EXPLANATION: CAPITALS INDICATE MAT TER ADDED TO EXISTIN G LAW.
[Brackets] indicate matter deleted from existing law.
Underlining indicates amendments to bill.
Strike out indicates matter stricken from the bill by amendment or deleted from the law by
amendment.
*hb0968*
HOUSE BILL 968
J2 2lr1510
CF SB 714
By: Delegate Kipke Delegates Kipke, Bagnall, Bhandari, Chisholm, Hill, Johnson,
Kaiser, Kelly, Kerr, Landis, R. Lewis, Pena–Melnyk, Pendergrass, and
K. Young
Introduced and read first time: February 10, 2022
Assigned to: Health and Government Operations
Committee Report: Favorable with amendments
House action: Adopted
Read second time: March 12, 2022
CHAPTER ______
AN ACT concerning 1
Health Occupations – Dental Assistants – Certification and Regulation 2
FOR the purpose of establishing a certification and regulatory scheme to certify dental 3
assistants to perform certain intraoral procedures; specifying the intraoral 4
procedures a dental assistant is authorized to perform without being certified by the 5
State Board of Dental Examiners and the intraoral procedures that require 6
certification; authorizing the Board to penalize a licensed dentist who allows a dental 7
assistant to provide dental care in an unauthorized manner or without required 8
instruction or supervision; and generally relating to dental assistants. 9
BY repealing and reenacting, without amendments, 10
Article – Health Occupations 11
Section 4–101(a) 12
Annotated Code of Maryland 13
(2021 Replacement Volume) 14
BY adding to 15
Article – Health Occupations 16
Section 4–101(b–1) and (c–1) 4–101(c–1) and (g–1), 4–301.1, 4–302.1, 4–304.1, 17
4–305.1, 4–307.1, 4–309.1, 4–313.1, and 4–315(a)(38) 18
Annotated Code of Maryland 19
(2021 Replacement Volume) 20
2 HOUSE BILL 968
BY repealing and reenacting, with amendments, 1
Article – Health Occupations 2
Section 4–205(a)(1)(iii), 4–301(b)(5), 4–315(a)(36) and (37), and 4–505 3
Annotated Code of Maryland 4
(2021 Replacement Volume) 5
SECTION 1. BE IT ENACTED BY THE GENERAL ASSEMBLY OF MARYLAND, 6
That the Laws of Maryland read as follows: 7
Article – Health Occupations 8
4–101. 9
(a) In this title the following words have the meanings indicated. 10
(B–1) “CERTIFIED DENTAL ASSI STANT” MEANS A DENTAL ASSIS TANT WHO IS 11
CERTIFIED BY THE BOARD TO PERFORM SPEC IFIED INTRAORAL PROC EDURES. 12
(C–1) “DENTAL ASSISTANT ” MEANS AN INDIVIDUAL WHO DIRECTLY ASSISTS A 13
DENTIST IN THE PRACT ICE OF DENTISTRY . 14
(G–1) “EXPANDED FUNCTION DEN TAL ASSISTANT ” MEANS A DENTAL 15
ASSISTANT WHO IS CER TIFIED BY THE BOARD TO PERFORM SPEC IFIC INTRAORAL 16
PROCEDURES . 17
4–205. 18
(a) In addition to the powers set forth elsewhere in this title, the Board may: 19
(1) Adopt regulations governing: 20
(iii) The use of a dental assistant by a licensed dentist in performing 21
intraoral procedures, INCLUDING: 22
