LAWRENCE J. HOGAN, JR., Governor Ch. 364
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Chapter 364
(House Bill 968)
AN ACT concerning
Health Occupations – Dental Assistants – Certification and Regulation
FOR the purpose of establishing a certification and regulatory scheme to certify dental
assistants to perform certain intraoral procedures; specifying the intraoral
procedures a dental assistant is authorized to perform without being certified by the
State Board of Dental Examiners and the intraoral procedu res that require
certification; authorizing the Board to penalize a licensed dentist who allows a dental
assistant to provide dental care in an unauthorized manner or without required
instruction or supervision; and generally relating to dental assistants.
BY repealing and reenacting, without amendments,
Article – Health Occupations
Section 4–101(a)
Annotated Code of Maryland
(2021 Replacement Volume)
BY adding to
Article – Health Occupations
Section 4–101(b–1) and (c–1) 4–101(c–1) and (g–1), 4–301.1, 4–302.1, 4–304.1,
4–305.1, 4–307.1, 4–309.1, 4–313.1, and 4–315(a)(38)
Annotated Code of Maryland
(2021 Replacement Volume)
BY repealing and reenacting, with amendments,
Article – Health Occupations
Section 4–205(a)(1)(iii), 4–301(b)(5), 4–315(a)(36) and (37), and 4–505
Annotated Code of Maryland
(2021 Replacement Volume)
SECTION 1. BE IT ENACTED BY THE GENERAL ASSEMBLY OF MARYLAND,
That the Laws of Maryland read as follows:
Article – Health Occupations
4–101.
(a) In this title the following words have the meanings indicated.
(B–1) “CERTIFIED DENTAL ASSI STANT” MEANS A DENTAL ASSIS TANT WHO IS
CERTIFIED BY THE BOARD TO PERFORM SPEC IFIED INTRAORAL PROC EDURES. Ch. 364 2022 LAWS OF MARYLAND
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(C–1) “DENTAL ASSISTANT ” MEANS AN INDIVIDUAL WHO DIRECTLY ASSISTS A
DENTIST IN THE PRACTICE OF D ENTISTRY.
(G–1) “EXPANDED FUNCTION DEN TAL ASSISTANT ” MEANS A DENTAL
ASSISTANT WHO IS CER TIFIED BY THE BOARD TO PERFORM SPEC IFIC INTRAORAL
PROCEDURES .
4–205.
(a) In addition to the powers set forth elsewhere in this title, the Board may:
(1) Adopt regulations governing:
(iii) The use of a dental assistant by a licensed dentist in performing
intraoral procedures, INCLUDING:
1. REASONABLE POLICIES A ND GUIDELINES FOR A
DENTAL ASSISTANT TO ASSIST IN PERFORMING INTRAORAL PRO CEDURES
AUTHORIZED UNDER § 4–301(A) OF THIS TITLE; AND
2. REASONABLE SUBJECT TO § 4–302.1(E) OF THIS
TITLE, REASONABLE EDUCATION OR TRAININ G REQUIREMENTS FOR A N INDIVIDUAL
TO BECOME A CERTIFIED AN EXPANDED FUNCTION DENTAL ASSISTANT AND
PERFORM THE INT RAORAL PROCEDURES AU THORIZED UNDER § 4–301.1(B) OF THIS
TITLE;
4–301.
(b) This section does not apply to:
(5) A dental assistant, if the dental assistant:
(i) Subject to the rules and regulations adopted by the Board,
performs only procedures that do not require the professional skills of a licensed dentist;
and
(ii) Performs intraoral [tasks] PROCEDURES IN ACCORDANCE
WITH § 4–301.1 OF THIS SUBTITLE only under the direct supervision of a licensed dentist
who personally is present in the office area where the [tasks] PROCEDURES are performed;
or
4–301.1.
