99TH GENERAL ASSEMBLY
State of Illinois
2015 and 2016
HB5948

 

Introduced , by Rep. Michael J. Zalewski

 

SYNOPSIS AS INTRODUCED:
 
225 ILCS 25/4  from Ch. 111, par. 2304
225 ILCS 25/17  from Ch. 111, par. 2317
225 ILCS 25/18.1

    Amends the Illinois Dental Practice Act. Changes the requirement of additional course work for public health dental hygienists from 72 to 20 hours. Makes changes to provisions concerning expanded functions for dental assistants. Allows public health dental hygienists to continue patient care if a dentist is not available, except in cases of a serious medical condition.


LRB099 20560 SMS 45111 b

 

 

A BILL FOR

 

HB5948LRB099 20560 SMS 45111 b

1    AN ACT concerning regulation.
 
2    Be it enacted by the People of the State of Illinois,
3represented in the General Assembly:
 
4    Section 5. The Illinois Dental Practice Act is amended by
5changing Sections 4, 17, and 18.1 as follows:
 
6    (225 ILCS 25/4)   (from Ch. 111, par. 2304)
7    (Section scheduled to be repealed on January 1, 2026)
8    Sec. 4. Definitions. As used in this Act:
9    "Address of record" means the designated address recorded
10by the Department in the applicant's or licensee's application
11file or license file as maintained by the Department's
12licensure maintenance unit. It is the duty of the applicant or
13licensee to inform the Department of any change of address and
14those changes must be made either through the Department's
15website or by contacting the Department.
16    "Department" means the Department of Financial and
17Professional Regulation.
18    "Secretary" means the Secretary of Financial and
19Professional Regulation.
20    "Board" means the Board of Dentistry.
21    "Dentist" means a person who has received a general license
22pursuant to paragraph (a) of Section 11 of this Act and who may
23perform any intraoral and extraoral procedure required in the

 

 

HB5948- 2 -LRB099 20560 SMS 45111 b

1practice of dentistry and to whom is reserved the
2responsibilities specified in Section 17.
3    "Dental hygienist" means a person who holds a license under
4this Act to perform dental services as authorized by Section
518.
6    "Dental assistant" means an appropriately trained person
7who, under the supervision of a dentist, provides dental
8services as authorized by Section 17.
9    "Dental laboratory" means a person, firm or corporation
10which:
11        (i) engages in making, providing, repairing or
12    altering dental prosthetic appliances and other artificial
13    materials and devices which are returned to a dentist for
14    insertion into the human oral cavity or which come in
15    contact with its adjacent structures and tissues; and
16        (ii) utilizes or employs a dental technician to provide
17    such services; and
18        (iii) performs such functions only for a dentist or
19    dentists.
20    "Supervision" means supervision of a dental hygienist or a
21dental assistant requiring that a dentist authorize the
22procedure, remain in the dental facility while the procedure is
23performed, and approve the work performed by the dental
24hygienist or dental assistant before dismissal of the patient,
25but does not mean that the dentist must be present at all times
26in the treatment room.

 

 

HB5948- 3 -LRB099 20560 SMS 45111 b

1    "General supervision" means supervision of a dental
2hygienist requiring that the patient be a patient of record,
3that the dentist examine the patient in accordance with Section
418 prior to treatment by the dental hygienist, and that the
5dentist authorize the procedures which are being carried out by
6a notation in the patient's record, but not requiring that a
7dentist be present when the authorized procedures are being
8performed. The issuance of a prescription to a dental
9laboratory by a dentist does not constitute general
10supervision.
11    "Public member" means a person who is not a health
12professional. For purposes of board membership, any person with
13a significant financial interest in a health service or
14profession is not a public member.
15    "Dentistry" means the healing art which is concerned with
16the examination, diagnosis, treatment planning and care of
17conditions within the human oral cavity and its adjacent
18tissues and structures, as further specified in Section 17.
19    "Branches of dentistry" means the various specialties of
20dentistry which, for purposes of this Act, shall be limited to
21the following: endodontics, oral and maxillofacial surgery,
22orthodontics and dentofacial orthopedics, pediatric dentistry,
23periodontics, prosthodontics, and oral and maxillofacial
24radiology.
25    "Specialist" means a dentist who has received a specialty
26license pursuant to Section 11(b).