1. REASONABLE POLICIES A ND GUIDELINES FOR A 23
DENTAL ASSISTANT TO ASSIST IN PERFORMING INTRAORAL PROCEDURES 24
AUTHORIZED UNDER § 4–301(A) OF THIS TITLE; AND 25
2. REASONABLE SUBJECT TO § 4–302.1(E) OF THIS 26
TITLE, REASONABLE EDUCATION OR TRAININ G REQUIREMENTS FOR A N INDIVIDUAL 27
TO BECOME A CERTIFIED AN EXPANDED FUNCTION DENTAL ASSISTANT AND 28
PERFORM THE INTRAORA L PROCEDURES AUTHORI ZED UNDER § 4–301.1(B) OF THIS 29
TITLE; 30
4–301. 31
HOUSE BILL 968 3
(b) This section does not apply to: 1
(5) A dental assistant, if the dental assistant: 2
(i) Subject to the rules and regulations adopted by the Board, 3
performs only procedures that do not require the professional skills of a licensed dentist; 4
and 5
(ii) Performs intraoral [tasks] PROCEDURES IN ACCORDANCE 6
WITH § 4–301.1 OF THIS SUBTITLE only under the direct supervision of a licensed dentist 7
who personally is present in the office area where the [tasks] PROCEDURES are performed; 8
or 9
4–301.1. 10
(A) (1) A DENTAL ASSISTANT MAY ASSIST A LICENSED DE NTIST IN 11
PROVIDING THE FOLLOW ING INTRAORAL PROCED URES UNDER THE DIREC T 12
SUPERVISION OF A LIC ENSED DENTIST WITHOU T BEING CERTIFIED BY THE BOARD: 13
(1) (I) RINSING AND ASPIRATIO N OF THE ORAL CAVITY ; 14
(2) (II) RETRACTION OF THE LIP S, CHEEKS, TONGUE, AND FLAPS; 15
(3) (III) PLACEMENT AND REMOVAL OF MATERIALS FOR THE 16
ISOLATION OF THE DEN TITION, PROVIDED THAT THE MA TERIAL IS NOT RETAIN ED 17
BY THE DENTITION ; 18
(4) (IV) INSTRUCTING ON ORAL H YGIENE; 19
(5) PERFORMING INTRAORAL PHOTOGRAPH Y OTHER THAN 20
CONVENTIONAL OR DIGI TAL X–RAY; 21
(6) (V) TAKING IMPRESSIONS FO R STUDY MODELS OR DI AGNOSTIC 22
CASTS; 23
(7) (VI) CONSTRUCTING ATHLETIC MOUTH GUARDS ON MODE LS; 24
(8) (VII) APPLYING TOPICAL ANES THESIA; 25
(9) (VIII) CURING BY THE USE OF HALOGEN L IGHT; 26
(10) (IX) CHECKING FOR LOOSE BA NDS; AND 27
(11) (X) ANY OTHER PROCEDURE T HAT THE BOARD AUTHORIZES BY 28
A RULE OR REGULATION . 29 4 HOUSE BILL 968
(2) A DENTAL ASSISTANT MAY ASSIST IN PERFORMING INTRAORAL 1
PHOTOGRAPHY , OTHER THAN CONVENTIO NAL OR DIG ITAL X–RAY, UNDER THE 2
GENERAL SUPERVISION OF A LICENSED DENTIS T WHO REVIEWS THE PH OTOGRAPHY 3
AND AUTHORIZES THE T REATMENT PLAN WITHOU T BEING CERTIFIED BY THE 4
BOARD. 5
(B) (1) EXCEPT FOR AN INDIVID UAL LICENSED AS A DE NTIST OR A 6
DENTAL HYGIENIST UND ER THIS TITLE, AN INDIVIDUAL SHALL BE CERTIFIED BY 7
THE BOARD AS A CERTIFIED AN EXPANDED FUNCTION DENTAL ASSISTANT 8
AUTHORIZED TO PERFOR M AT LEAST ONE OF TH E FOLLOWING INTRAORA L 9
PROCEDUR ES BEFORE THE INDIVI DUAL MAY PERFORM THE INTRAORAL 10
PROCEDURE IN THE STATE: 11
(I) ASSISTING IN ORTHODON TIC PROCEDURES AUTHO RIZED 12
BY THE BOARD IN REGULATION ; 13
(II) PLACING DENTAL SEALAN TS; 14
(III) AS PART OF DENTAL PRO PHYLAXIS OR BEFORE T HE 15
PERFORMANCE OF ESTHE TIC AND CEMENTATION PROCEDURES , CORONAL 16
