | Program OfficerIowa Dental Board | 400 SW 8th St. Suite D | Des Moines, IA 50309Office: 515.281.3248 | Fax: 515.281.7969 | http://www.dentalboard.iowa.gov/






7/18/2018 State of Iowa Mail - Fwd: Supporting code changes

https://mail.google.com/mail/u/0/?ui=2&ik=886cdaff22&jsver=hICmByCRTiM.en.&cbl=gmail_fe_180711.12_p1&view=pt&search=inbox&th=164adcdfff3… 2/2



-- Steve Garrison | Program OfficerIowa Dental Board | 400 SW 8th St. Suite D | Des Moines, IA 50309Office: 515.281.3248 | Fax: 515.281.7969 | http://www.dentalboard.iowa.gov/








7/5/2018 State of Iowa Mail - Public Comment on IAC 650 - Ch 10



Public Comment on IAC 650 - Ch 10 3 messages

Danielle Pettit-Majewski <[email protected]> Thu, Jul 5, 2018 at 3:07 PMReply-To: [email protected]: [email protected]

Mr. Garrison-

Good afternoon. I wanted to tell you that I’m incredibly pleased to see the proposed change in 650 – 10.5(153) PublicHealth Supervision. As an Administrator for a Local Public Health Agency and a Title V agency, I will tell you thatchanging the requirement from three years of experience to one year of experience, would have been incredibly helpfullast year. We had a vacancy for our I-Smile Coordinator for seven months in 2017 because we couldn’t find a singleapplicant with three years of experience. In our rural area, it is incredibly difficult to find a dental hygienist. We had onecandidate who had about 2 ½ years of experience, and we had to get a special waiver to get a Public Health Supervisionagreement. This waiver process required our position to remain vacant for four months longer than would have beennecessary had this change been in place last year. That meant we had to reduce services to our community members.

Eventually our waiver was approved and our dental hygienist was hired, and she has been doing incredibly well. If adentist is willing to provide supervision to a hygienist, let’s remove barriers to care for other rural counties like mine.

I am definitely in favor of this change.

Thanks!

Danielle Pettit-Majewski BS, MPH

Administrator

Washington County Public Health & Home Care

110 North Iowa Avenue, Suite 300

Washington, IA 52353

p) 319-653-7758 f)319-653-6870

This e-mail message, including any attachments, is for the sole use of the intended recipient(s) and may containconfidential and privileged information covered by the Electronic Communications Privacy Act, 18 U.S.C. §§ 2510-2521. Any unauthorized review, use, disclosure or distribution is prohibited. If you are not the intended recipient, please contactthe sender by reply e-mail and destroy all copies of the original message.

“Public health is filled with heroes, both well known and unknown. They arevisible on the national or international stage or they work quietly in

https://maps.google.com/?q=110+North+Iowa+Avenue,+Suite+300+Washington,+IA+52353&entry=gmail&source=g

https://maps.google.com/?q=110+North+Iowa+Avenue,+Suite+300+Washington,+IA+52353&entry=gmail&source=g

7/5/2018 State of Iowa Mail - Public Comment on IAC 650 - Ch 10


communities with families and individuals. When they do their job, they oftenbecome invisible.” ~Dr. Harrison Spencer

Steven Garrison <[email protected]> Thu, Jul 5, 2018 at 3:17 PMTo: [email protected]

Thank you for your comments. Best,[Quoted text hidden]-- Steve Garrison | Program OfficerIowa Dental Board | 400 SW 8th St. Suite D | Des Moines, IA 50309Office: 515.281.3248 | Fax: 515.281.7969 | http://www.dentalboard.iowa.gov/




Danielle Pettit-Majewski <[email protected]> Thu, Jul 5, 2018 at 3:20 PMReply-To: [email protected]: Steven Garrison <[email protected]>

Thanks for your considera� on!

Danielle

From: Steven Garrison [mailto:[email protected]] Sent: Thursday, July 05, 2018 3:17 PM To: [email protected] Subject: Re: Public Comment on IAC 650 - Ch 10

[Quoted text hidden]





PublicHealthIt.v..r. 1..!noi.. Pr6r..r.

