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.
Italics indicate opposite chamber/conference committee amendments.
*hb0968*
HOUSE BILL 968
J2 (2lr1510)
ENROLLED BILL
— Health and Government Operations/Education, Health, and Environmental
Affairs —
Introduced by Delegate Kipke Delegates Kipke, Bagnall, Bhandari, Chisholm, Hill,
Johnson, Kaiser, Kelly, Kerr, Landis, R. Lewis, Pena–Melnyk, Pendergrass,
and K. Young
Read and Examined by Proofreaders:
_______________________________________________
Proofreader.
_______________________________________________
Proofreader.
Sealed with the Great Seal and presented to the Governor, for his approval this
_______ day of _______________ at ________________________ o’clock, ________M.
______________________________________________
Speaker.
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 2 HOUSE BILL 968
Section 4–101(a) 1
Annotated Code of Maryland 2
(2021 Replacement Volume) 3
BY adding to 4
Article – Health Occupations 5
Section 4–101(b–1) and (c–1) 4–101(c–1) and (g–1), 4–301.1, 4–302.1, 4–304.1, 6
4–305.1, 4–307.1, 4–309.1, 4–313.1, and 4–315(a)(38) 7
Annotated Code of Maryland 8
(2021 Replacement Volume) 9
BY repealing and reenacting, with amendments, 10
Article – Health Occupations 11
Section 4–205(a)(1)(iii), 4–301(b)(5), 4–315(a)(36) and (37), and 4–505 12
Annotated Code of Maryland 13
(2021 Replacement Volume) 14
SECTION 1. BE IT ENACTED BY THE GENERAL ASSEMBLY OF MARYLAND, 15
That the Laws of Maryland read as follows: 16
Article – Health Occupations 17
4–101. 18
(a) In this title the following words have the meanings indicated. 19
(B–1) “CERTIFIED DENTAL ASSI STANT” MEANS A DENTAL ASSIS TANT WHO IS 20
CERTIFIED BY THE BOARD TO PERFORM SPEC IFIED INTRAORAL PROC EDURES. 21
(C–1) “DENTAL ASSISTANT” MEANS AN INDIVIDUAL WHO DIRECTLY ASSISTS A 22
DENTIST IN THE PRACT ICE OF DENTISTRY . 23
(G–1) “EXPANDED FUNCTION DEN TAL ASSISTANT ” MEANS A DENTAL 24
ASSISTANT WHO IS CER TIFIED BY THE BOARD TO PERFORM SPEC IFIC INTRAORAL 25
PROCEDURES . 26
4–205. 27
(a) In addition to the powers set forth elsewhere in this title, the Board may: 28
(1) Adopt regulations governing: 29
(iii) The use of a dental assistant by a licensed dentist in performing 30
intraoral procedures, INCLUDING: 31
HOUSE BILL 968 3
1. REASONABLE POLICIES A ND GUIDELINES FOR A 1
DENTAL ASSISTANT TO ASSIST IN PERFORMING INTRAORAL PROCEDURES 2
AUTHORIZED UNDER § 4–301(A) OF THIS TITLE; AND 3
2. REASONABLE SUBJECT TO § 4–302.1(E) OF THIS 4
TITLE, REASONABLE EDUCATION OR TRAININ G REQUIREMENTS FOR A N INDIVIDUAL 5
TO BECOME A CERTIFIED AN EXPANDED FUNCTION DENTAL ASSISTANT AND 6
PERFORM THE INTRAORA L PROCEDURES AUTHORI ZED UNDER § 4–301.1(B) OF THIS 7
TITLE; 8
4–301. 9
(b) This section does not apply to: 10
(5) A dental assistant, if the dental assistant: 11
(i) Subject to the rules and regulations adopted by the Board, 12