POLISHING SOLELY FOR STAIN AND BIOFILM RE MOVAL; 17
(IV) APPLYING SILVER DIAMI NE FLUORIDE; 18
(V) MONITORING NITROUS OX IDE BY OBSERVING A PATIE NT: 19
1. DURING THE FLOW OF NI TROUS OXIDE; 20
2. DURING THE REDUCTION OF THE FLOW OF NITRO US 21
OXIDE; 22
3. DURING THE SHUTTING O FF OF EQUIPMENT 23
CONTROLLING THE FLOW OF NITROUS OXIDE ; AND 24
4. AT ALL TIMES IN BETWE EN THE START OF THE FLOW 25
OF NITROUS OXIDE UNT IL THE NITROUS OXIDE HAS BEEN TERMINATED AND THE 26
PATIENT HAS FULLY AW OKEN AND IS COHERENT ; OR 27
(VI) ADDITIONAL INTRAORAL PROCEDURES AUTHORIZE D BY 28
THE BOARD IN REGULATIONS . 29
(2) A DENTAL ASSISTANT WHO IS CERTIFIED BY THE BOARD TO 30
PERFORM AN INTRAORAL PROCEDURE LISTED IN PARAGRAPH (1) OF THIS 31 HOUSE BILL 968 5
SUBSECTION MAY PERFO RM THE INTRAORAL PRO CEDURE LISTED IN PAR AGRAPH 1
(1) OF THIS SUBSECTION I F A LICENSED DENTIST : 2
(I) GIVES THE CERTIFIED D ENTAL ASSISTANT SPEC IFIC 3
INSTRUCTIONS TO PERF ORM THE INTRAORAL PR OCEDURE; AND 4
(II) DIRECTLY SUPERVISES T HE CERTIFIED DENTAL ASSIS TANT 5
PERFORMING THE INTRA ORAL PROCEDURE . 6
4–302.1. 7
(A) TO QUALIFY FOR A CERT IFICATE TO BE A CERTIFIED AN EXPANDED 8
FUNCTION DENTAL ASSISTANT , AN APPLICANT SHALL B E AN INDIVIDUAL WHO 9
MEETS THE REQUIREMEN TS OF THIS SECTION . 10
(B) THE APPLICANT MUST BE OF GOOD MORAL CHARACTER . 11
(C) THE APPLICANT MUST B E AT LEAST 17 18 YEARS OLD. 12
(D) THE APPLICANT MUST : 13
(1) BE A HIGH SCHOOL GRAD UATE OR HAVE ATTAINE D A HIGH 14
SCHOOL EQUIVALENCY ; 15
(2) HAVE SUCCESSFULLY COM PLETED A COURSE OF STUDY 16
APPROVED, SUBJECT TO SUBSECTIO N (E) OF THIS SECTION , BY THE BOARD 17
RELATED TO THE INTRA ORAL PROCEDURE FOR W HICH THE APPLICANT H AS 18
APPLIED FOR A CERTIF ICATE; 19
(3) HAVE THE APPROPRIATE CERTIFICATION FROM T HE DENTAL 20
ASSISTING NATIONAL BOARD; 21
(4) HAVE PASS ED ANY EXAMINATION P ROVIDED FOR IN A 22
REGULATION ADOPTED B Y THE BOARD; AND 23
(5) SUBMIT TO A STATE CRIMINAL HISTOR Y RECORDS CHECK . 24
(E) THE BOARD MAY NOT APPROVE A COURSE OF STUDY UN DER 25
SUBSECTION (D)(2) OF THIS SECTION UNLE SS THE COURSE OF STU DY IS PART OF: 26
(1) A U.S. DEPARTMENT OF LABOR JOB CORPS DENTAL ASSISTIN G 27
PROGRAM; 28
6 HOUSE BILL 968
(2) A DENTAL ASSISTING PRO GRAM LOCATED WITHIN AN 1
INSTITUTION OF POSTS ECONDARY EDUCATION T HAT IS ACCREDITED BY AN 2
ACCREDITING INSTITUT ION RECOGNIZED BY TH E U.S. DEPARTMENT OF 3
EDUCATION; 4
(3) A DENTAL ASSISTING PRO GRAM THAT IS LOCATED WITHIN A HIGH 5
SCHOOL AND IS RECOGN IZED BY AN ACCREDITI NG BODY RECOGNIZED B Y THE U.S. 6
DEPARTMENT OF EDUCATION OR THE HIGH SCHOOL ACCREDITING B ODY OF A 7
STATE; OR 8
(4) A DENTAL ASSISTING PRO GRAM THAT I S ACCREDITED BY THE 9
COUNCIL ON DENTAL ACCREDITATION , OR A SUCCESSOR ORGAN IZATION. 10
4–304.1. 11
TO APPLY FOR A CERTIF ICATE TO BE A CERTIFIED AN EXPANDED FUNCTION 12