Webster County Health Deparlment723 l"iAve. S, Suite 220Fort Dodge, lA 50S01Telephone: (515) 573-4107 Faxz (515) 955-1682Email: [email protected]

July 16,2018

Ms. Stuecker, Mr. Garrison and Mr. McCollum,

Webster County Health Department would like to thank the lowa Dental Board for this opportunity toprovide public comments regarding changes to lowa Administrative Code 650-Chapters 10 and 16.

We would recommend that the lowa Dental Board approve the following changes: removing theprohibition of ownership of a dental practice by a dental hygienisi; updates to public healthsupervision requirements for dental hygienists; implementing procedures for the use of silver diaminefluoride in public health supervision and updating the requirements for notifying the Board of a changein name or address. We think it is important for the board to consider the collaborative effort by themany stakeholders who provided input for these changes.

The changes to this rule will allow the dental hygiene workforce more opportunities to serve residentsthrough a community based organized public health system. Reducing the numberof years of wortexperience from three years to one year for a dental hygienist to work under public health supervisionwill bring more qualified individuals into the public health supervision workforce. The challenges facedby patients for geting into a traditional dental practice setting will be reduced if dental hygienists areable to utilize silver diamine fluoride when working under public heahh supervision in such places asnursing homes and school dental health programs. Taking dental services into community setting willreduce the burden of dental disease, provide additional opportunities to educate lowans on theimportance of good oral health and lower the risk of more expensive medical and dental care.

Your thoughtful consideration of these comments is appreciated.

/ura-ugfKari PrescottExecutive DirectorWebster County Health Department7235 15t Ave SFort Dodge, lA 50501kprescott@webstercountvia. orq(s1s) 573{107 Ext

7/13/2018 State of Iowa Mail - Iowa Administrative Code 650-Chapters 10 and 16



Iowa Administrative Code 650-Chapters 10 and 16 2 messages

Melissa Ringnalda <[email protected]> Fri, Jul 13, 2018 at 1:40 PMTo: [email protected]

Mr. Garrison, Hello Mr. Garrison, My name is Melissa Ringnalda, I am a registered dental hygienist. I am wri� ng you to express my concern allowingPublic Health Dental Hygienist to only have 1 year of clinical experience. I completely understand the issue withfinding dental hygienist to work in public health and by lowering the number of years of experience will open up awider range of poten� al candidates for so call posi� ons. However, by lowering the years of experience you now takea very green dental hygienist and place them in a situa� on to accurately screen pa� ents who will have a wide rangeof poten� al issues. I worked in private prac� ce for 10 years before I worked in Public Health. If it wasn’t for all ofthose years of experience I would not have been able to accurately discuss, screen, or even educate my clients atPublic Health. I learned so much from the Den� sts I worked for to help me in the den� stry field. Just by going to anaccredited dental hygiene program and being in private prac� ce is not going to expose you to everything that ispossible in the oral cavity. When in the Public Health Sector as a dental hygienist you don’t have an experiencedDen� st to go and ask their advice on a par� cular case. You don’t get the records of your clients from their dentalhome to compare what you are seeing in their oral cavity. You have to have the experience to know what you visuallyare seeing. That experience is valuable and doesn’t come from being in dental hygiene school for 2 years and only 1

year of private prac� ce. I learned more in my 1st 5 years out of school and without that I would have been very lostand done a disservice to the clients who NEED the services provided in Public Health. Please consider this informa� on and do not let the years of experience be lowered from 3 years to 1 year under thisnew apposed law. In regards to Silver Diamide Fluoride I feel that the best place for this to be placed on clients will be in public health. These are the clients who would benefit from it the most. However I wouldn’t want a dental hygienist with only 1year of experience to place this on children’s teeth. Not that the hygienist wouldn’t be capable, they just would nothave the experience of working with children who would poten� ally have several areas in the mouth that would needto be arrested by the use of Silver Diamide Fluoride. It is ge� ng to be more difficult for people with medicaid insurance to find dental care. Having this be available in thepublic health sector will help benefit some many and help the reduc� on of dental caries if the protocol allows it to beused to its fullest benefit. Thank you for your � me,Melissa Ringnalda, RDH

Steven Garrison <[email protected]> Fri, Jul 13, 2018 at 1:41 PMTo: [email protected]

Thank you Ms. Ringnalda. I'll include this with the public comments. [Quoted text hidden]-- Steve Garrison | Program Officer