performs only procedures that do not require the professional skills of a licensed dentist; 13
and 14
(ii) Performs intraoral [tasks] PROCEDURES IN ACCORDANCE 15
WITH § 4–301.1 OF THIS SUBTITLE only under the direct supervision of a licensed dentist 16
who personally is present in the office area where the [tasks] PROCEDURES are performed; 17
or 18
4–301.1. 19
(A) (1) A DENTAL ASSISTANT MAY ASSIST A LICENSED DE NTIST IN 20
PROVIDING THE FOLLOW ING INTRAORAL PROCED URES UNDER THE DIREC T 21
SUPERVISION OF A LIC ENSED DENTIST WITHOU T BEING CERTIFIED BY THE BOARD: 22
(1) (I) RINSING AND ASPIRATIO N OF THE ORAL CAVITY ; 23
(2) (II) RETRACTION OF THE LIP S, CHEEKS, TONGUE, AND FLAPS; 24
(3) (III) PLACEMENT AND REMOVAL OF MATERIALS FOR THE 25
ISOLATION OF THE DENTITION , PROVIDED THAT THE MA TERIAL IS NOT RETAIN ED 26
BY THE DENTITION ; 27
(4) (IV) INSTRUCTING ON ORAL H YGIENE; 28
(5) PERFORMING INTRAORAL PHOTOGRAPHY OTHER TH AN 29
CONVENTIONAL OR DIGI TAL X–RAY; 30
4 HOUSE BILL 968
(6) (V) TAKING IMPRESSIONS FO R STUDY MODELS OR DIAGNOSTIC 1
CASTS; 2
(7) (VI) CONSTRUCTING ATHLETIC MOUTH GUARDS ON MODE LS; 3
(8) (VII) APPLYING TOPICAL ANES THESIA; 4
(9) (VIII) CURING BY THE USE OF HALOGEN LIGHT ; 5
(10) (IX) CHECKING FOR LOOSE BA NDS; AND 6
(11) (X) ANY OTHER PROCEDURE T HAT THE BOARD AUTHORIZES BY 7
A RULE OR REGULATION . 8
(2) A DENTAL ASSISTANT MAY ASSIST IN PERFORMING INTRAORAL 9
PHOTOGRAPHY , OTHER THAN CONVENTIO NAL OR DIGITAL X–RAY, UNDER THE 10
GENERAL SUPERVISION OF A LICENSED DENTIS T WHO REVIEWS THE PH OTOGRAPHY 11
AND AUTHORIZES THE TREATMENT PLAN WITHO UT BEING CERTIFIED B Y THE 12
BOARD. 13
(B) (1) EXCEPT FOR AN INDIVID UAL LICENSED AS A DE NTIST OR A 14
DENTAL HYGIENIST UND ER THIS TITLE, AN INDIVIDUAL SHALL BE CERTIFIED BY 15
THE BOARD AS A CERTIFIED AN EXPANDED FUNCTION DENTAL ASSISTANT 16
AUTHORIZED TO PERFORM AT LEAST ONE OF THE FOL LOWING INTRAORAL 17
PROCEDURES BEFORE TH E INDIVIDUAL MAY PER FORM THE INTRAORAL 18
PROCEDURE IN THE STATE: 19
(I) ASSISTING IN ORTHODON TIC PROCEDURES AUTHO RIZED 20
BY THE BOARD IN REGULATION ; 21
(II) PLACING DENTAL SEALAN TS; 22
(III) AS PART OF DENTAL PRO PHYLAXIS OR BEFORE T HE 23
PERFORMANCE OF ESTHE TIC AND CEMENTATION PROCEDURES , CORONAL 24
POLISHING SOLELY FOR STAIN AND BIOFILM RE MOVAL; 25
(III) CORONAL POLISHING ONL Y TO REMOVE STAIN OR BIOFILM: 26
1. IN CONNECTION WITH A DENTAL PROPHYLAXIS : 27
A. AS DETERMINED NECESSARY AND APPROPRIATE , 28
SECONDARY TO THE MOR E COMPLEX DENTAL PRO CEDURES OF A DENTAL 29
PROPHYLAXIS , SUCH AS REMOVAL OF H ARD AND SOFT DEPOSIT S AND STAIN OF THE 30
TOOTH CROWN , ROOT SURFACES , AND PERIODONTAL POCK ET; AND 31 HOUSE BILL 968 5
B. IF APPLICABLE, IN CONSULTATION WITH THE 1
TREATING DENTAL HYGI ENIST; OR 2
2. BEFORE A DENTIST PERF ORMS AN ESTHETIC OR 3
CEMENTATION PROCEDUR E; 4
(IV) APPLYING SILVER DIAMI NE FLUORIDE; 5
(V) MONITORING NITROUS OX IDE BY OBSERVING A PATIE NT: 6