DENTAL ASSISTANT , AN APPLICANT SHALL : 13
(1) SUBMIT AN APPLICATION TO THE BOARD IN A MANNER THAT THE 14
BOARD REQUIRES ; AND 15
(2) PAY TO THE BOARD AN APPLICATION FEE SET BY THE BOARD. 16
4–305.1. 17
(A) AN APPLICANT WHO OTHE RWISE QUALIFIES FOR A CERTIFICATE TO BE 18
A CERTIFIED AN EXPANDED FUNCTION DENTAL ASSISTANT IS ENTITLED TO BE 19
EXAMINED AS PROVIDED FOR IN THIS SECTION . 20
(B) THE BOARD SHALL NOTIFY EA CH QUALIFIED APPLICA NT OF THE TIME 21
AND PLACE OF THE EXA MINATION. 22
(C) THE BOARD SHALL DETERMINE THE SUBJECTS , SCOPE, FORM, AND 23
PASSING SCORE FOR EX AMINATIONS GIVEN UND ER THIS SECTION. 24
(D) AN APPLICANT SHALL PAY TO THE BOARD AN EXAMINATION FEE SET BY 25
THE BOARD IN AN AMOUNT TH AT DOES NOT EXCEED T HE COSTS OF ADMINIST ERING 26
THE EXAMINATION . 27
4–307.1. 28
(A) THE BOARD SHALL ISSUE AN APPROPRIATE CERTIFIC ATE TO ANY 29
APPLICANT WHO MEETS THE REQUIREMENTS OF THIS TITLE AND REGULATIONS 30
ADOPTED BY THE BOARD FOR THAT CERTIF ICATE. 31 HOUSE BILL 968 7
(B) THE BOARD SHALL INCLUDE O N EACH CERTIFICATE T HAT THE BOARD 1
ISSUES: 2
(1) THE NAME OF THE CERTI FIED INDIVIDUAL; 3
(2) THE DATE THE CERTIFIC ATE WAS ISSUED; 4
(3) THE INTRAORAL PROCEDU RES THAT THE CERTIFIED D ENTAL 5
ASSISTANT IS QUALIFI ED TO PERFORM ; 6
(4) A SERIAL NUMBER ; 7
(5) THE SIGNATURES OF THE PRESIDENT AND SECRET ARY OF THE 8
BOARD; AND 9
(6) THE SEAL OF THE BOARD. 10
(C) THE BOARD SHALL ISSUE A C ERTIFICATE TO REPLAC E A LOST OR 11
DESTROYED CERTIFICAT E IF THE CERTIFIED D ENTAL ASSISTANT PAYS A FEE SET BY 12
THE BOARD THAT APPROXIMAT ES THE ACTUAL COST O F REPLACING THE 13
CERTIFICATE. 14
(D) AN INDIVIDUAL MAY BE SIMULTANEOUSLY CERTI FIED AS A DENTAL 15
RADIATION TECHNOLOGI ST UNDER § 4–505 OF THIS TITLE AND AS A CERTIFIED AN 16
EXPANDED FUNCTION DENTAL ASSISTANT . 17
4–309.1. 18
(A) A CERTIFICATE EXPIRES ON THE DATE SET BY T HE BOARD, UNLESS THE 19
CERTIFICATE IS RENEW ED FOR AN ADDITIONAL TERM AS PROVIDED FOR BY THE 20
BOARD. 21
(B) AT LEAST 1 MONTH BEFORE A CERT IFICATE EXPIRES , THE BOARD 22
SHALL SEND TO THE CE RTIFIED DENTAL ASSIS TANT, BY ELECTRONIC MEANS AND 23
FIRST–CLASS MAIL TO THE LA ST KNOWN ELECTRONIC OR PHYSICAL ADDRESS OF 24
THE DENTAL ASSISTANT , A RENEWAL NOTICE THA T STATES THE: 25
(1) DATE ON WHICH THE CUR RENT CERTIFICATE EXPIRES ; 26
(2) DATE BY WHICH THE REN EWAL APPLICATION MUS T BE RECEIVED 27
BY THE BOARD FOR THE RENEWAL TO BE ISSUED AND MAI LED BEFORE THE 28
CERTIFICATE EXPIRES ; AND 29
8 HOUSE BILL 968
(3) AMOUNT OF THE RENEWAL FEE. 1
4–313.1. 2
EACH HOLDER OF A CERT IFICATE TO BE A CERTIFIED AN EXPANDED 3
FUNCTION DENTAL ASSISTANT SHA LL KEEP THE CERTIFIC ATE, AND ANY CURRENT 4
RENEWAL, IN THE OFFICE WHERE THE DENTAL ASSISTANT IS EMPLOYED. 5
4–315. 6
(a) Subject to the hearing provisions of § 4–318 of this subtitle, the Board may 7