LAWRENCE J. HOGAN, JR., Governor Ch. 364
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(A) (1) A DENTAL ASSISTANT MAY ASSIST A LICENSED DE NTIST IN
PROVIDING THE FOLLOW ING INTRAORAL PROCED URES UNDER THE DIREC T
SUPERVISION OF A LIC ENSED DENTIST WITHOU T BEING CERTIFIED BY THE BOARD:
(1) (I) RINSING AND ASPIRATIO N OF THE ORAL CAVITY ;
(2) (II) RETRACTION OF THE LIP S, CHEEKS, TONGUE, AND FLAPS;
(3) (III) PLACEMENT AND REMOVAL OF MATERIALS FOR THE
ISOLATION OF THE DEN TITION, PROVIDED THAT THE MA TERIAL IS NOT RETAIN ED
BY THE DENTITION ;
(4) (IV) INSTRUCTING ON ORAL H YGIENE;
(5) PERFORMING INTRAORAL PHOTOGRAPHY OTHER TH AN
CONVENTIONAL OR DIGI TAL X–RAY;
(6) (V) TAKING IMPRESSIONS FO R STUDY MODELS OR DI AGNOSTIC
CASTS;
(7) (VI) CONSTRUCTING ATHLETIC MOUTH GUARDS ON MODELS;
(8) (VII) APPLYING TOPICAL ANES THESIA;
(9) (VIII) CURING BY THE USE OF HALOGEN LIGHT ;
(10) (IX) CHECKING FOR LOOSE BA NDS; AND
(11) (X) ANY OTHER PROCEDURE T HAT THE BOARD AUTHORIZES BY
A RULE OR REGULATION .
(2) A DENTAL ASSISTANT MAY ASSIST IN PERFORMING INTRAORAL
PHOTOGRAPHY , OTHER THAN CONVENTIO NAL OR DIGITAL X–RAY, UNDER THE
GENERAL SUPERVISION OF A LICENSED DENTIS T WHO REVIEWS THE PH OTOGRAPHY
AND AUTHORIZES THE T REATMENT PLAN WITHOU T BEING CERTIFIED BY THE
BOARD.
(B) (1) EXCEPT FOR AN INDIVIDUAL LI CENSED AS A DENTIST OR A
DENTAL HYGIENIST UND ER THIS TITLE, AN INDIVIDUAL SHALL BE CERTIFIED BY
THE BOARD AS A CERTIFIED AN EXPANDED FUNCTION DENTAL ASSISTANT
AUTHORIZED TO PERFOR M AT LEAST ONE OF TH E FOLLOWING INTRAORA L
PROCEDURES BEFO RE THE INDIVIDUAL MA Y PERFORM THE INTRAO RAL
PROCEDURE IN THE STATE:
Ch. 364 2022 LAWS OF MARYLAND
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(I) ASSISTING IN ORTHODON TIC PROCEDURES AUTHO RIZED
BY THE BOARD IN REGULATION ;
(II) PLACING DENTAL SEALAN TS;
(III) AS PART OF DENTAL PRO PHYLAXIS OR BEFORE T HE
PERFORMANCE OF ESTHETIC AND CEMENTA TION PROCEDURES , CORONAL
POLISHING SOLELY FOR STAIN AND BIOFILM RE MOVAL;
(III) CORONAL POLISHING ONL Y TO REMOVE STAIN OR BIOFILM:
1. IN CONNECTION WITH A DENTAL PROPHYLAXIS :
A. AS DETERMINED NECESSARY AND APPROPRIATE ,
SECONDARY TO THE MOR E COMPLEX DENTAL PRO CEDURES OF A DENTAL
PROPHYLAXIS , SUCH AS REMOVAL OF H ARD AND SOFT DEPOSIT S AND STAIN OF THE
TOOTH CROWN , ROOT SURFACES , AND PERIODONTAL POCK ET; AND
B. IF APPLICABLE, IN CONSULTATION WITH THE
TREATING DENTAL HYGI ENIST; OR
2. BEFORE A DENTIST PERF ORMS AN ESTHETIC OR
CEMENTATION PROCEDUR E;
(IV) APPLYING SILVER DIAMI NE FLUORIDE;
(V) MONITORING NITROUS OX IDE BY OBSERVING A PATIE NT:
1. DURING THE FLOW OF NITROUS OXIDE ;
2. DURING THE REDUCTION OF THE FLOW OF NITRO US
OXIDE;
3. DURING THE SHUTTING O FF OF EQUIPMENT
CONTROLLING THE FLOW OF NITROUS OXIDE ; AND
4. AT ALL TIMES IN BETWE EN THE START OF THE FLOW
OF NITROUS OXIDE UNT IL THE NITROUS OXIDE HAS BEEN TERMINATED AND THE
PATIENT HAS FULLY AW OKEN AND IS COHERENT ; OR
(VI) ADDITIONAL INTRAORAL PROCEDURES AUTHORIZE D BY
THE BOARD IN REGULATIONS .