1. DURING THE FLOW OF NI TROUS OXIDE; 7
2. DURING THE REDUCTION OF THE FLOW OF NITRO US 8
OXIDE; 9
3. DURING THE SHUTTING O FF OF EQUIPMENT 10
CONTROLLING THE FLOW OF NITROUS OXIDE ; AND 11
4. AT ALL TIMES IN BETWE EN THE START OF THE FLOW 12
OF NITROUS OXI DE UNTIL THE NITROUS OXIDE HAS BEEN TERMI NATED AND THE 13
PATIENT HAS FULLY AW OKEN AND IS COHERENT ; OR 14
(VI) ADDITIONAL INTRAORAL PROCEDURES AUTHORIZE D BY 15
THE BOARD IN REGULATIONS . 16
(2) A DENTAL ASSISTANT WHO IS CERTIFIED BY THE BOARD TO 17
PERFORM AN INTRA ORAL PROCEDURE LISTE D IN PARAGRAPH (1) OF THIS 18
SUBSECTION MAY PERFO RM THE INTRAORAL PRO CEDURE LISTED IN PAR AGRAPH 19
(1) OF THIS SUBSECTION I F A LICENSED DENTIST : 20
(I) GIVES THE CERTIFIED D ENTAL ASSISTANT SPEC IFIC 21
INSTRUCTIONS TO PERF ORM THE INTRAORAL PR OCEDURE; AND 22
(II) DIRECTLY SUPERVISES T HE CERTIFIED DENTAL ASSISTANT 23
PERFORMING THE INTRA ORAL PROCEDURE . 24
4–302.1. 25
(A) TO QUALIFY FOR A CERT IFICATE TO BE A CERTIFIED AN EXPANDED 26
FUNCTION DENTAL ASSISTANT , AN APPLICANT SHALL B E AN INDIVIDUAL WHO 27
MEETS THE REQUIREMENTS OF THIS SECTION. 28
(B) THE APPLICANT MUST BE OF GOOD MORAL CHARAC TER. 29 6 HOUSE BILL 968
(C) THE APPLICANT MUST B E AT LEAST 17 18 YEARS OLD. 1
(D) THE APPLICANT MUST : 2
(1) BE A HIGH SCHOOL GRAD UATE OR HAVE ATTAINE D A HIGH 3
SCHOOL EQUIVALENCY ; 4
(2) HAVE SUCCESSFULLY COMPLET ED A COURSE OF STUDY 5
APPROVED, SUBJECT TO SUBSECTIO N (E) OF THIS SECTION , BY THE BOARD 6
RELATED TO THE INTRA ORAL PROCEDURE FOR W HICH THE APPLICANT H AS 7
APPLIED FOR A CERTIF ICATE; 8
(3) HAVE THE APPROPRIATE CERTIFICATION FROM T HE DENTAL 9
ASSISTING NATIONAL BOARD; 10
(4) HAVE PASSED ANY EXAMI NATION PROVIDED FOR IN A 11
REGULATION ADOPTED B Y THE BOARD; AND 12
(5) SUBMIT TO A STATE CRIMINAL HISTOR Y RECORDS CHECK . 13
(E) THE BOARD MAY NOT APPROVE A COURSE OF STUDY UN DER 14
SUBSECTION (D)(2) OF THIS SECTION UNLESS THE CO URSE OF STUDY IS PAR T OF: 15
(1) A U.S. DEPARTMENT OF LABOR JOB CORPS DENTAL ASSISTIN G 16
PROGRAM; 17
(2) A DENTAL ASSISTING PRO GRAM LOCATED WITHIN AN 18
INSTITUTION OF POSTS ECONDARY EDUCATION T HAT IS ACCREDITED BY AN 19
ACCREDITING INSTITUT ION RECOGNIZED BY THE U.S. DEPARTMENT OF 20
EDUCATION; 21
(3) A DENTAL ASSISTING PRO GRAM THAT IS LOCATED WITHIN A HIGH 22
SCHOOL AND IS RECOGN IZED BY AN ACCREDITI NG BODY RECOGNIZED B Y THE U.S. 23
DEPARTMENT OF EDUCATION OR THE HIGH SCHOOL ACCREDITING B ODY OF A 24
STATE; OR 25
(4) A DENTAL ASSISTING PRO GRAM THAT IS ACCREDI TED BY THE 26
COUNCIL ON DENTAL ACCREDITATION , OR A SUCCESSOR ORGAN IZATION. 27
4–304.1. 28
TO APPLY FOR A CERTIF ICATE TO BE A CERTIFIED AN EXPANDED FUNCTION 29
DENTAL ASSISTANT , AN APPLICANT SHALL : 30 HOUSE BILL 968 7
(1) SUBMIT AN APPLICATION TO TH E BOARD IN A MANNER THA T THE 1
BOARD REQUIRES ; AND 2
(2) PAY TO THE BOARD AN APPLICATION FEE SET BY THE BOARD. 3
4–305.1. 4
