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| Montana Administrative Register Notice 24-138-83 | No. 8 04/26/2024 | |
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BEFORE THE BOARD OF DENTISTRY DEPARTMENT OF LABOR AND INDUSTRY STATE OF MONTANA
TO: All Concerned Persons
1. On May 21, 2024, at 9:00 a.m., a public hearing will be held via remote conferencing to consider the proposed changes to the above-stated rules. There will be no in-person hearing. Interested parties may access the remote conferencing platform in the following ways: a. Join Zoom Meeting, https://mt-gov.zoom.us/j/86083012769 Meeting ID: 860 8301 2769, Passcode: 366479 -OR- b. Dial by telephone, +1 406 444 9999 or +1 646 558 8656 Meeting ID: 860 8301 2769, Passcode: 366479
2. The Department of Labor and Industry (department) will make reasonable accommodations for persons with disabilities who wish to participate in this public hearing or need an alternative accessible format of this notice. If you require an accommodation, contact the department no later than 5:00 p.m., on May 14, 2024, to advise us of the nature of the accommodation that you need. Please contact the department at P.O. Box 1728, Helena, Montana 59624-1728; telephone (406) 444-5466; Montana Relay 711; or e-mail laborlegal@mt.gov.
3. GENERAL STATEMENT OF REASONABLE NECESSITY: Consistent with the Red Tape Relief initiative as well as its ongoing obligation to review its own rules, the Board of Dentistry (board) undertakes this rulemaking to simplify, shorten, and clarify its own rules for improved usability by the public.
4. The proposed new rules are as follows:
NEW RULE I APPLICATION FOR LICENSURE (1) Each application for licensure from the board must include: (a) a completed application form; (b) the initial license fee; (c) verification of applicable educational requirements; (d) proof of a current cardiopulmonary resuscitation (CPR), advanced cardiac life support (ACLS), or pediatric advanced life support (PALS) card. Internet courses will be accepted if a hands-on evaluation of clinical competency is also included; and (e) successful completion of the jurisprudence exam with a score of at least 75 percent. (2) The department will obtain a query from the National Practitioner Data Bank. (3) An applicant licensed in any other jurisdiction at any time shall cause the other jurisdictions to submit a current verification of licensure directly to the board. (4) An applicant may voluntarily withdraw their application by written request if the application has not appeared on a board agenda. Application fees are not refundable.
AUTH: 37-1-131, 37-4-205, 37-29-201, MCA IMP: 37-1-131, 37-4-301, 37-4-401, 37-4-402, 37-29-201, 37-29-303, 37-29-306, MCA
REASON: There is reasonable necessity to adopt NEW RULE I to shorten and simplify the administrative rules. Presently, the board has multiple rules governing license applications. This proposal seeks to simplify the rules by consolidating all such rules into one location, applicable to all license types.
NEW RULE II CONTINUING EDUCATION (1) Licensees must obtain the following continuing education (CE) hours per three-year cycle with a starting date of 2015, prior to renewal: (a) 60 hours for dentists. If a dentist also holds an anesthesia permit, the dentist must obtain as part of the 60 hours the following anesthesia-specific education: (i) 20 hours for deep sedation/general anesthesia; or (ii) 12 hours for moderate sedation. (b) 36 hours for dental hygienists: (i) three hours of fluoride agents, topical oral anesthetics, or nonsystemic oral antimicrobials for dental hygienists who qualify for limited prescriptive authority under 37-4-401, MCA; and (ii) 12 additional hours for dental hygienists with a limited access permit. (c) 36 hours for denturists. (2) Continuing education requirements do not apply until a licensee's first full year of licensure. (3) Board/staff will not preapprove CE programs or sponsors. Licensees must select quality programs that: (a) contribute to professional knowledge and competence; (b) contain significant intellectual or practical content; and (c) are germane to the licensed profession. (4) All licensees shall affirm an understanding of their recurring duty to comply with CE requirements as part of annual license renewal. (5) Licensees must maintain CE documentation and make the documentation available upon request. Documentation must include: (a) licensee name; (b) presenter or sponsor; (c) course title and/or description of content; (d) course date(s); and (e) number of CE hours earned. (6) Licensees found to be in noncompliance with CE requirements may be subject to administrative suspension. Licensees may not apply CE hours used to complete delinquent CE requirements for the next education reporting period. (7) Any CE hours required by disciplinary order do not apply toward hours required annually. (8) The department, with respect to any CE audit it performs, shall determine the percentage to audit based on a statistically relevant sampling of the total number of licensees and the compliance rate of past audits. (9) In addition to the continuing education requirements above, all licensees shall maintain a current cardiopulmonary resuscitation (CPR), advanced cardiac life support (ACLS), or pediatric advanced life support (PALS) card. Internet courses will be accepted if a hands-on evaluation of clinical competency is also included. (10) One-time credit for first-time preparation and teaching of a program which meets the criteria in (3) qualifies for the number of hours granted to individuals who take the program.