 

 

HB5948- 4 -LRB099 20560 SMS 45111 b

1    "Dental technician" means a person who owns, operates or is
2employed by a dental laboratory and engages in making,
3providing, repairing or altering dental prosthetic appliances
4and other artificial materials and devices which are returned
5to a dentist for insertion into the human oral cavity or which
6come in contact with its adjacent structures and tissues.
7    "Impaired dentist" or "impaired dental hygienist" means a
8dentist or dental hygienist who is unable to practice with
9reasonable skill and safety because of a physical or mental
10disability as evidenced by a written determination or written
11consent based on clinical evidence, including deterioration
12through the aging process, loss of motor skills, abuse of drugs
13or alcohol, or a psychiatric disorder, of sufficient degree to
14diminish the person's ability to deliver competent patient
15care.
16    "Nurse" means a registered professional nurse, a certified
17registered nurse anesthetist licensed as an advanced practice
18nurse, or a licensed practical nurse licensed under the Nurse
19Practice Act.
20    "Patient of record" means a patient for whom the patient's
21most recent dentist has obtained a relevant medical and dental
22history and on whom the dentist has performed an examination
23and evaluated the condition to be treated.
24    "Dental responder" means a dentist or dental hygienist who
25is appropriately certified in disaster preparedness,
26immunizations, and dental humanitarian medical response

 

 

HB5948- 5 -LRB099 20560 SMS 45111 b

1consistent with the Society of Disaster Medicine and Public
2Health and training certified by the National Incident
3Management System or the National Disaster Life Support
4Foundation.
5    "Mobile dental van or portable dental unit" means any
6self-contained or portable dental unit in which dentistry is
7practiced that can be moved, towed, or transported from one
8location to another in order to establish a location where
9dental services can be provided.
10    "Public health dental hygienist" means a hygienist who
11holds a valid license to practice in the State, has 2 years of
12full-time clinical experience or an equivalent of 4,000 hours
13of clinical experience and has completed 20 72 hours of
14additional course work in areas specific to public health
15dentistry, including, but not limited to, emergency procedures
16for medically compromised patients, pharmacology, medical
17recordkeeping procedures, geriatric dentistry, pediatric
18dentistry, and pathology, and works in a public health setting
19pursuant to a written public health supervision agreement as
20defined by rule by the Department with a dentist working in or
21contracted with a local or State government agency or
22institution or who is providing services as part of a certified
23school-based program or school-based oral health program.
24    "Public health setting" means a federally qualified health
25center; a federal, State, or local public health facility; Head
26Start; a special supplemental nutrition program for Women,

 

 

HB5948- 6 -LRB099 20560 SMS 45111 b

1Infants, and Children (WIC) facility; or a certified
2school-based health center or school-based oral health
3program.
4    "Public health supervision" means the supervision of a
5public health dental hygienist by a licensed dentist who has a
6written public health supervision agreement with that public
7health dental hygienist while working in an approved facility
8or program that allows the public health dental hygienist to
9treat patients, without a dentist first examining the patient
10and being present in the facility during treatment, (1) who are
11eligible for Medicaid or (2) who are uninsured and whose
12household income is not greater than 200% of the federal
13poverty level.
14(Source: P.A. 99-25, eff. 1-1-16; 99-492, eff. 12-31-15.)
 