(A) AN APPLICANT WHO OTHE RWISE QUALIFIES FOR A CERTIFICATE TO BE 5
A CERTIFIED AN EXPANDED FUNCTION DENTAL ASSISTANT IS ENTITLED TO BE 6
EXAMINED AS PROVIDED FOR IN THIS SECTION . 7
(B) THE BOARD SHALL NOTIFY EA CH QUALIFIED APPLICA NT OF THE TIME 8
AND PLACE OF THE EXA MINATION. 9
(C) THE BOARD SHALL DETERMINE THE SUBJECTS , SCOPE, FORM, AND 10
PASSING SCORE FOR EX AMINATIONS GIVEN UNDER THIS SECTION . 11
(D) AN APPLICANT SHALL PA Y TO THE BOARD AN EXAMINATION FEE SET BY 12
THE BOARD IN AN AMOUNT TH AT DOES NOT EXCEED T HE COSTS OF ADMINIST ERING 13
THE EXAMINATION . 14
4–307.1. 15
(A) THE BOARD SHALL ISSUE AN APPROPRIATE CERTIFIC ATE TO ANY 16
APPLICANT WHO MEETS THE REQ UIREMENTS OF THIS TI TLE AND REGULATIONS 17
ADOPTED BY THE BOARD FOR THAT CERTIF ICATE. 18
(B) THE BOARD SHALL INCLUDE O N EACH CERTIFICATE T HAT THE BOARD 19
ISSUES: 20
(1) THE NAME OF THE CERTI FIED INDIVIDUAL; 21
(2) THE DATE THE CERTIFIC ATE WAS ISSUED; 22
(3) THE INTRAORAL PROCEDU RES THAT THE CERTIFI ED DENTAL 23
ASSISTANT IS QUALIFI ED TO PERFORM ; 24
(4) A SERIAL NUMBER ; 25
(5) THE SIGNATURES OF THE PRESIDENT AND SECRET ARY OF THE 26
BOARD; AND 27
(6) THE SEAL OF THE BOARD. 28 8 HOUSE BILL 968
(C) THE BOARD SHALL ISSUE A CERTIFICATE TO REPLA CE A LOST OR 1
DESTROYED CERTIFICAT E IF THE CERTIFIED D ENTAL ASSISTANT PAYS A FEE SET BY 2
THE BOARD THAT APPROXIMAT ES THE ACTUAL COST O F REPLACING THE 3
CERTIFICATE. 4
(D) AN INDIVIDUAL MAY BE SIMULTANEOUSLY CERTI FIED AS A DENTAL 5
RADIATION TECHNOLOGIST UNDER § 4–505 OF THIS TITLE AND AS A CERTIFIED AN 6
EXPANDED FUNCTION DENTAL ASSISTANT . 7
4–309.1. 8
(A) A CERTIFICATE EXPIRES ON THE DATE SET BY T HE BOARD, UNLESS THE 9
CERTIFICATE IS RENEW ED FOR AN ADDITIONAL TERM AS PROVIDED FOR BY THE 10
BOARD. 11
(B) AT LEAST 1 MONTH BEFORE A CERTI FICATE EXPIRES , THE BOARD 12
SHALL SEND TO THE CE RTIFIED DENTAL ASSIS TANT, BY ELECTRONIC MEANS AND 13
FIRST–CLASS MAIL TO THE LA ST KNOWN ELECTRONIC OR PHYSICAL ADDRESS OF 14
THE DENTAL ASSISTANT , A RENEWAL NOTICE THA T STATES THE: 15
(1) DATE ON WHICH THE CUR RENT CERTIFICATE EXP IRES; 16
(2) DATE BY WHICH THE REN EWAL APPLICATION MUS T BE RECEIVED 17
BY THE BOARD FOR THE RENEWAL TO BE ISSUED AND MAI LED BEFORE THE 18
CERTIFICATE EXPIRES ; AND 19
(3) AMOUNT OF THE RENEWAL FEE. 20
4–313.1. 21
EACH HOLDER OF A CERT IFICATE TO BE A CERTIFIED AN EXPANDED 22
FUNCTION DENTAL ASSISTANT SHA LL KEEP THE CERTIFIC ATE, AND ANY CURRENT 23
RENEWAL, IN THE OFFICE WHERE THE DENTAL ASSISTANT IS EMPLOYED. 24
4–315. 25
(a) Subject to the hearing provisions of § 4–318 of this subtitle, the Board may 26
deny a general license to practice dentistry, a limited license to practice dentistry, or a 27
teacher’s license to practice dentistry to any applicant, reprimand any licensed dentist, 28
place any licensed dentist on probation, or suspend or revoke the license of any licensed 29
dentist, if the applicant or licensee: 30