REASON: The board is repealing ARM 24.138.2101, 24.138.2102, 24.138.2103, 24.138.2104, 24.138.2105, and 24.138.2106 and replacing them with this new rule to simplify and standardize with procedures used by all licensing boards. The board is amending the CE standards in (3) to simplify and provide broader guidance as to acceptable CE content and allowing for credit for preparing and teaching programs in (10)
5. The rules as proposed to be amended provide as follows, new matter underlined, deleted matter interlined:
24.138.301 DEFINITIONS For the purposes of this chapter, the following definitions apply: (1) "Administration is as follows: (a) "enteral administration" means the agent is absorbed through the gastrointestinal tract or oral mucosa (oral, rectal, or sublingual); (b) "inhalation administration" means a gaseous or volatile agent is introduced into the lungs and absorbed through the gas/blood interface. Because sedation and general anesthesia are a continuum, it is not always possible to predict how an individual patient will respond. Practitioners intending to produce a given level of sedation should be able to diagnose and manage the physiologic consequences (rescue) for patients whose level of sedation becomes deeper than initially intended; (c) "parenteral administration" means the agent is absorbed intramuscularly, intravenously, intranasally, submucosally, subcutaneously, or intraosseously; (d) "transdermal administration" means the agent is absorbed through a patch or by iontophoresis through the skin; and (e) "transmucosal administration" means the agent is absorbed across the mucosa (intranasal, rectal, or sublingual). (3) and (4) remain the same but are renumbered (2) and (3). (6) "Inhalation sedation" means the use of nitrous oxide/oxygen in concentrations of up to 70/30 percent to provide mild relaxation and analgesia. Nitrous oxide/oxygen may produce minimal sedation, moderate sedation, deep sedation, or general anesthesia when used in combination with a sedative agent or agents. Inhalation sedation may be used in the pediatric or adult populations. (7) "Maximum recommended dose" (MRD) means the maximum Food and Drug Administration (FDA)-recommended dose of a drug, as printed in the FDA-approved labeling for unmonitored dose. (8) "Minimal sedation" means a minimally depressed level of consciousness, produced by a pharmacological method, that retains the patient's ability to independently and continuously maintain an airway and respond normally to tactile stimulation and verbal command. Although cognitive function and coordination may be modestly impaired, ventilatory and cardiovascular functions are unaffected. When the intent is minimal sedation for adults, the appropriate dose of a single enteral drug is no more than the MRD of a drug that can be prescribed for unmonitored home use. (9) "Moderate sedation" means a drug-induced depression of consciousness during which patients respond purposefully to verbal commands, either alone or accompanied by light tactile stimulation. No interventions are required to maintain a patent airway, and spontaneous ventilation is adequate. Cardiovascular function is usually maintained. The drugs and/or techniques used for moderate sedation should render the unintended loss of consciousness unlikely. Repeated dosing of an agent before the effects of previous dosing is obtained may result in a greater alteration of the state of consciousness than intended. A patient whose only response is reflex withdrawal from a painful stimulus is not in a state of moderate sedation. (10) "Supplemental dosing" means a single additional dose of the initial dose of the initial drug necessary for prolonged procedures under minimal sedation. The supplemental dose should not exceed one-half of the initial total dose and should not be administered until the dentist has determined that one clinical half-life of the initial dose has passed. The total aggregate dose must not exceed one and a half times the MRD on the day of administration. (11) "Trained healthcare professional" means a person who serves as an anesthesia monitor in a dental office. Such person shall maintain current certification in the American Heart Association's Basic Life Support for Healthcare Providers or its equivalent, shall be trained in monitoring patient vital signs, and shall be competent in the use of monitoring and emergency equipment appropriate for the level of sedation utilized. (The term "competent" as used in these rules means displaying special skill or knowledge derived from training and experience).
AUTH: 37-1-131, 37-4-205, 37-4-340, 37-4-511, 37-29-201, MCA IMP: 37-1-131, 37-4-101, 37-4-205, 37-4-340, 37-4-408, 37-29-201, MCA
REASON: The board is combining definition sections for ease of reference and understanding. The board is repealing definitions in (1), (2), (6), (8), (10) and (11) as those are commonly understood terms and do not require defining. The board is amending the definitions of direct and general supervision to account for supervision of hygienists as described throughout the chapter along with denturist direct supervision of interns. The board has also inserted the definitions that previously existed in the anesthesia definition section. Additionally, the board determined it is reasonably necessary to repeal the definition of prophylaxis in stricken (9). The term, as defined in current rule, can be inconsistent with insurance billing codes utilized by licensees under their allowed scopes. Authorizing and Implementing citations are being updated to include the new definitions.
24.138.402 FEE SCHEDULE (1) through (15) remain the same. (16) Deep sedation/ general anesthesia permit application fee 200 (17) Deep sedation/general anesthesia permit renewal fee 25 (18) Moderate sedation permit application fee 200 (19) Moderate sedation permit renewal fee 25 (20) Initial anesthesia permit inspection fee 200 (21) Anesthesia permit reinspection fee 150 (16) remains the same but is renumbered (22). (23) The Board of Dentistry adopts and incorporates by reference the fee abatement rule of the Department of Labor and Industry found at ARM 24.101.301.
AUTH: 37-1-134, 37-4-205, 37-4-340, 37-4-341, 37-4-405, 37-29-201, MCA IMP: 17-2-302, 17-2-303, 37-1-134, 37-1-141, 37-4-301, 37-4-340, 37-4-341, 37-4-402, 37-4-405, 37-4-511, 37-29-303, MCA
REASON: The board is combining fee rules for easier locating by licensees. Fees for anesthesia permits have been moved into this rule from ARM 24.138.3215, which has been proposed for repeal. The board is also moving the fee abatement rule provision into the fee rule for easier locating and understanding by licensees and the public.