7/13/2018 State of Iowa Mail - Iowa Administrative Code 650-Chapters 10 and 16


Iowa Dental Board | 400 SW 8th St. Suite D | Des Moines, IA 50309Office: 515.281.3248 | Fax: 515.281.7969 | http://www.dentalboard.iowa.gov/






7ノ 16ノ2018 State of!owa Mail― FwdilAC 650 comments

Braness, C h riste I <ch ristel.bra ness@i owa. gov>

Fwd:IAC 650 cornrnentsl message

Phil Mccollum <[email protected]> Sun,」 u115,2018 at 6:07 PM

To: ChristelA Braness <[email protected]>, "Stuecker, Jill IDB]" <[email protected]>

Forwarded messageFrom: <[email protected]>Date: Sun, Jul 15, 2018 al3:34 PMSubject: IAC 650 commentsTo: <[email protected]>

Dear Mr. McCollum,

I would like to thank the lowa Dental Board for this opportunity to provide public comments regarding changes to lowaAdministrative Code 650-Chapters 10 and 16. I recommend that the lowa Dental Board approve the following changes:removing the prohibition of a dental practice by a dental hygienist; updates to public health supervision requirements fordental hygienists; implementing procedures for the use of silver diamine fluoride in public health supervision and updatingthe requirements for notifying the Board of a change in name or address. I think it is important for the board to considerthe collaborative effort by the many stakeholders who provided input for these changes.

The changes to this rule will allow the dental hygiene workforce more opportunities to serve those who live in theircommunities. Reducing the number of years of work experience from three years to one year for a dental hygienist towork under public health supervision will bring more qualified individuals into the public health supervision workforce. Thechallenges faced by patients for getting into a traditional dental practice setting will be reduced if dental hygienists areable to utilize silver diamine fluoride when working under public health supervision in such places as nursing homes andschool dental health programs. Taking dental services into community setting will reduce the burden of dental disease,provide additional opportunities to educate lowans on the importance of good oral health and lower the risk of moreexpensive medical and dental care.

I am a registered licensed dietitian and I know first hand the value of good oral health care as people age in maximizingtheir nutritional health, overall health and ability to live independently in the community. These rule changes will benefitthe older lowans I work with.

Your thoughtful consideration of these comments is appreciated.Sincerely,Carlene Russell, MS RDN LDNPleasant Hill, [email protected]

Phil McCollum I Associate Director


Office: 51 5.281.3739 | Fax: 51 5.28'1 .7969 | hftp://wwwdentalboard.iowa.gov

Ensuring that lowans receive professional, competent, and safe dental care of the highest quality.


Confidentiality Notice: This e-mailmessage, including any attachments, is for the so/e use of the intended recipient(s), and maycontain confidential and privileged information. Any unauthorized review, use, disc/osure or distribution is prohibited. lf you are notthe intended recipient(s), p/ease contact the sender by reply e-mail and destroy all copies of the original message.

https:i/mail.google.com/mail/u/0?ik=bb15062aUU*r1"nv=pt&search=all&permthid=thread-f%3A1606099725625839707&simpl=msg-fo/o3A16060997256... 111

7/19/2018 State of Iowa Mail - Rule changes



Rule changes 3 messages

Carol Moreno <[email protected]> Thu, Jul 19, 2018 at 7:05 AMTo: [email protected]

Dear Steven Garrison, I echo Dr Davidson comments. Sincerely, Dr Carol Moreno Sent from my iPhone

Steven Garrison <[email protected]> Thu, Jul 19, 2018 at 7:38 AMTo: [email protected]

Received, thank you. [Quoted text hidden]-- Steve Garrison | Program OfficerIowa Dental Board | 400 SW 8th St. Suite D | Des Moines, IA 50309Office: 515.281.3248 | Fax: 515.281.7969 | http://www.dentalboard.iowa.gov/




Steven Garrison <[email protected]> Thu, Jul 19, 2018 at 7:38 AMTo: "Stuecker, Jill" <[email protected]>

Added to folder. [Quoted text hidden]-- Steve Garrison | Program OfficerIowa Dental Board | 400 SW 8th St. Suite D | Des Moines, IA 50309Office: 515.281.3248 | Fax: 515.281.7969 | http://www.dentalboard.iowa.gov/








CH.I002 lAWS OF THE SEVENTY-EIGHTH G.A., 2000 SESSION

CHAPTER 1002 DENTAL ASSISTANTS - REGISTRATION AND SCOPE OF AUTHORITY

H.F.686

2

AN ACT providing registration requirements and establishing a scope of authority for dental assistants, and providing an effective date.