LAWRENCE J. HOGAN, JR., Governor Ch. 364
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(2) A DENTAL ASSISTANT WHO IS CERTIFIED BY THE BOARD TO
PERFORM AN INTRAORAL PROCEDURE LISTED IN PARAGRAPH (1) OF THIS
SUBSECTION MAY PERFO RM THE INTRAORAL PRO CEDURE LISTED IN PAR AGRAPH
(1) OF THIS SUBSECTION I F A LICENSED DENTIST :
(I) GIVES THE CERTIFIED D ENTAL ASSISTANT SPEC IFIC
INSTRUCTIONS TO PERF ORM THE INTRAORAL PR OCEDURE; AND
(II) DIRECTLY SUPERVISES T HE CERTIFIED DENTAL ASSISTANT
PERFORMING THE INTRA ORAL PROCEDURE .
4–302.1.
(A) TO QUALIFY FOR A CERT IFICATE TO BE A CERTIFIED AN EXPANDED
FUNCTION DENTAL ASSISTANT , AN APPLICANT SHALL B E AN INDIVIDUAL WHO
MEETS THE REQUIREMEN TS OF THIS SECTION.
(B) THE APPLICANT MUST BE OF GOOD MORAL CHARAC TER.
(C) THE APPLICANT MUST B E AT LEAST 17 18 YEARS OLD.
(D) THE APPLICANT MUST :
(1) BE A HIGH SCHOOL GRAD UATE OR HAVE ATTAINE D A HIGH
SCHOOL EQUIVALENCY ;
(2) HAVE SUCCESSFULLY COM PLETED A COURSE OF STUDY
APPROVED, SUBJECT TO SUBSECTIO N (E) OF THIS SECTION , BY THE BOARD
RELATED TO THE INTRA ORAL PROCEDURE FOR W HICH THE APPLICANT H AS
APPLIED FOR A CERTIF ICATE;
(3) HAVE THE APPROPRIATE CERTIFICATION FROM T HE DENTAL
ASSISTING NATIONAL BOARD;
(4) HAVE PASSED ANY EXAMI NATION PROVIDED FOR IN A
REGULATION ADOPTED B Y THE BOARD; AND
(5) SUBMIT TO A STATE CRIMINAL HISTOR Y RECORDS CHECK .
(E) THE BOARD MAY NOT APPROVE A COURSE OF STUDY UN DER
SUBSECTION (D)(2) OF THIS SECTION UNLE SS THE COURSE OF STUDY IS PA RT OF:
(1) A U.S. DEPARTMENT OF LABOR JOB CORPS DENTAL ASSISTIN G
PROGRAM; Ch. 364 2022 LAWS OF MARYLAND
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(2) A DENTAL ASSISTING PRO GRAM LOCATED WITHIN AN
INSTITUTION OF POSTS ECONDARY EDUCATION T HAT IS ACCREDITED BY AN
ACCREDITING INSTITUT ION RECOGNIZED BY TH E U.S. DEPARTMENT OF
EDUCATION;
(3) A DENTAL ASSISTING PRO GRAM THAT IS LOCATED WITHIN A HIGH
SCHOOL AND IS RECOGN IZED BY AN ACCREDITI NG BODY RECOGNIZED B Y THE U.S.