24.138.406 FUNCTIONS FOR DENTAL AUXILIARIES AND AUXILIARIES WHO HOLD DENTAL ASSISTANT CERTIFICATION (1) Dental auxiliaries (a) remains the same. (b) was instructed and trained by a licensed dentist. (a) making radiographic exposures as prescribed by the supervising dentist (i) has graduated from an accredited program of dental assisting, dental hygiene, or dentistry accredited by the Commission on Dental Accreditation or its successor; or (ii) has been certified in dental radiology as a result of military experience; or (iii) has successfully completed a board-approved radiology written examination; (b) through (m) remain the same. (n) placing pit and fissure sealants; (o) digital capture of dental images; (q) sodium bicarbonate air polishing. (3) Dental auxiliaries performing any intraoral procedure must be under the direct supervision of a licensed dentist. (a) place pit and fissure sealants following an in-person comprehensive oral examination or periodic examination within the preceding 30 days (b) perform other intraoral procedures not requiring direct supervision; and (c) expose radiographs. (a) initiating, adjusting, and monitoring nitrous oxide flow for a patient who has been prescribed and administered nitrous oxide; (b) applying silver diamine fluoride agents; (c) placing and removing rubber dams; (d) placing and removing matrices; (e) polishing amalgam restorations; and (f) applying topical anesthetic agents. (d) through (j) remain the same but are renumbered (a) through (g). (
IMP: 37-4-408, MCA
REASON: The board is amending this rule to repeal language duplicative of statute in (7)(a), (b), (c), and (8) and to reorganize the rule for better readability and clarity. The board has moved supervision requirements under (10) and (11) to its unprofessional conduct rule. The board is clarifying that metal based polishing is prohibited under (6), but adding that sodium bicarbonate based polishing is allowed with direct supervision under (2). Additionally, (6)(m) is being stricken since the board is proposing to repeal a specific definition of prophylaxis (see REASON in ARM 24.138.301).
24.138.407 FUNCTIONS FOR DENTAL HYGIENISTS (e) through (h) remain the same but are renumbered (b) through (e). (4) remains the same but is renumbered (3).
AUTH: 37-1-131, 37-4-205, 37-4-401, 37-4-408, MCA IMP: 37-1-131, 37-4-401, 37-4-405, 37-4-408, MCA
REASON: The board is amending this rule to repeal language duplicative of statute in (1) and (3). The board is also striking the qualifications of a hygienist from this rule, as those qualifications are set in ARM 24.138.503, and moved the supervision requirements of the dentist to ARM 24.138.2301. The board is further amending the rule to improve readability and organization.
24.138.419 LIMITED PRESCRIPTIVE AUTHORITY – QUALIFICATIONS – ALLOWABLE PERCENTAGES OF TOPICAL AGENTS (1) Education and competency for dental hygiene prescriptive authority will be accomplished by (3) remains the same but is renumbered (2).
AUTH: 37-1-131, 37-4-205, 37-4-401, MCA IMP: 37-1-131, 37-4-401, 37-4-405, MCA
REASON: The board is amending this rule to move continuing education and renewal requirements to those respective rules
24.138.502 (a) (b) (c) (2) (a) patient-based or, beginning March 12, 2020, a simulated patient-based operative exam, to include one direct posterior class II composite and any one of the following: (i) direct posterior class II composite; or (ii) direct posterior class II amalgam; or (iii) direct anterior class III composite; (b) patient-based or, beginning March 12, 2020, a simulated patient-based periodontal exam; (c) non-patient-based endodontics exam, to include: (i) anterior access; (ii) posterior access; and (iii) obturation of one canal; and (d) non-patient-based prosthodontics exam.
IMP: 37-1-131, 37-4-301, 37-4-401, 37-4-402, MCA
REASON: The board is amending this rule to reflect changes in how scores are received from testing entities and to include the requirements of the clinical practical exam, so that all qualifications for licensure as a dentist are in one location. In addition, the board is updating clinical examination components to reflect current examinations. The board has moved standardized application requirements to NEW RULE I.
24.138.503 (a) (b) (c) (2) The patient-based or simulated patient-based clinical practical exam must include the following: (a) clinical competency and patient competency with the following components: (i) pocket depth; (ii) recession; (iii) calculus detection and removal; and (iv) intraoral and extraoral assessment. (3) (4) The board may review applications from applicants who have taken a clinical practical examination that does not meet the above criteria as nonroutine for licensure. (5) Local anesthetic certification requires: (a) education and training regarding the administration of local anesthetic agents as demonstrated by: (i) successful passage of a board-approved local anesthetic examination, that includes a written and clinical component, within the last five years; or (ii) proof of completion in coursework and training regarding the administration of local anesthetic agents and written verification that the applicant has practiced administering local anesthetic agents in another jurisdiction within the last five years; (b) a copy of the applicant's current CPR, ACLS, or PALS card; (c) payment of appropriate fees; and (d) copies of any local anesthetic agent authorization(s) held in other states.
AUTH: 37-1-131, 37-4-205, 37-4-402, MCA IMP: 37-1-131, 37-4-401, 37-4-402, MCA
REASON: The board is amending this rule to reflect changes in how scores are received from testing entities and to include the requirements of the clinical practical exam, so that all qualifications for licensure as a dental hygienist are in one location. The board has moved standardized application requirements to NEW RULE I. The board is further amending the rule to improve readability and organization.
24.138.511 (a) (i) a board-approved written denturist examination; and (ii) a board-approved clinical/practical denturist examination; (b) (c) (2) The clinical internship must consist of 2000 clock hours of training and performance as follows: (a) 36 hours minimum in: (i) patient charting; (ii) operatory sanitation; (iii) oral examination; (iv) impressions, preliminary and final (pour models, custom trays); (v) processing (wax up, flask boil out, packing, grind-polish); and (vi) delivery-post adjustment; (b) 12 hours minimum in: (i) bite registrations; (ii) articulations; (iii) set ups; and (iv) try ins; (c) 48 hours minimum in: (i) tooth repairs; and (ii) broken or fractured plates or partials; and (d) 24 units of processed relines (one plate - one unit).