Be It Enacted by the General Assembly of the State of Iowa:

Section 1. Section 147.13, subsection 8, Code 1999, is amended to read as follows: 8. For dentistry. and dental hygiene, and dental assisting. dental examiners.

Sec. 2. Section 147.80, Code 1999, is amended by adding the following new subsection: NEW SUBSECTION. 27A. Registration to practice as a dental assistant, registration to

practice as a dental assistant under a reciprocal agreement, or renewal of registration to practice as a dental assistant.

Sec. 3. Section 153.14, subsection 1, Code 1999, is amended to read as follows: 1. Students of dentistry who practice dentistry upon patients at clinics in connection with

their regular course of instruction at the state dental college and students of dental hygiene who practice upon patients at clinics in connection with their regular course of instruction at state-approved schools. and students of dental assisting who practice upon patients at clinics in connection with a regular course of instruction determined by the board of dentistry pursuant to section 153.39.

Sec. 4. Section 153.14, Code 1999, is amended by adding the following new subsection: NEW SUBSECTION. 5. Persons registered to practice as a dental assistant.

Sec. 5. NEW SECTION. 153.38 DENTAL ASSISTANTS - SCOPE OF TERM. A registered dental assistant may perform those services of assistance to a licensed den

tist as determined by the board of dentistry by rule. Such services shall be performed under supervision of a licensed dentist in a dental office, a public or private school, public health agencies, hospitals, and the armed forces, but shall not be construed to authorize a dental assistant to practice dentistry or dental hygiene. Every licensed dentist who utilizes the services of a registered dental assistant for the purpose of assistance in the practice of dentistry shall be responsible for acts delegated to the registered dental assistant. A dentist shall delegate to a registered dental assistant only those acts which are authorized to be delegated to registered dental assistants by the board of dentistry.

Sec. 6. NEW SECTION. 153.39 DENTAL ASSISTANTS - REGISTRATION REQUIREMENTS, RENEWAL, REVOCATION, OR SUSPENSION.

1. A person shall not practice on or after July 1, 2001 as a dental assistant unless the person has registered with the board and received a certificate of registration pursuant to this chapter.

2. A person shall be registered upon the successful completion of education and examination requirements. Education requirements shall be determined by the board by rule, and may be satisfied either through a formal series of classes or through job equivalency training, according to standards to be determined by the board. The education requirements may include possession of a valid certificate in a nationally recognized course in cardiopulmonary resuscitation. Successful passage of an examination administered by the board, which shall include sections regarding infection control, hazardous materials, and jurisprudence, shall also be required. The board shall establish continuing education requirements as a condition of renewing registration as a registered dental assistant, as well as standards for the suspension or revocation of registration.

3 LAWS OFTHE SEVENTY-EIGHTH G.A., 2000 SESSION CH.1003

3. Individuals employed as a dental assistant as of July 1,2001, shall be registered with the board and receive a certificate of registration, and individuals employed as a dental assistant after July 1,2001, shall have a sixty-day period following their first date of employment after July 1, 2001, to comply with the provisions of subsection 1.

Sec. 7. LEG ISLA TIVE INTENT. It is the intent of the general assembly that the board of dental examiners adopt rules authorized pursuant to sections 5 and 6 of this Act, to be adopted on or before January 1,2001. The board shall consider, in adopting rules, recommendations of the scope of practice review committee relating to practice as a dental assistant. The board shall not, however, adopt rules that delegate to a dental assistant any of the following services:

1. Administration of local anesthesia. 2. Placement of sealants. 3. Removal of any plaque, stain, calculus, or hard natural or synthetic material except by

toothbrush, floss, or rubber cup coronal polish.

Sec. 8. EFFECTIVE DATE. Section 7 of this Act, being deemed of immediate importance, takes effect upon enactment for the purpose of developing rules for adoption on or before January 1,2001.

Approved February 23,2000

CHAPTER 1003 LICENSURE, OWNERSHIP, OPERATION, OR CONTROL OF

MOTOR VEHICLE DEALERS - MANUFACTURERS, DISTRIBUTORS, WHOLESALERS, AND IMPORTERS

H.F.2106

AN ACT prohibiting motor vehicle manufacturers, distributors, wholesalers, and importers from being licensed as, owning an interest in, operating, or controlling a motor vehicle dealer, providing exceptions, and making a penalty applicable.