15    (225 ILCS 25/17)  (from Ch. 111, par. 2317)
16    (Section scheduled to be repealed on January 1, 2026)
17    Sec. 17. Acts constituting the practice of dentistry. A
18person practices dentistry, within the meaning of this Act:
19        (1) Who represents himself or herself as being able to
20    diagnose or diagnoses, treats, prescribes, or operates for
21    any disease, pain, deformity, deficiency, injury, or
22    physical condition of the human tooth, teeth, alveolar
23    process, gums or jaw; or
24        (2) Who is a manager, proprietor, operator or conductor
25    of a business where dental operations are performed; or

 

 

HB5948- 7 -LRB099 20560 SMS 45111 b

1        (3) Who performs dental operations of any kind; or
2        (4) Who uses an X-Ray machine or X-Ray films for dental
3    diagnostic purposes; or
4        (5) Who extracts a human tooth or teeth, or corrects or
5    attempts to correct malpositions of the human teeth or
6    jaws; or
7        (6) Who offers or undertakes, by any means or method,
8    to diagnose, treat or remove stains, calculus, and bonding
9    materials from human teeth or jaws; or
10        (7) Who uses or administers local or general
11    anesthetics in the treatment of dental or oral diseases or
12    in any preparation incident to a dental operation of any
13    kind or character; or
14        (8) Who takes impressions of the human tooth, teeth, or
15    jaws or performs any phase of any operation incident to the
16    replacement of a part of a tooth, a tooth, teeth or
17    associated tissues by means of a filling, crown, a bridge,
18    a denture or other appliance; or
19        (9) Who offers to furnish, supply, construct,
20    reproduce or repair, or who furnishes, supplies,
21    constructs, reproduces or repairs, prosthetic dentures,
22    bridges or other substitutes for natural teeth, to the user
23    or prospective user thereof; or
24        (10) Who instructs students on clinical matters or
25    performs any clinical operation included in the curricula
26    of recognized dental schools and colleges; or

 

 

HB5948- 8 -LRB099 20560 SMS 45111 b

1        (11) Who takes impressions of human teeth or places his
2    or her hands in the mouth of any person for the purpose of
3    applying teeth whitening materials, or who takes
4    impressions of human teeth or places his or her hands in
5    the mouth of any person for the purpose of assisting in the
6    application of teeth whitening materials. A person does not
7    practice dentistry when he or she discloses to the consumer
8    that he or she is not licensed as a dentist under this Act
9    and (i) discusses the use of teeth whitening materials with
10    a consumer purchasing these materials; (ii) provides
11    instruction on the use of teeth whitening materials with a
12    consumer purchasing these materials; or (iii) provides
13    appropriate equipment on-site to the consumer for the
14    consumer to self-apply teeth whitening materials.
15    The fact that any person engages in or performs, or offers
16to engage in or perform, any of the practices, acts, or
17operations set forth in this Section, shall be prima facie
18evidence that such person is engaged in the practice of
19dentistry.
20    The following practices, acts, and operations, however,
21are exempt from the operation of this Act:
22        (a) The rendering of dental relief in emergency cases
23    in the practice of his or her profession by a physician or
24    surgeon, licensed as such under the laws of this State,
25    unless he or she undertakes to reproduce or reproduces lost
26    parts of the human teeth in the mouth or to restore or

 

 

HB5948- 9 -LRB099 20560 SMS 45111 b

1    replace lost or missing teeth in the mouth; or
2        (b) The practice of dentistry in the discharge of their
3    official duties by dentists in any branch of the Armed
4    Services of the United States, the United States Public
5    Health Service, or the United States Veterans
6    Administration; or
7        (c) The practice of dentistry by students in their
8    course of study in dental schools or colleges approved by
9    the Department, when acting under the direction and
10    supervision of dentists acting as instructors; or
11        (d) The practice of dentistry by clinical instructors
12    in the course of their teaching duties in dental schools or
13    colleges approved by the Department:
14            (i) when acting under the direction and
15        supervision of dentists, provided that such clinical
16        instructors have instructed continuously in this State
17        since January 1, 1986; or
18            (ii) when holding the rank of full professor at
19        such approved dental school or college and possessing a
20        current valid license or authorization to practice
21        dentistry in another country; or
22        (e) The practice of dentistry by licensed dentists of
23    other states or countries at meetings of the Illinois State
24    Dental Society or component parts thereof, alumni meetings
25    of dental colleges, or any other like dental organizations,
26    while appearing as clinicians; or