AUTH: 37-1-131, 37-29-201, MCA IMP: 37-1-131, 37-29-201, 37-29-302, 37-29-303, 37-29-306, MCA
REASON: The board is amending this rule to include the internship requirements, so all qualifications for a denturitry license are in a single rule. The board has moved standard application requirements to NEW RULE I. The board is further amending the rule to improve readability and organization.
24.138.514 (1) Licenses may be placed on inactive status by paying the appropriate fee and: (a) indicating inactive status on the renewal form; or (b) informing the board office in writing or e-mail. (2) Inactive licensees shall: (a) renew annually; and (b) inform the board of all address/contact changes. (3) Inactive status licensees may not practice in Montana. (4) To convert from inactive to active, a licensee must submit: (a) documentation demonstrating completion of all the continuing education hours required in [NEW RULE II] for the most current renewal year; (b) license verification from all jurisdictions where the licensee held a license while inactive, including a detailed explanation of all pending or final discipline imposed; and (i) completion of a clinical competency course(s) or skills assessment analysis approved by the board; or (ii) passage of a board-approved regional or state examination within the most recent five years; and (iii) any other information the board may require for evidence of operative competency.
AUTH: 37-1-131, 37-1-319, 37-4-205, 37-29-201, MCA
REASON: The board is simplifying and streamlining this rule by striking repetitive provisions and simplifying the language. All continuing education (CE) rules have been moved into NEW RULE II that is cited with regard to proof of CE.
24.138.530 LICENSURE (b) verification of active licensure in Montana or another jurisdiction within the previous five years; or (d) remains the same. (g) and (h) remain the same but are renumbered (f) and (g). (2) Dentists and dental hygienists actively licensed in good standing in another state and seeking to practice in Montana under a restricted temporary volunteer license shall: (a) provide license verifications(s) from all states where currently licensed; (b) provide the name and address of the location(s) where the applicant intends to provide services; and (c) provide dental or dental hygiene services only to individuals served by clinics listed in 37-4-103 (6), MCA. (3) Temporary volunteer licenses under (2) are valid for 14 days from the date of issuance. (4) Renewal fees and late fees or a portion of such fees may be waived for eligible persons applying for licensure under this rule
AUTH: 37-1-131, 37-4-340, 37-4-341, MCA IMP: 37-1-131, 37-1-141, 37-4-340, 37-4-341, MCA
REASON: The board is amending this rule after feedback from prospective volunteers that the rule is burdensome and difficult to comply with. The board is amending the rule to allow for easier application of prospective volunteers, and is amending the rule for better readability. The board is also combining temporary volunteer license requirements with retired license requirements to place all requirements for volunteers into one rule.
24.138.906 DENTURIST SCOPE OF PRACTICE (5) All partial denture patients shall be referred to a dentist to determine what is needed prior to the denturist starting service. (6) Denturists must guarantee all new services completed by the denturist. The guarantee starts from the day of final insertion.
AUTH: 37-1-131, 37-29-201, MCA IMP: 37-1-131, 37-29-102, 37-29-103, 37-29-404, MCA
REASON: The board has combined existing denturist scope of practice rules into a single rule for ease of understanding.
24.138.2301 UNPROFESSIONAL CONDUCT (a) Continuing to practice (b) and (c) remain the same. (d) (f) remains the same but is renumbered (e). (h) remains the same but is renumbered (g). (k) through (m) remain the same but are renumbered (j) through (l). (p) through (r) remain the same but are renumbered (n) through (p). (u) remains the same but is renumbered (s). (u) Knowingly suppressing, omitting, or concealing any fact or law without which the advertisement would be deceptive or misleading. (v) Failing to adequately maintain complete records of each patient (w) Administering, dispensing, or prescribing approved topical agents in violation of board rules. (x) Extracting teeth or performing dental treatment upon the written or verbal prescription of someone other than a licensed dentist. (y) Failing to comply with a monitoring agreement entered into with the board's professional assistance program. (z) Failing to comply with the provisions of the Guidelines for Infection Control in Dental Health-Care Settings, 2003. (aa) Failing to pass an anesthesia permit inspection under ARM 24.138.3227.
AUTH: 37-1-319, 37-4-205, 37-4-408, 37-29-201, 75-10-1006, MCA IMP: 37-1-316, 37-1-319, 37-4-101, 37-4-405, 37-4-408, 37-29-402, 37-29-403, 75-10-1006, MCA
REASON: The board is combining all unprofessional conduct rules into one rule, so as not to repeat identical provisions or duplicate statute. The board is further moving advertising, infection control, infectious waste, and bloodborne pathogen requirements into the unprofessional conduct rules. The board is adding (aa) to clarify failing an anesthesia permit inspection due to lack of compliance with those regulations is unprofessional conduct. Finally, the board is cleaning up outdated language for ease of understanding.
24.138.2703 RESPONSIBILITIES OF (a) provide two tracks for assistance of licensees or license applicants under the board's jurisdiction: (i) and (ii) remain the same. (b) provide recommendations to (c) recommend (d) remains the same. (2) Upon the discharge of a participant from the program, the program shall report to the board the discharge of the participant, and if applicable, provide to the board: (a) verification of the participant's satisfactory completion of monitoring and program requirements as appropriate for public safety; (b) verification of the participant's completion of board final order terms and conditions with recommendation of the program for discharge; and/or (c) notification that the participant is transferring to another jurisdiction. (2) and (3) remain the same but are renumbered (3) and (4).