DEPARTMENT OF EDUCATION OR THE HIGH SCHOOL ACCREDITING B ODY OF A
STATE; OR
(4) A DENTAL ASSISTING PROGRAM THA T IS ACCREDITED BY T HE
COUNCIL ON DENTAL ACCREDITATION , OR A SUCCESSOR ORGAN IZATION.
4–304.1.
TO APPLY FOR A CERTIF ICATE TO BE A CERTIFIED AN EXPANDED FUNCTION
DENTAL ASSISTANT , AN APPLICANT SHALL :
(1) SUBMIT AN APPLICATION TO THE BOARD IN A MANNER THA T THE
BOARD REQUIRES ; AND
(2) PAY TO THE BOARD AN APPLICATION FEE SET BY THE BOARD.
4–305.1.
(A) AN APPLICANT WHO OTHE RWISE QUALIFIES FOR A CERTIFICATE TO BE
A CERTIFIED AN EXPANDED FUNCTION DENTAL ASSISTANT IS ENTITLED TO BE
EXAMINED AS PROVIDED FOR IN THIS SECTION .
(B) THE BOARD SHALL NOTIFY EA CH QUALIFIED APPLICA NT OF THE TIME
AND PLACE OF THE EXA MINATION.
(C) THE BOARD SHALL DETERMINE THE SUBJECTS , SCOPE, FORM, AND
PASSING SCORE FOR EX AMINATIONS GIVEN UND ER THIS SECTION.
(D) AN APPLICANT SHALL PA Y TO THE BOARD AN EXAMINATION FEE SET BY
THE BOARD IN AN AMOUNT TH AT DOES NOT EXCEED T HE COSTS OF ADMINIST ERING
THE EXAMINATION .
4–307.1.
LAWRENCE J. HOGAN, JR., Governor Ch. 364
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(A) THE BOARD SHALL ISSUE AN APPROPRIATE CERTIFIC ATE TO ANY
APPLICANT WHO MEETS THE REQUIREMENTS OF THIS TITLE AND REGUL ATIONS
ADOPTED BY THE BOARD FOR THAT CERTIF ICATE.
(B) THE BOARD SHALL INCLUDE O N EACH CERTIFICATE T HAT THE BOARD
ISSUES:
(1) THE NAME OF THE CERTI FIED INDIVIDUAL;
(2) THE DATE THE CERTIFIC ATE WAS ISSUED;
(3) THE INTRAORAL PROCEDU RES THAT THE CERTIFI ED DENTAL
ASSISTANT IS QUALIFI ED TO PERFORM ;
(4) A SERIAL NUMBER ;
(5) THE SIGNATURES OF THE PRESIDENT AND SECRET ARY OF THE
BOARD; AND
(6) THE SEAL OF THE BOARD.
(C) THE BOARD SHALL ISSUE A C ERTIFICATE TO REPLACE A LOST OR
DESTROYED CERTIFICAT E IF THE CERTIFIED D ENTAL ASSISTANT PAYS A FEE SET BY
THE BOARD THAT APPROXIMAT ES THE ACTUAL COST O F REPLACING THE
CERTIFICATE.
(D) AN INDIVIDUAL MAY BE SIMULTANEOUSLY CERTI FIED AS A DENTAL
RADIATION TECHNOLOGI ST UNDER § 4–505 OF THIS TITLE AND AS A CERTIFIED AN
EXPANDED FUNCTION DENTAL ASSISTANT .
4–309.1.
(A) A CERTIFICATE EXPIRES ON THE DATE SET BY T HE BOARD, UNLESS THE
CERTIFICATE IS RENEW ED FOR AN ADDITIONAL TERM AS PROVIDED FOR BY THE
BOARD.