 

 

HB5948- 10 -LRB099 20560 SMS 45111 b

1        (f) The use of X-Ray machines for exposing X-Ray films
2    of dental or oral tissues by dental hygienists or dental
3    assistants; or
4        (g) The performance of any dental service by a dental
5    assistant, if such service is performed under the
6    supervision and full responsibility of a dentist.
7        For purposes of this paragraph (g), "dental service" is
8    defined to mean any intraoral procedure or act which shall
9    be prescribed by rule or regulation of the Department.
10    Dental service, however, shall not include:
11            (1) Any and all diagnosis of or prescription for
12        treatment of disease, pain, deformity, deficiency,
13        injury or physical condition of the human teeth or
14        jaws, or adjacent structures.
15            (2) Removal of, or restoration of, or addition to
16        the hard or soft tissues of the oral cavity, except for
17        the placing, carving, and finishing of amalgam
18        restorations by dental assistants who have had
19        additional formal education and certification as
20        determined by the Department. A dentist utilizing
21        dental assistants shall not supervise more than 4
22        dental assistants at any one time for placing, carving,
23        and finishing of amalgam restorations.
24            (3) Any and all correction of malformation of teeth
25        or of the jaws.
26            (4) Administration of anesthetics, except for

 

 

HB5948- 11 -LRB099 20560 SMS 45111 b

1        monitoring of nitrous oxide, conscious sedation, deep
2        sedation, and general anesthetic as provided in
3        Section 8.1 of this Act, that may be performed only
4        after successful completion of a training program
5        approved by the Department. A dentist utilizing dental
6        assistants shall not supervise more than 4 dental
7        assistants at any one time for the monitoring of
8        nitrous oxide.
9            (5) Removal of calculus from human teeth.
10            (6) Taking of impressions for the fabrication of
11        prosthetic appliances, crowns, bridges, inlays,
12        onlays, or other restorative or replacement dentistry.
13            (7) The operative procedure of dental hygiene
14        consisting of oral prophylactic procedures, except for
15        coronal polishing and pit and fissure sealants, which
16        may be performed by a dental assistant who has
17        successfully completed a training program approved by
18        the Department. Dental assistants may perform coronal
19        polishing under the following circumstances: (i) the
20        coronal polishing shall be limited to polishing the
21        clinical crown of the tooth and existing restorations,
22        supragingivally; (ii) the dental assistant performing
23        the coronal polishing shall be limited to the use of
24        rotary instruments using a rubber cup or brush
25        polishing method (air polishing is not permitted); and
26        (iii) the supervising dentist shall not supervise more

 

 

HB5948- 12 -LRB099 20560 SMS 45111 b

1        than 4 dental assistants at any one time for the task
2        of coronal polishing or pit and fissure sealants.
3            In addition to coronal polishing and pit and
4        fissure sealants as described in this item (7), a
5        dental assistant who has at least 2,000 hours of direct
6        clinical patient care experience and who has
7        successfully completed a training program approved by
8        rule by the Department may perform: (A) coronal scaling
9        above the gum line, supragingivally, on the clinical
10        crown of the tooth only on patients 12 years of age or
11        younger who have an absence of periodontal disease and
12        who are not medically compromised or individuals with
13        special needs and (B) intracoronal temporization of a
14        tooth. The training program approved by the Department
15        must: (I) include a minimum of 16 hours of instruction
16        in both didactic and clinical manikin or human subject
17        instruction; all training programs shall include
18        courses in dental anatomy, public health dentistry,
19        medical history, dental emergencies, and managing the
20        pediatric patient; (II) include an outcome assessment
21        examination that demonstrates competency; (III)
22        require the supervising dentist to observe and approve
23        the completion of 10 6 full mouth supragingival scaling
24        procedures; and (IV) issue a certificate of completion
25        of the training program, which must be kept on file at
26        the dental office. A dental assistant must have