AUTH: 37-1-131, 37-4-205, 37-29-201, MCA IMP: 37-1-131, 37-1-312, 37-4-311, 37-4-312, 37-4-313, 37-4-314, MCA
REASON: The board is amending this rule to include the responsibilities of the assistance program to manage intake, monitoring, and discharge, as well as the reporting to the board requirements. These requirements were previously contained in multiple rules, so the board is combining for ease of understanding and repealing the extraneous rules.
24.138.2707 PROTOCOL FOR SELF-REPORTING TO A (4) remains the same but is renumbered (3).
AUTH: 37-1-131, 37-4-205, 37-29-201, MCA IMP: 37-1-131, 37-1-312, 37-4-311, 37-4-312, 37-4-313, 37-4-314, MCA
REASON: The board is amending this rule to repeal unnecessary sections that repeat 37-4-312, MCA.
24.138.2710 PROTOCOL FOR DISCIPLINARY TRACK (1) All licensees or license applicants under the jurisdiction of the board who participate in the program (2) Licensees or license applicants are admitted to the disciplinary track through one or more of the following: (a) remains the same. (b) as a result of a sanction imposed by a board final order (3) The program shall also report licensees who have discharged from the program.
AUTH: 37-1-131, 37-4-205, 37-29-201, MCA IMP: 37-1-131, 37-1-312, 37-4-311, 37-4-312, 37-4-313, 37-4-314, MCA
REASON: The board is striking (2)(c) and (d) as a requirement to participate in the disciplinary track is a sanction, which can only be imposed after a board final order- either as a disciplinary action or as a licensing decision.
24.138.2712 PROTOCOL FOR NONDISCIPLINARY TRACK (1) A licensee or license applicant under the jurisdiction of the board who participates in the program (2) and (3) remain the same.
AUTH: 37-1-131, 37-4-205, 37-29-201, MCA IMP: 37-1-131, 37-1-312, 37-4-311, 37-4-312, 37-4-313, 37-4-314, MCA
REASON: The board is striking the unnecessary reference to statute contained in this rule.
24.138.3003 ADVERTISING (2) All advertisements are presumed to have been approved by the (3) A Montana licensed dentist listing or advertising the dentist's services under any specialty practice dental category in ARM 24.138.3101 must clearly disclose within the licensee's individual advertisement that the services are provided by a general dentist. (4) Licensees must maintain records of advertising, including a copy of the advertisement, for a period of two years after publication.
AUTH: 37-4-205, MCA IMP: 37-4-205, MCA
REASON: The board is amending this rule to remove unnecessary wording, and to repeal provisions that duplicate ARM 24.138.2301.
24.138.3101 GENERAL STANDARDS FOR SPECIALTIES (a) dental public health; (b) endodontics; (c) oral pathology; (d) oral and maxillofacial surgery; (e) orthodontic dentofacial orthopedics; (f) pedodontics (dentistry for children); (g) periodontics; (h) prosthodontics; (i) oral and maxillofacial radiology; (j) oral medicine; and (k) dental anesthesiology. (b) remains the same but is renumbered (2). (3) A licensee shall not advertise using the terms "specialist" or "specializing" unless the licensee has met the board standards for specialization as set forth in this rule. (4) A licensee who possesses a verifiable combination of education and experience is not prohibited from including in the licensee's practice one or more branches of dentistry listed in (1).
AUTH: 37-4-205, MCA
REASON: The board is combining ARM 24.138.3101 and 24.138.3102 to include all specialty requirements in a single rule. The board is repealing the requirement that specialists may only practice in the area of specialty as overregulation. Specialists receive the same training as dentists and are qualified to perform the same work.
24.138.3221 MINIMUM QUALIFYING STANDARDS (1) A Montana licensed dentist must possess a permit to administer moderate sedation or deep sedation/general anesthesia. (2) All requirements for the use of moderate sedation or deep sedation/general anesthesia apply, regardless of the agent used or the route of administration, when the intended or probable effect is a level of depression greater than minimal sedation. (3) A deep sedation/general anesthesia permit is required to administer or employ any agent(s) which has a narrow margin for maintaining consciousness, including, but not limited to, ultrashort-acting barbiturates, including, but not limited to, sodium methohexital, thiopental, propofol, ketamine, etomidate, and similarly acting drugs, or quantity of agent(s), or technique(s), or any combination, thereof, that would possibly render a patient deeply sedated or generally anesthetized. (4) All applicants for deep sedation/general anesthesia permits must have: (a) completed a residency accredited by the Commission on Dental Accreditation in one of the following areas: (i) remains the same. (ii) a minimum of two years in an advanced general dentistry education program in dental anesthesiology (b) completed an advanced course in cardiac life support within two years of the date of permit application. Web-based courses must include a hands-on lab or megacode portion of training. (5) All applicants for moderate sedation permits must have: (a) received formal training in moderate sedation techniques from an institution, organization, or training course. If training for moderate sedation is through continuing education, proof of course content must accompany the initial application in the form of a course outline or syllabus; and (b) a minimum of 60 hours of instruction plus management of at least 20 dental patients, by the intravenous route. (a) complete a course of instruction of a minimum of 14 hours, including a clinical component. This course of instruction may be completed as part of the predoctoral dental education program or in a postdoctoral continuing education competency course (b) demonstrate competence and skill in administering nitrous oxide/oxygen sedation by virtue of experience and/or comparable alternative training (a) and (b) remain the same. (8) Applicants who meet all requirements for a moderate sedation or deep sedation/general permit with the exception of having passed an initial inspection may be issued a temporary permit to administer moderate sedation or deep sedation/general prior to the initial inspection.