deny a general license to practice dentistry, a limited license to practice dentistry, or a 8
teacher’s license to practice dentistry to any applicant, reprimand any licensed dentist, 9
place any licensed dentist on probation, or suspend or revoke the license of any licensed 10
dentist, if the applicant or licensee: 11
(36) Fails to comply with the requirements of the Prescription Drug 12
Monitoring Program in Title 21, Subtitle 2A of the Health – General Article; [or] 13
(37) Accepts or tenders rebates or splits fees in violation of § 4–103(c) of this 14
subtitle; OR 15
(38) ALLOWS A DENTAL ASSIS TANT TO ASSIST IN TH E PRACTICE OF 16
DENTISTRY: 17
(I) IN AN UNAUTHORIZED MA NNER IN VIOLATION OF THIS 18
TITLE OR REGULATIONS ADOPTED BY THE BOARD; 19
(II) WITHOUT SPECIFICALLY INSTRUCTING THE CERTIFIED 20
DENTAL ASSISTANT TO PERFORM AN INTRAORAL PROCEDURE THAT THE C ERTIFIED 21
DENTAL ASSISTANT IS AUTHORIZED TO PERFOR M; OR 22
(III) FAILING TO PROVIDE DI RECT SUPERVISION OF A DENTAL 23
ASSISTANT. 24
4–505. 25
(a) The Board of Dental Examiners shall: 26
(1) Define, for the purpose of this section, the terms “dental radiation 27
technologist” and “practice dental radiation technology”; 28
(2) Adopt rules and regulations concerning qualifications, training, 29
certification, monitoring of, and enforcement requirements for a dental radiation 30
technologist; and 31
HOUSE BILL 968 9
(3) Provide for a requirement to ensure competency in new safety and 1
technological advances. 2
(b) The qualifications required of applicants for Board certification as a dental 3
radiation technologist shall include requirements established by: 4
(1) The American Dental Association; or 5
(2) Any applicable federal standards for training and certification. 6
(c) After July 1, 1988, an individual must be certified by the Board as a dental 7
radiation technologist before a licensed dentist may employ the individual to practice 8
dental radiation technology. 9
(d) After July 1, 1988, an individual may not practice dental radiation technology 10
unless certified by the Board. 11
(e) At least 1 month before a certificate expires, the Board shall send to each 12
certificate holder, by electronic means or first–class mail to the last known electronic or 13
physical address of the certificate holder, a renewal notice that states: 14
(1) The date on which the current certificate expires; 15
(2) The date by which the renewal application must be received by the 16
Board for the renewal to be issued and mailed before the certificate expires; and 17
(3) The amount of the renewal fee. 18
(F) AN INDIVIDUAL MAY BE SIMULTANEOUSLY CERTI FIED AS A DENTAL 19
RADIATION TECHNOLOGI ST UNDER THIS SECTIO N AND AS A CERTIFIED AN 20
EXPANDED FUNCTION DENTAL ASSISTANT . 21
SECTION 2. AND BE IT FURTHER ENACTED, That this Act shall take effect 22
October 1, 2022. 23