 

 

HB5948- 13 -LRB099 20560 SMS 45111 b

1        successfully completed an approved coronal polishing
2        course prior to taking the coronal scaling course. A
3        dental assistant performing these functions shall be
4        limited to the use of hand instruments only. In
5        addition, coronal scaling as described in this
6        paragraph shall only be utilized on patients who are
7        eligible for Medicaid or who are uninsured and whose
8        household income is not greater than 200% of the
9        federal poverty level. A dentist may not supervise more
10        than 2 dental assistants at any one time for the task
11        of coronal scaling. This paragraph is inoperative on
12        and after January 1, 2021.
13        The limitations on the number of dental assistants a
14    dentist may supervise contained in items (2), (4), and (7)
15    of this paragraph (g) mean a limit of 4 total dental
16    assistants or dental hygienists doing expanded functions
17    covered by these Sections being supervised by one dentist.
18        (h) The practice of dentistry by an individual who:
19            (i) has applied in writing to the Department, in
20        form and substance satisfactory to the Department, for
21        a general dental license and has complied with all
22        provisions of Section 9 of this Act, except for the
23        passage of the examination specified in subsection (e)
24        of Section 9 of this Act; or
25            (ii) has applied in writing to the Department, in
26        form and substance satisfactory to the Department, for

 

 

HB5948- 14 -LRB099 20560 SMS 45111 b

1        a temporary dental license and has complied with all
2        provisions of subsection (c) of Section 11 of this Act;
3        and
4            (iii) has been accepted or appointed for specialty
5        or residency training by a hospital situated in this
6        State; or
7            (iv) has been accepted or appointed for specialty
8        training in an approved dental program situated in this
9        State; or
10            (v) has been accepted or appointed for specialty
11        training in a dental public health agency situated in
12        this State.
13        The applicant shall be permitted to practice dentistry
14    for a period of 3 months from the starting date of the
15    program, unless authorized in writing by the Department to
16    continue such practice for a period specified in writing by
17    the Department.
18        The applicant shall only be entitled to perform such
19    acts as may be prescribed by and incidental to his or her
20    program of residency or specialty training and shall not
21    otherwise engage in the practice of dentistry in this
22    State.
23        The authority to practice shall terminate immediately
24    upon:
25            (1) the decision of the Department that the
26        applicant has failed the examination; or

 

 

HB5948- 15 -LRB099 20560 SMS 45111 b

1            (2) denial of licensure by the Department; or
2            (3) withdrawal of the application.
3(Source: P.A. 98-147, eff. 1-1-14; 98-463, eff. 8-16-13;
498-756, eff. 7-16-14; 99-492, eff. 12-31-15.)
 
5    (225 ILCS 25/18.1)
6    (Section scheduled to be repealed on January 1, 2021)
7    Sec. 18.1. Public health dental supervision
8responsibilities.
9    (a) When working together in a public health supervision
10relationship, dentists and public health dental hygienists
11shall enter into a public health supervision agreement. The
12dentist providing public health supervision must:
13        (1) be available to provide an appropriate level of
14    contact, communication, collaboration, and consultation
15    with the public health dental hygienist and must meet
16    in-person with the public health dental hygienist at least
17    quarterly for review and consultation;
18        (2) have specific standing orders or policy guidelines
19    for procedures that are to be carried out for each location
20    or program, although the dentist need not be present when
21    the procedures are being performed;
22        (3) provide for the patient's additional necessary
23    care in consultation with the public health dental
24    hygienist;
25        (4) file agreements and notifications as required; and

 

 