IMP: 37-1-131, 37-4-101, 37-4-511, MCA
REASON: The board is amending this rule to remove unnecessary words. The board is also putting all requirements for each level of permit together for ease of understanding by licensees and the public. Language regarding the process for the temporary permit that is issued prior to initial inspection has been moved from the repealed ARM 24.138.3219 to (8). The board is requiring that the cardiac life support training in new (4)(b) have been completed within the last two years instead of three in order to ensure current training and standards for patient safety.
24.138.3223 MINIMUM MONITORING STANDARDS (1) Minimum standards for monitoring (a) remains the same. (b) intraoperative: (i) through (iii) remain the same. (iv) (v) through (2) remain the same. (3) Minimum standards for monitoring minimal sedation patients shall include the following: (a) (i) through (b) remain the same. (4) (a) (i) through (v) remain the same. (b)
AUTH: 37-1-131, 37-4-205, 37-4-408, MCA IMP: 37-1-131, 37-4-101, 37-4-205, 37-4-408, 37-4-511, MCA
REASON: This rule is being clarified to more accurately reflect that the board licenses people, not facilities, and it is those individual licensees who are held accountable under the board's regulations. It has also been amended to remove redundant language and for simplicity and better readability.
24.138.3225 (a) through (k) remain the same. (2) A permit holder performing moderate sedation (a) through (e) remain the same. (f) defibrillator; (f) through (h) remain the same but are renumbered (g) through (i). (3) A
IMP: 37-1-131, 37-4-101, 37-4-511, MCA
REASON: This rule is being clarified to more accurately reflect that the board licenses people, not facilities, and it is those individual licensees who are held accountable under the board's regulations. The requirement for licensees providing moderate sedation to also have an electrocardiac monitor and defibrillator is necessary as the patient could potentially slip into deep sedation and a defibrillator could be necessary, just as it is with deep anesthesia/general anesthesia.
24.138.3227 ONSITE INSPECTION OF PERMIT HOLDERS (1) Each (2) The onsite inspection shall include (a) demonstration of: (i) recognition and (ii) knowledge of respective roles in normal operating procedures and in various emergency situations; and (iii) proficiency in handling emergency situations; (b) the presence of drugs and equipment appropriate for the level of sedation or anesthesia to be provided (c) (3)
IMP: 37-1-131, 37-4-101, 37-4-511, MCA
REASON: The board is amending this rule for clearer wording and indication of expectations of licensees and to align with the disciplinary authority of the board. Further, the board is amending language to reflect that the board licenses individuals, not the facilities where licensees practice.
24.138.3231 REPORTING ADVERSE OCCURRENCES (1) All actively licensed dentists (2) The report required by this rule shall include, but not be limited to, the following information: (a) through (h) remain the same.
IMP: 37-1-131, 37-4-101, 37-4-511, MCA
REASON: The board is amending this rule to remove extra words for easier reading by licensees and the public.
6. The rules proposed to be repealed are as follows:
24.138.206 DENTAL HYGIENIST COMMITTEE
AUTH: 37-4-205, MCA IMP: 37-4-205, MCA
REASON: The board is striking requirements for this standing committee as unnecessary. The board has authority to convene committees when needed to assist the board in conducting its business.
24.138.208 DENTURIST COMMITTEE
AUTH: 37-29-201, MCA IMP: 37-29-201, MCA
REASON: The board is striking requirements for this standing committee as unnecessary. The board has authority to convene committees when needed to assist the board in conducting its business.
24.138.306 TEETH WHITENING
REASON: The board is repealing this rule, as the Legislature sets the scope of practice of dentistry.
24.138.403 MANDATORY CERTIFICATION
AUTH: 37-1-131, 37-4-205, 37-29-201, MCA IMP: 37-1-131, 37-1-321, 37-29-201, 37-29-401, MCA
REASON: The board determined it is reasonable to combine the ongoing requirement for life saving certification with the ongoing requirement for continuing education. The two rules can be combined for standardization and reduction purposes.
24.138.414 DISPLAY OF LICENSES
AUTH: 37-4-205, 37-29-201, MCA IMP: 37-4-205, 37-4-326, 37-29-201, MCA
REASON: The board is repealing this rule as unnecessary since the board does not license practices or facilities, only practitioners. The public can use the online license lookup system to view the current license status of any individual twenty-four hours a day.
24.138.415 NINETY-DAY GUARANTEE REQUIRED BY DENTURISTS
AUTH: 37-29-201, MCA IMP: 37-29-404, MCA
REASON: The board is repealing this rule and moving it to ARM 24.138.906 so that all denturist provisions are in the same rule for ease of readability and understanding.
24.138.416 PRIOR REFERRAL FOR PARTIAL DENTURES
AUTH: 37-1-131, 37-29-201, MCA IMP: 37-29-403, MCA
REASON: The board is repealing this rule and moving it to ARM 24.138.906 so that all denturist provisions are in the same rule for ease of readability and understanding.
24.138.417 DENTAL SCREENINGS
IMP: 37-4-101, 37-4-205, 37-4-401, MCA
REASON: The board is repealing this rule as unnecessary. Board staff does not currently receive questions about whether dental health screenings constitute the practice of dentistry and does not anticipate an increase in complaints related to dental health screenings.
24.138.418 INFECTION CONTROL
AUTH: 37-1-131, 75-10-1006, MCA IMP: 37-1-131, 75-10-1005, MCA
REASON: The board moved this requirement to its unprofessional conduct rule for ease of readability.
24.138.430 FEE ABATEMENT
AUTH: 37-1-131, 37-4-205, 37-29-201, MCA IMP: 17-2-302, 17-2-303, 37-1-134, MCA
REASON: The board is moving this rule into ARM 24.138.301 so all fee-related information is contained in the same rule.