(B) AT LEAST 1 MONTH BEFORE A CERTI FICATE EXPIRES , THE BOARD
SHALL SEND TO THE CE RTIFIED DENTAL ASSIS TANT, BY ELECTRONIC MEANS AND
FIRST–CLASS MAIL TO THE LA ST KNOWN ELECTRONIC OR PHYSICAL ADDRESS O F
THE DENTAL ASSISTANT , A RENEWAL NOTICE THA T STATES THE:
(1) DATE ON WHICH THE CUR RENT CERTIFICATE EXP IRES;
Ch. 364 2022 LAWS OF MARYLAND
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(2) DATE BY WHICH THE REN EWAL APPLICATION MUS T BE RECEIVED
BY THE BOARD FOR THE RENEWAL TO BE ISSUED AND MAI LED BEFORE TH E
CERTIFICATE EXPIRES ; AND
(3) AMOUNT OF THE RENEWAL FEE.
4–313.1.
EACH HOLDER OF A CERT IFICATE TO BE A CERTIFIED AN EXPANDED
FUNCTION DENTAL ASSISTANT SHA LL KEEP THE CERTIFIC ATE, AND ANY CURRENT
RENEWAL, IN THE OFFICE WHERE THE DENTAL ASSISTANT IS EMPLOYED.
4–315.
(a) Subject to the hearing provisions of § 4–318 of this subtitle, the Board may
deny a general license to practice dentistry, a limited license to practice dentistry, or a
teacher’s license to practice dentistry to any applicant, reprimand any licensed dentist,
place any licensed dentist on probation, or suspend or revoke the license of any licensed
dentist, if the applicant or licensee:
(36) Fails to comply with the requirements of the Prescription Drug
Monitoring Program in Title 21, Subtitle 2A of the Health – General Article; [or]
(37) Accepts or tenders rebates or splits fees in violation of § 4–103(c) of this
subtitle; OR
(38) ALLOWS A DENTAL ASSIS TANT TO ASSIST IN TH E PRACTICE OF
DENTISTRY:
(I) IN AN UNAUTHORIZED MANNER IN VIOLATION OF THIS
TITLE OR REGULATIONS ADOPTED BY THE BOARD;
(II) WITHOUT SPECIFICALLY INSTRUCTING THE CERT IFIED
DENTAL ASSISTANT TO PERFORM AN INTRAORAL PROCEDURE THAT THE C ERTIFIED
DENTAL ASSISTANT IS AUTHORIZED TO PERFOR M; OR
(III) FAILING TO PROVIDE DIRE CT SUPERVISION OF A DENTAL
ASSISTANT.
4–505.
(a) The Board of Dental Examiners shall:
LAWRENCE J. HOGAN, JR., Governor Ch. 364
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(1) Define, for the purpose of this section, the terms “dental radiation
technologist” and “practice dental radiation technology”;
(2) Adopt rules and regulations concerning qualifications, training,
certification, monitoring of, and enforcement requirements for a dental radiation
technologist; and
(3) Provide for a requirement to ensure competency in new safety and
technological advances.
(b) The qualifications required of applicants for Board certification as a dental
radiation technologist shall include requirements established by:
(1) The American Dental Association; or
(2) Any applicable federal standards for training and certification.
(c) After July 1, 1988, an individual must be certified by the Board as a dental
radiation technologist before a licensed dentist may employ the individual to practice
dental radiation technology.
(d) After July 1, 1988, an individual may not practice dental radiation technology
unless certified by the Board.
(e) At least 1 month before a certificate expires, the Board shall send to each
certificate holder, by electronic means or first–class mail to the last known electronic or
physical address of the certificate holder, a renewal notice that states:
(1) The date on which the current certificate expires;
(2) The date by which the renewal application must be received by the
Board for the renewal to be issued and mailed before the certificate expires; and
(3) The amount of the renewal fee.
(F) AN INDIVIDUAL MAY BE SIMULTANEOUSLY CERTI FIED AS A DENTAL
RADIATION TECHNOLOGI ST UNDER THIS SECTIO N AND AS A CERTIFIED AN
EXPANDED FUNCTION DENTAL ASSISTANT .
SECTION 2. AND BE IT FURTHER ENACTED, That this Act shall take effect
October 1, 2022.
Approved by the Governor, May 16, 2022.