(36) Fails to comply with the requirements of the Prescription Drug 31
Monitoring Program in Title 21, Subtitle 2A of the Health – General Article; [or] 32 HOUSE BILL 968 9
(37) Accepts or tenders rebates or splits fees in violation of § 4–103(c) of this 1
subtitle; OR 2
(38) ALLOWS A DENTAL ASSIS TANT TO ASSIST IN TH E PRACTICE OF 3
DENTISTRY: 4
(I) IN AN UNAUTHORIZED MA NNER IN VIOLATION OF THIS 5
TITLE OR REGULATIONS ADOPTED BY THE BOARD; 6
(II) WITHOUT SPECIFICALLY INSTRUCTING THE CERT IFIED 7
DENTAL ASSISTANT TO PERFORM AN INTRAORAL PROCEDURE THAT THE C ERTIFIED 8
DENTAL ASSISTANT IS AUTHORIZED TO PERFOR M; OR 9
(III) FAILING TO PROVIDE DI RECT SUPERVISION OF A DENTAL 10
ASSISTANT. 11
4–505. 12
(a) The Board of Dental Examiners shall: 13
(1) Define, for the purpose of this section, the terms “dental radiation 14
technologist” and “practice dental radiation technology”; 15
(2) Adopt rules and regulations concerning qualifications, training, 16
certification, monitoring of, and enforcement requirements for a dental radiation 17
technologist; and 18
(3) Provide for a requirement to ensure competency in new safety and 19
technological advances. 20
(b) The qualifications required of applicants for Board certification as a dental 21
radiation technologist shall include requirements established by: 22
(1) The American Dental Association; or 23
(2) Any applicable federal standards for training and certification. 24
(c) After July 1, 1988, an individual must be certified by the Board as a dental 25
radiation technologist before a licensed dentist may employ the individual to practice 26
dental radiation technology. 27
(d) After July 1, 1988, an individual may not practice dental radiation technology 28
unless certified by the Board. 29
10 HOUSE BILL 968
(e) At least 1 month before a certificate expires, the Board shall send to each 1
certificate holder, by electronic means or first–class mail to the last known electronic or 2
physical address of the certificate holder, a renewal notice that states: 3
(1) The date on which the current certificate expires; 4
(2) The date by which the renewal application must be received by the 5
Board for the renewal to be issued and mailed before the certificate expires; and 6
(3) The amount of the renewal fee. 7
(F) AN INDIVIDUAL MAY BE SIMULTANEOUSL Y CERTIFIED AS A DEN TAL 8
RADIATION TECHNOLOGI ST UNDER THIS SECTIO N AND AS A CERTIFIED AN 9
EXPANDED FUNCTION DENTAL ASSISTANT . 10
SECTION 2. AND BE IT FURTHER ENACTED, That this Act shall take effect 11
October 1, 2022. 12
Approved:
________________________________________________________________________________
Governor.
________________________________________________________________________________
Speaker of the House of Delegates.
________________________________________________________________________________
President of the Senate.