24.138.504 APPROVED CLINICAL EXAM CRITERIA FOR DENTISTS AND DENTAL HYGIENISTS
AUTH: 37-1-131, 37-4-205, 37-4-402, MCA IMP: 37-1-131, 37-4-301, 37-4-402, MCA
REASON: The board is repealing this rule as unnecessary and covered by ARM 24.138.502 and 24.138.503.
24.138.505 DENTIST LICENSURE BY CREDENTIALS
IMP: 37-1-131, 37-1-304, 37-4-301, MCA
REASON: The board is repealing this rule as unnecessary and has moved all application requirements into NEW RULE I. It is reasonably necessary to remove language that unnecessarily duplicates statutory provisions as well as processes that are addressed in standardized application procedures for all boards.
24.138.506 DENTAL HYGIENIST LICENSURE BY CREDENTIALS
REASON: The board is combining all application rules into NEW RULE I for ease of understanding. It is reasonably necessary to remove language that unnecessarily duplicates statutory provisions as well as processes that are addressed in standardized application procedures for all boards.
24.138.508 DENTAL HYGIENE LOCAL ANESTHETIC AGENT CERTIFICATION
AUTH: 37-1-131, 37-4-205, 37-4-402, MCA IMP: 37-1-131, 37-4-401, 37-4-402, MCA
REASON: The board is moving all qualifications for dental hygienists into one rule for readability and ease of finding information.
24.138.512 DENTURIST INTERNSHIP
AUTH: 37-1-131, 37-29-201, MCA IMP: 37-1-131, 37-29-201, 37-29-302, 37-29-303, MCA
REASON: The board combined the internship requirements with the requirements for licensure as a denturist for ease of reading and understanding.
24.138.513 DENTAL HYGIENISTS – TEMPORARY PRACTICE PERMITS
AUTH: 37-1-131, 37-1-319, 37-4-205, MCA IMP: 37-1-131, 37-1-305, 37-1-319, 37-4-402, MCA
REASON: The board is repealing this rule as duplicative of 37-1-305, MCA.
24.138.525 REACTIVATION OF AN EXPIRED LICENSE
AUTH: 37-1-131, 37-1-141, 37-4-205, 37-29-201, MCA
REASON: The board is repealing this rule to standardize reactivation of expired licenses with the process under ARM 24.101.408.
24.138.540 MILITARY TRAINING OR EXPERIENCE
AUTH: 37-1-145, MCA IMP: 37-1-145, MCA
REASON: Reasonable necessity exists to repeal this rule, effective October 1, 2023, at the earliest, due to House Bill 583 (2023). That legislation amends 37-1-145, MCA, and eliminates the requirement for adoption by the board of a specific military training rule, setting forth specific obligations for the board to accept military experience for granting licensure. As such, the need for this rule is obsolete.
24.138.601 RESTRICTED TEMPORARY LICENSURE OF NONRESIDENT VOLUNTEER DENTISTS AND DENTAL HYGIENISTS
AUTH: 37-1-131, 37-4-205, 37-4-341, MCA IMP: 37-1-131, 37-1-141, 37-4-341, MCA
REASON: The board is repealing this rule as unnecessary and containing similar information as ARM 24.138.530. The board has combined the two rules so that volunteer license information is contained in a single rule.
24.138.603 SCOPE OF TREATMENT FOR TEMPORARY VOLUNTEER LICENSE
AUTH: 37-1-131, 37-4-205, 37-4-341, MCA
REASON: The board has combined its rules regarding volunteer licensing into one rule.
24.138.2101 DEFINITION OF CONTINUING EDUCATION
AUTH: 37-1-319, 37-4-205, 37-29-201, MCA
24.138.2102 SUBJECT MATTER ACCEPTABLE FOR DENTIST AND DENTAL HYGIENIST CONTINUING EDUCATION
AUTH: 37-1-319, 37-4-205, 37-4-401, MCA IMP: 37-1-306, 37-1-319, 37-4-401, MCA
24.138.2103 SUBJECT MATTER ACCEPTABLE FOR DENTURIST CONTINUING EDUCATION
AUTH: 37-1-319, 37-29-201, MCA
24.138.2104 REQUIREMENTS AND RESTRICTIONS
AUTH: 37-1-319, 37-4-205, 37-4-401, 37-29-201, MCA IMP: 37-1-306, 37-1-319, 37-4-401, MCA
24.138.2105 CONTINUING EDUCATION – AUDIT
IMP: 37-1-131, 37-1-306, 37-1-319, 37-1-321, MCA
24.138.2106 EXEMPTIONS AND EXCEPTIONS
AUTH: 37-1-319, MCA
REASON: The board is repealing all continuing education rules and moving the requirements into NEW RULE II. The board is simplifying and streamlining continuing education requirements to standardize them with other licensing boards. The board believes its licensees can select quality continuing education without the board's rules being overly specific. The board is striking the provision on random audits as it unnecessarily duplicates the statutory provisions of 37-1-306, MCA.
24.138.2302 UNPROFESSIONAL CONDUCT FOR DENTURISTS
AUTH: 37-1-136, 37-1-319, 37-29-201, 75-10-1006, MCA IMP: 37-1-316, 37-1-319, 37-29-402, 37-29-403, 75-10-1006, MCA
24.138.2303 UNPROFESSIONAL CONDUCT FOR DENTAL HYGIENISTS
AUTH: 37-1-319, 37-4-205, 37-4-408, 75-10-1006, MCA IMP: 37-1-316, 37-1-319, 37-4-405, 37-4-408, 75-10-1006, MCA
24.138.2701 REHABILITATION PROGRAM PURPOSE
AUTH: 37-1-131, 37-4-205, 37-29-201, MCA IMP: 37-1-131, 37-1-312, 37-4-311, 37-4-312, 37-4-313, 37-4-314, MCA
REASON: The board is repealing this rule as unnecessary repetition of 37-4-312, MCA.
