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131st MAINE LEGISLATURE
FIRST SPECIAL SESSION-2023
Legislative Document No. 1581H.P. 1026House of Representatives, April 11, 2023
An Act Regarding Dental Hygienists and Dental Therapists
Reference to the Committee on Health Coverage, Insurance and Financial Services
suggested and ordered printed.
ROBERT B. HUNT
Clerk
Presented by Representative MASTRACCIO of Sanford.
Cosponsored by Senator GROHOSKI of Hancock. Page 1 - 131LR1296(01)
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2 as amended by PL 2021, c. 223, §12, is further
3 amended to read:
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5 hygienist may perform the following under the direct supervision of a dentist:
6 A. Administer local anesthesia or nitrous oxide analgesia, as long as the dental
7 hygienist or faculty dental hygienist has authority to administer the relevant medication
8 pursuant to section 18345, subsection 2, paragraph D or E.
9 as amended by PL 2021, c. 223, §12, is further
10 amended to read:
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12 hygienist may perform under the general supervision of a dentist all of the activities that
13 may be delegated to an unlicensed person pursuant to section 18371, subsection 3. A dental
14 hygienist and faculty dental hygienist may also perform the following procedures under the
15 general supervision of a dentist:
16 A. Prescribe, dispense or administer anticavity toothpastes or topical gels with 1.1%
17 or less sodium fluoride and oral rinses with 0.05%, 0.2%, 0.44% or 0.5% sodium
18 fluoride, as well as chlorhexidine gluconate oral rinse;
19 A-1. Prescribe, dispense or administer fluoride, silver diamine fluoride, antimicrobial
20 solutions for mouth rinsing, other nonsystemic antimicrobial agents, desensitizing
21 agents and resorbable antimicrobial agents;
22 C. Apply desensitizing agents to teeth;
23 D. Apply fluoride to control caries;
24 F. Apply sealants;
25 J. Expose and process radiographs;
26 S. Perform all procedures necessary for a complete prophylaxis, including but not
27 limited to scaling and root planing and periodontal maintenance;
28 U. Perform complete periodontal and dental restorative charting;
29 X. Perform oral inspections, recording all conditions that should be called to the
30 attention of the dentist;
31 GG. Place localized delivery of chemotherapeutic agents when treatment is planned
32 by the dentist;
33 JJ. Place temporary restorations as an emergency procedure, as long as the patient is
34 informed of the temporary nature of the restoration in compliance with the protocol
35 adopted by the board; and
36 TT. Smooth and polish amalgam restorations.;
37 ZZ. Administer local anesthesia, as long as the dental hygienist or faculty dental
38 hygienist has authority to administer the medication pursuant to section 18345,
39 subsection 2, paragraph D; Page 2 - 131LR1296(01)
1 AAA. Perform dental hygiene assessment, dental hygiene diagnosis and dental
2 hygiene treatment planning for dental hygiene services; and
3 BBB. Obtain impressions for and deliver athletic mouth guards and custom fluoride
4 trays.
5 as amended by PL 2017, c. 388, §§20 and 21,
6 is further amended to read:
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8 following duties without supervision by a dentist:
9 A. Interview patients and record complete medical and dental histories;
10 B. Take and record the vital signs of blood pressure, pulse and temperature;
11 C. Perform oral inspections, recording all conditions that should be called to the
12 attention of a dentist;
13 D. Perform complete periodontal and dental restorative charting;
14 E. Perform all procedures necessary for a complete prophylaxis, including but not
15 limited to scaling and root planing and periodontal maintenance;
16 F. Apply fluoride to control caries;
17 G. Apply desensitizing agents to teeth;
18 H. Apply topical anesthetics;
19 I. Apply sealants;
20 J. Smooth and polish amalgam restorations, limited to slow-speed application only;
21 L. Obtain impressions for and deliver athletic mouth guards and custom fluoride trays;
22 M. Place and remove rubber dams;
23 N. Place temporary restorations in compliance with the protocol adopted by the board;
24 O. Apply topical antimicrobials, including fluoride but excluding antibiotics, for the
25 purposes of bacterial reduction, caries control and desensitization in the oral cavity.
26 The independent practice dental hygienist shall follow current manufacturer's
27 instructions in the use of these medicaments;
28 P. Expose and process radiographs, including but not limited to vertical and horizontal
29 bitewing films, periapical films, panoramic images and full-mouth series, under
30 protocols developed by the board as long as the independent practice dental hygienist
31 has a written agreement with a licensed dentist that provides that the dentist is available
32 to interpret all dental radiographs within 21 days from the date the radiograph is taken
33 and that the dentist will sign a radiographic review and findings form and provide the
34 radiographs to a dentist as needed; and
35 Q. Prescribe, dispense or administer anticavity toothpastes or topical gels with 1.1%
36 or less sodium fluoride and oral rinses with 0.05%, 0.2%, 0.44% or 0.5% sodium
37 fluoride, as well as chlorhexidine gluconate oral rinse. For the purposes of this
38 paragraph, "topical" includes superficial and intraoral application. fluoride, silver
39 diamine fluoride, antimicrobial solutions for mouth rinsing, other nonsystemic
40 antimicrobial agents, desensitizing agents and resorbable antimicrobial agents; Page 3 - 131LR1296(01)
1 R. Administer local anesthesia, as long as the independent practice dental hygienist
2 has authority to administer the medication pursuant to section 18345, subsection 2,
3 paragraph D; and
4 S. Perform dental hygiene assessment, dental hygiene diagnosis and dental hygiene
5 treatment planning for dental hygiene services.