HB5948- 16 -LRB099 20560 SMS 45111 b

1        (5) include procedures for creating and maintaining
2    dental records, including protocols for transmission of
3    all records between the public health dental hygienist and
4    the dentist following each treatment, which shall include a
5    notation regarding procedures authorized by the dentist
6    and performed by the public health dental hygienist and the
7    location where those records are to be kept.
8    Each dentist and hygienist who enters into a public health
9supervision agreement must document and maintain a copy of any
10change or termination of that agreement.
11    Dental records shall be owned and maintained by the
12supervising dentist for all patients treated under public
13health supervision, unless the supervising dentist is an
14employee of a public health clinic or federally qualified
15health center, in which case the public health clinic or
16federally qualified health center shall maintain the records.
17    If a dentist ceases to be employed or contracted by the
18facility, the dentist shall notify the facility administrator
19that the public health supervision agreement is no longer in
20effect. A new public health supervision agreement is required
21for the public health dental hygienist to continue treating
22patients under public health supervision.
23    A dentist entering into an agreement under this Section may
24supervise and enter into agreements for public health
25supervision with 2 public health dental hygienists. This shall
26be in addition to the limit of 4 dental hygienists per dentist

 

 

HB5948- 17 -LRB099 20560 SMS 45111 b

1set forth in subsection (g) of Section 18 of this Act.
2    (b) A public health dental hygienist providing services
3under public health supervision may perform only those duties
4within the accepted scope of practice of dental hygiene, as
5follows:
6        (1) the operative procedures of dental hygiene,
7    consisting of oral prophylactic procedures, including
8    prophylactic cleanings, application of fluoride, and
9    placement of sealants;
10        (2) the exposure and processing of x-ray films of the
11    teeth and surrounding structures; and
12        (3) such other procedures and acts as shall be
13    prescribed by rule of the Department.
14    Any patient treated under this subsection (b) must be
15examined by a dentist before additional services can be
16provided by a public health dental hygienist. However, if a
17patient makes a good faith effort to be examined by a dentist
18but one is not readily available, a public health dental
19hygienist may offer to continue care until such time a dentist
20can examine the patient, except when a public health dental
21hygienist observes evidence of a serious medical condition, in
22which case the patient should immediately be referred to a
23dentist.
24    (c) A public health dental hygienist providing services
25under public health supervision must:
26        (1) provide to the patient, parent, or guardian a

 

 

HB5948- 18 -LRB099 20560 SMS 45111 b

1    written plan for referral or an agreement for follow-up
2    that records all conditions observed that should be called
3    to the attention of a dentist for proper diagnosis;
4        (2) have each patient sign a permission slip or consent
5    form that informs them that the service to be received does
6    not take the place of regular dental checkups at a dental
7    office and is meant for people who otherwise would not have
8    access to the service;
9        (3) inform each patient who may require further dental
10    services of that need;
11        (4) maintain an appropriate level of contact and
12    communication with the dentist providing public health
13    supervision; and
14        (5) complete an additional 4 hours of continuing
15    education in areas specific to public health dentistry
16    yearly.
17    (d) Each public health dental hygienist who has rendered
18services under subsections (c), (d), and (e) of this Section
19must complete a summary report at the completion of a program
20or, in the case of an ongoing program, at least annually. The
21report must be completed in the manner specified by the
22Division of Oral Health in the Department of Public Health
23including information about each location where the public
24health dental hygienist has rendered these services. The public
25health dental hygienist must submit the form to the dentist
26providing supervision for his or her signature before sending

 

 

HB5948- 19 -LRB099 20560 SMS 45111 b

1it to the Division.
2    (e) Public health dental hygienists providing services
3under public health supervision may be compensated for their
4work by salary, honoraria, and other mechanisms by the
5employing or sponsoring entity. Nothing in this Act shall
6preclude the entity that employs or sponsors a public health
7dental hygienist from seeking payment, reimbursement, or other
8source of funding for the services provided.
9    (f) This Section is repealed on January 1, 2021.
10(Source: P.A. 99-492, eff. 12-31-15.)