24.138.2705 REPORTING OF SUSPECTED IMPAIRMENT
AUTH: 37-1-131, 37-4-205, 37-29-201, MCA IMP: 37-1-131, 37-1-312, 37-4-311, 37-4-312, 37-4-313, 37-4-314, MCA
REASON: The board is repealing this rule as unnecessary repetition of 37-4-312, MCA.
24.138.2714 REPORTING TO THE BOARD
AUTH: 37-1-131, 37-4-205, 37-29-201, MCA IMP: 37-1-131, 37-1-312, 37-4-311, 37-4-312, 37-4-313, 37-4-314, MCA
REASON: The board is repealing this rule as unnecessary, as the reporting requirements are in ARM 24.138.2710 and 24.138.2712, and are covered by the contract.
24.138.2716 DISCHARGE REQUIREMENTS
AUTH: 37-1-131, 37-4-205, 37-29-201, MCA IMP: 37-1-131, 37-1-312, 37-4-311, 37-4-312, 37-4-313, 37-4-314, MCA
REASON: The board is repealing this rule as unnecessary after moving the discharge reporting requirements to ARM 24.138.2703, which already contained the program's reporting requirements to the board.
24.138.2719 RELAPSE
AUTH: 37-1-131, 37-4-205, 37-29-201, MCA IMP: 37-1-131, 37-1-312, 37-4-311, 37-4-312, 37-4-313, 37-4-314, MCA
REASON: The board is repealing this rule as unnecessary. The assistance program's contract requires monitoring of licensees. Spelling out the requirements for the handling of relapses takes away from the professional judgment of the monitoring program and does not allow for individual circumstances of the monitored licensees.
24.138.3001 ADVERTISING FEE INFORMATION
AUTH: 37-4-205, MCA IMP: 37-4-205, MCA
REASON: The board is repealing advertising rules as being overly regulatory. The board has included the necessary provisions governing the conduct of advertising in ARM 24.138.2301.
24.138.3002 ADVERTISING CONTENT
AUTH: 37-4-205, MCA IMP: 37-4-205, MCA
REASON: The board is repealing advertising rules as being overly regulatory. The board has included the necessary provisions governing the conduct of advertising in ARM 24.138.2301.
24.138.3102 SPECIALTY ADVERTISING
AUTH: 37-4-205, MCA IMP: 37-4-205, MCA
REASON: The board is repealing this rule as unnecessary. Advertising provisions are covered in ARM 24.138.2301 and 24.138.3003, and this rule largely repeats information contained in ARM 24.138.3101.
24.138.3211 DEFINITIONS RELATED TO ANESTHESIA
REASON: Reasonable necessity exists to repeal this rule as part of the effort to simplify and shorten the administrative rules. Presently, the board has multiple definitions rules. This proposal consolidates those definitions into a single rule for ease of use by the public.
24.138.3213 EFFECT OF 2011 STATUTE AND RULE AMENDMENTS ON CURRENTLY ISSUED ANESTHESIA PERMITS
REASON: The board is repealing this rule as all permits previously obtained under this rule have been converted, and any new applicants for anesthesia permits are required to demonstrate they meet the qualifications in ARM 24.138.3221.
24.138.3215 ANESTHESIA FEE SCHEDULE
IMP: 37-1-134, 37-4-101, 37-4-511, MCA
REASON: Reasonable necessity exists to repeal this rule as part of the effort to simplify and shorten the administrative rules. Presently, the board has multiple fee rules. This proposal consolidates those definitions into a single rule for ease of use by the public.
24.138.3217 PRACTICE OF ANESTHESIA
IMP: 37-1-131, 37-4-101, 37-4-511, MCA
REASON: The board is repealing this rule as unnecessary. The requirement to hold a permit to administer anesthesia is covered in ARM 24.138.3221.
24.138.3219 PERMIT REQUIRED FOR ADMINISTRATION OF ANESTHESIA
IMP: 37-1-131, 37-4-101, 37-4-511, MCA
REASON: The board is repealing this rule as unnecessary. The requirement to hold a permit is covered in ARM 24.138.3221.
24.138.3229 ANESTHESIA CONTINUING EDUCATION
IMP: 37-1-131, 37-1-306, 37-1-319, 37-1-321, MCA
REASON: Reasonable necessity exists to repeal this rule as part of the effort to simplify and shorten the administrative rules. Presently, the board has multiple continuing education rules. This proposal consolidates those requirements into a single rule for ease of use by the public.
7. Concerned persons may present their data, views, or arguments at the hearing. Written data, views, or arguments may also be submitted at dli.mt.gov/rules or P.O. Box 1728, Helena, Montana 59624. Comments must be received no later than 5:00 p.m., May 24, 2024.
8. An electronic copy of this notice of public hearing is available at dli.mt.gov/rules and sosmt.gov/ARM/register.
9. The agency maintains a list of interested persons who wish to receive notices of rulemaking actions proposed by the agency. Persons wishing to have their name added to the list may sign up at dli.mt.gov/rules or by sending a letter to P.O. Box 1728, Helena, Montana 59624 and indicating the program or programs about which they wish to receive notices.
10. The bill sponsor contact requirements of 2-4-302, MCA, do not apply.
11. Pursuant to 2-4-111, MCA, the agency has determined that the rule changes proposed in this notice will not have a significant and direct impact upon small businesses.
12. Department staff has been designated to preside over and conduct this hearing.
Certified to the Secretary of State April 16, 2024.
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