6 as amended by PL 2017, c. 388, §§22 and 23,
7 is further amended to read:
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9 procedures in a public health setting under a supervision agreement with a dentist that
10 outlines the roles and responsibilities of the collaboration:
11 A. Prescribe, dispense or administer anticavity toothpastes or topical gels with 1.1%
12 or less sodium fluoride and oral rinses with 0.05%, 0.2%, 0.44% or 0.5% sodium
13 fluoride, as well as chlorhexidine gluconate oral rinse fluoride, silver diamine fluoride,
14 antimicrobial solutions for mouth rinsing, other nonsystemic antimicrobial agents,
15 desensitizing agents and resorbable antimicrobial agents;
16 B. Apply cavity varnish;
17 C. Apply desensitizing agents to teeth;
18 D. Apply fluoride to control caries;
19 E. Apply liquids, pastes or gel topical anesthetics;
20 F. Apply sealants;
21 G. Apply topical antimicrobials, including fluoride but excluding antibiotics, for the
22 purposes of bacterial reduction, caries control and desensitization in the oral cavity.
23 The public health dental hygienist shall follow current manufacturer’s instructions in
24 the use of these medicaments. For the purposes of this paragraph, "topical" includes
25 superficial and intramuscular application;
26 I. Expose and process radiographs upon written standing prescription orders from a
27 dentist who is available to interpret all dental radiographs within 21 days and who will
28 complete and sign a radiographic review and findings form;
29 J. For instruction purposes, demonstrate to a patient how the patient should place and
30 remove removable prostheses, appliances or retainers;
31 K. For the purposes of eliminating pain or discomfort, remove loose, broken or
32 irritating orthodontic appliances;
33 L. Give oral health instruction;
34 M. Interview patients and record complete medical and dental histories;
35 N. Irrigate and aspirate the oral cavity;
36 O. Isolate operative fields;
37 P. Perform all procedures necessary for a complete prophylaxis, including but not
38 limited to scaling and root planing and periodontal maintenance;
39 Q. Perform complete periodontal and dental restorative charting;
40 R. Perform dietary analyses for dental disease control; Page 4 - 131LR1296(01)
1 S. Perform temporary filling procedures without a dentist present under protocols
2 adopted by board rule;
3 T. Perform oral inspections, recording all conditions that should be called to the
4 attention of the dentist;
5 U. Perform pulp vitality tests pursuant to the direction of a dentist;
6 V. Place and remove gingival retraction cord without vasoconstrictor;
7 W. Place and remove matrix bands for purposes of fabricating or placing temporary
8 restorations;
9 X. Place and remove rubber dams;
10 Y. Place and remove wedges for purposes of fabricating or placing temporary
11 restorations;
12 Z. Place temporary restorations in compliance with the protocol adopted by board rule;
13 AA. Remove excess cement from the supragingival surfaces of teeth;
14 BB. Retract lips, cheek, tongue and other tissue parts;
15 CC. Smooth and polish restorations, limited to slow-speed application only;
16 DD. Take and record the vital signs of blood pressure, pulse and temperature;
17 EE. Take dental plaque smears for microscopic inspection and patient education;
18 FF. Obtain impressions for and deliver athletic mouth guards and custom fluoride
19 trays; and
20 GG. Take intraoral photographs.
21 HH. Perform dental hygiene assessment, dental hygiene diagnosis and dental hygiene
22 treatment planning for dental hygiene services; and
23 II. Administer local anesthesia, as long as the public health dental hygienist has
24 authority to administer the medication pursuant to section 18345, subsection 2,
25 paragraph D.
26 as amended by PL 2021, c. 223, §13, is further
27 amended to read:
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29 limited practice settings, if authorized by a written practice agreement with under the
30 general supervision of a supervising dentist licensed in this State pursuant to subsection 3.
31 A. To the extent permitted in a written practice agreement, a dental therapist may
32 provide the care and services listed in this paragraph only under the direct general
33 supervision of the supervising dentist:
34 (1) Perform oral health assessments, pulpal disease assessments for primary and
35 young teeth, simple cavity preparations and restorations and simple extractions;
36 (2) Prepare and place stainless steel crowns and aesthetic anterior crowns for
37 primary incisors and prepare, place and remove space maintainers;
38 (4) Administer local anesthesia and nitrous oxide analgesia; Page 5 - 131LR1296(01)
1 (6) Conduct urgent management of dental trauma, perform suturing, extract
2 primary teeth and perform nonsurgical extractions of periodontally diseased
3 permanent teeth if authorized in advance by the supervising dentist; and
4 (7) Provide, dispense and administer anti-inflammatories, nonprescription
5 analgesics, antimicrobials, antibiotics and anticaries materials.
6 B. To the extent permitted in a written practice agreement, a dental therapist may
7 provide the care and services identified in section 18371, subsection 3 and section
8 18374 under the general supervision of the supervising dentist.
9 as amended by PL 2019, c. 388, §10, is
10 further amended to read:
11 B. A dental therapist may practice only under the direct general supervision of a dentist
12 through a written practice agreement signed by both parties. A written practice
13 agreement is a signed document that outlines the functions that the dental therapist is
14 authorized to perform, which may not exceed the scopes of practice specified in
15 subsections 1 and 2. A dental therapist may practice only under the standing order of
16 the supervising dentist, may provide only care that follows written protocols and may
17 provide only services that the dental therapist is authorized to provide by the written
18 practice agreement.
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20 This bill changes the supervision required for dental hygienists, independent practice
21 dental hygienists and public health dental hygienists to administer local anesthesia from
22 direct to general supervision. The bill also changes the supervision for dental therapists
23 from direct to general supervision. The bill also makes other changes to the scope of
24 practice for dental hygienists, independent practice dental hygienists and public health
25 dental hygienists.
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