Be It Enacted by the General Assembly of the State of Iowa:

Section 1. Section 322.3, Code Supplement 1999, is amended by adding the following new subsection:

NEW SUBSECTION. 14. A manufacturer, distributor, wholesaler, or importer shall not directly or indirectly be licensed as, own an interest in, operate, or control a motor vehicle dealer. This subsection shall not prohibit any of the following:

a. A manufacturer or importer from being licensed as a motor vehicle dealer or owning an interest in, operating, or controlling a motor vehicle dealership for a period not to exceed one year to facilitate transfer of the motor vehicle dealership to a new owner if both of the following apply:

(1) The prior owner transferred the motor vehicle dealership to the manufacturer or importer. (2) The motor vehicle dealership is continuously offered for sale by the manufacturer or

importer upon reasonable terms and conditions. b. A manufacturer or importer from temporarily owning an interest in a motor vehicle

dealership for the purpose of enhancing opportunities for persons who lack the financial resources to purchase the motor vehicle dealership without such assistance. A manufacturer or importer may temporarily own an interest in a motor vehicle dealership pursuant to

jstuecker

Highlight

jstuecker

Highlight

Draft Bill Language for Repeal

Section 1. REPEAL. 2000 Iowa Acts, chapter 1002, section 7, is repealed.

Explanation

This bill removes legislative intent from the 2000 Iowa Acts prohibiting the dental board from adopting

rules that would allow a dental assistant to administer local anesthesia, place sealants, or remove any

plaque, stain, calculus, or hard natural or synthetic material except by toothbrush, floss, or rubber cup

coronal polish. Currently in Code section 153.38 the board has authority to determine the scope of

practice for dental assistants by administrative rule.

Draft Bill Language for Iowa Code, Chapter 153

An act relating to the scope of practice of registered dental assistants.

Section 1. Section 153.38 is amended to read as follows:

A registered dental assistant may perform those services of assistance to a licensed dentist as

determined by the board by rule. The dental board may not adopt rules that would allow a dental

assistant to administer local anesthesia, or remove calculus or hard natural material. Only expanded

function level 2 trained dental assistants may be permitted to place sealants. Only expanded function

level 1 or 2 trained dental assistants may remove any plaque, stain, calculus, or hard natural or synthetic

material by means other than toothbrush, floss, or rubber cup coronal polish.

Examiner Selection Criteria Examiner must be in good standing with his/her State Board, with no existing or pending

disciplinary sanctions. If an examiner has had an adjudicated malpractice claim within the past five years, his/her eligibility to serve will be determined by the Examiner Evaluation and Assignment Committee (EEAC). Each examiner will be required to self- report all claims pending to the Chairperson of the EEAC upon discovery.

Examiner shall have successfully completed a Commission on Dental Accreditation

(CODA) approved educational program in dentistry or dental hygiene. Examiner must possess an active license to practice dentistry or dental hygiene for at

least five (5) years prior to becoming an examiner in any category. Examiner must have passed a clinical examination with a patient based component.

Examiner must have a health status which allows him/her to perform the examiner’s

duties assigned to them. Examiner must be willing and available to participate in at least three examinations per

year. Examiner must be willing to apply the examination performance criteria as established

by CRDTS including but not limited to established standards and evaluation criteria, be willing to accept comments and critiques from examining peers as well as the results of statistical profiles an adjust behavior appropriately.

Examiner will be classified as (A) a Current Member of a Member Board; (B) a Deputy

Examiner designated by a Member Board; (C) an Exchange Member who is an experienced examiner from a State which is not a member of this Corporation; or (D) a Consultant Examiner who is an experienced examiner from a Member State. Persons

in category C or D must i) meet the qualifications specified in the Bylaws of this Corporation; ii) be selected by the Examination Evaluation and Assignment Committee (EEAC); and iii) be approved by the Steering Committee. Qualifications for each examiner category are listed in Article 7, Section 1 Examiner Pool of the Bylaws of this Corporation.

New examiners, defined as anyone regardless of category who has not actually given a

patient based examination for CRDTS, must observe at least one patient based prior to being assigned as an examiner.

iowa dental board

Documents