BILL ANALYSIS
AB 1334
Page 1
Date of Hearing: April 26, 2005
ASSEMBLY COMMITTEE ON BUSINESS AND PROFESSIONS
Gloria Negrete McLeod, Chair
AB 1334 (Salinas) - As Introduced: February 22, 2005
SUBJECT : Dentistry: registered dental hygienists.
SUMMARY : Authorizes a Registered Dental Hygienist in
Alternative Practice (RDHAP) to perform all the duties of a
Registered Dental Hygienist (RDH) and eliminates the requirement
that a patient must present a prescription from a dentist or
physician to be treated by a RDHAP. Specifically, this bill :
1)Authorizes a RDHAP to perform all the functions of a RDH, as
defined, independent of a dentist, without a prescription from
a dentist or physician and surgeon for dental hygiene
services.
2)Provides that a RDHAP may hire and supervise Registered Dental
Assistants (RDA).
3)Expands the scope of practice of a RDHAP to include:
a) Coronal polishing, after providing evidence to the
Dental Board of California (Board) of having completed a
Board-approved course in that procedure;
b) Application of tropical fluoride; and,
c) Application of sealants, after providing evidence to the
Board of having completed a Board-approved course in that
procedure.
EXISTING LAW :
1)Defines a RDHAP as a Dental Hygienist who may provide
authorized preventive and therapeutic services independent of
a dentist, by prescription provided by a dentist or physician
and surgeon. RDHAPs may perform:
a) All the functions of a dental assistant (DA) or a RDA;
b) Specified functions of a RDH including dental hygiene
assessment, development, planning, and implementation of a
AB 1334
Page 2
dental hygiene care plan to include oral health education,
counseling, and health screenings; and,
c) Specified preventive and therapeutic interventions, and
application of topical, therapeutic and subgingival agents
used for the control of caries and periodontal disease.
2)Authorizes a RDHAP to perform dental hygiene services only in
the following settings:
a) Residences of the homebound;
b) Schools;
c) Residential facilities and other institutions; and,
d) Dental health professional shortage areas, as certified
by the Office of Statewide Health Planning and Development
in accordance with existing office guidelines.
3)Provides that a RDH may perform all the functions performed by
a DA or a RDA and other procedures under supervision,
including, soft-tissue curettage, administration of local
anesthesia, taking of impressions for bleaching trays, and the
placement of in-office tooth-whitening devices.
4)Requires that a RDHAP perform dental hygiene services only for
a patient who presents a written prescription for dental
hygiene services issued by a dentist or physician and surgeon
who has preformed a physical examination and a diagnosis of
the patient prior to the prescription being provided.
5)Requires a RDHAP to have an existing relationship with at
least one dentist for referral, consultation, and emergency
service.
6)Provides that a RDHAP may hire and supervise DAs.
FISCAL EFFECT : Unknown. This bill is keyed, non-fiscal.
COMMENTS :
Background . According to the Committee on Dental Auxiliaries
(COMDA) dental hygienists were allowed to practice independently
for 16 years under two Health Manpower Pilot Projects prior to
AB 1334
Page 3
the establishment of the RDHAP license category. During those
16 years, there was no prescription requirement and there is no
evidence that any public harm occurred.
During the 2000 legislative sunset review process, legislation
was enacted requiring the Board to hire a consultant to review
the scopes of dental auxiliary practice, including RDHAPs. The
independent consultant's report notes: "In fixing the existing
RDHAP environment, patients must be 'of record' or first
examined and diagnosed by a physician or dentist before any
procedures can be delegated to a dental auxiliary?However, this
requirement can present a considerable barrier in the path to
providing basic preventive services to underserved populations.
By definition, these are the very patients that are least likely
to have access to a dentist or physician. In settings such as
'dental health professionals shortage areas' or in programs
seeking to provide preventive services to school children or
rural farm workers, first obtaining an examination and
prescription from a physician or dentist may effectively prevent
an individual from obtaining dental care."
Support . According to the sponsor, the California Dental
Hygienists Association (CDHA), "during the Health Man Power
Pilot Project more than 20,000 patients were seen by RDHAPs who
were providing only those services for which they are uniquely
trained and educated to offer. This was done without
prescription and the final comments by the University of
California - Los Angeles and Cal State Northridge was that
RDHAPs could provide their preventive services on a safe level
that is par with a dental office.
While this legislation removes the prescription, it does not
remove the requirement that an RDHAP have a contractual
relationship with a dentist. At no time does a dental hygienist
suggest that the care, support and treatment by a dentist is
anything less than an absolutely critical choice for individual
consumers. The CDHA supports the concept that only dental
hygiene services be provided independently and that there be
absolute and total respect given to the scope of practice of a
dentist."
Opposition . In their letter of opposition the California Dental
Association (CDA) states that "until 2004, there were only 18
RDHAPs licensed throughout the entire state. In one year alone,
the new RDHAP educational programs have graduated almost 100
AB 1334
Page 4
RDHAPs and we expect to have more than 150 licensees throughout
the state by the end of this year. Data regarding patient
visits is scant and is not significant enough to ensure patient
safety. The sponsors of the bill states that dentists and/or
physicians are not providing the necessary prescriptions and
this is a barrier to care. Although COMDA has received a number
of letters from RDHAPs to this effect, no thorough study has
been done, and it may not be the case a majority of the time."
According to the Board, this bill, "while expanding the scope of
practice for RDHAPs, eliminates the requirement that a hygienist
have a written prescription from a dentist or physician and
surgeon who has preformed a prior diagnosis on the patients
before referring to the alternative practice. Patient diagnosis
is not part of hygiene training."
REGISTERED SUPPORT / OPPOSITION :
Support
California Dental Hygienist Association (sponsor)
Opposition
California Dental Association
Dental Board of California
Analysis Prepared by : Tracy Rhine / B. & P. / (916) 319-3301