Florida Senate - 2019 COMMITTEE AMENDMENT
Bill No. SB 684
Senate . House
The Committee on Children, Families, and Elder Affairs (Rader)
recommended the following:
1 Senate Amendment (with title amendment)
3 Delete lines 621 - 852
4 and insert:
5 (7) A dental therapist under the direct or indirect
6 supervision of a dentist may administer local anesthesia,
7 including intraoral block anesthesia or soft tissue infiltration
8 anesthesia, or both, if she or he has completed the course
9 described in subsection (5) and presents evidence of current
10 certification in basic or advanced cardiac life support.
(7) A licensed dentist, or a dental therapist who is
12 authorized by her or his supervising dentist, may utilize an X
13 ray machine, expose dental X-ray films, and interpret or read
14 such films. Notwithstanding The provisions of part IV of chapter
15 468 to the contrary notwithstanding, a licensed dentist, or a
16 dental therapist who is authorized by her or his supervising
17 dentist, may authorize or direct a dental assistant to operate
18 such equipment and expose such films under her or his direction
19 and supervision, pursuant to rules adopted by the board in
20 accordance with s. 466.024 which ensure that said assistant is
21 competent by reason of training and experience to operate said
22 equipment in a safe and efficient manner. The board may charge a
23 fee not to exceed $35 to defray the cost of verifying compliance
24 with requirements adopted pursuant to this section.
25 (9) (8) Notwithstanding The provisions of s. 465.0276
26 notwithstanding, a dentist need not register with the board or
27 comply with the continuing education requirements of that
28 section if the dentist confines her or his dispensing activity
29 to the dispensing of fluorides and chlorhexidine chlorohexidine
30 rinse solutions; provided that the dentist complies with and is
31 subject to all laws and rules applicable to pharmacists and
32 pharmacies, including, but not limited to, chapters 465, 499,
33 and 893, and all applicable federal laws and regulations, when
34 dispensing such products.
35 Section 13. Subsection (1) of section 466.018, Florida
36 Statutes, is amended to read:
37 466.018 Dentist of record; patient records.—
38 (1) Each patient shall have a dentist of record. The
39 dentist of record shall remain primarily responsible for all
40 dental treatment on such patient regardless of whether the
41 treatment is rendered by the dentist or by another dentist,
42 dental therapist, dental hygienist, or dental assistant
43 rendering such treatment in conjunction with, at the direction
44 or request of, or under the supervision of such dentist of
45 record. The dentist of record shall be identified in the record
46 of the patient. If treatment is rendered by a dentist other than
47 the dentist of record or by a dental hygienist, dental
48 therapist, or dental assistant, the name or initials of such
49 person shall be placed in the record of the patient. In any
50 disciplinary proceeding brought pursuant to this chapter or
51 chapter 456, it shall be presumed as a matter of law that
52 treatment was rendered by the dentist of record unless otherwise
53 noted on the patient record pursuant to this section. The
54 dentist of record and any other treating dentist are subject to
55 discipline pursuant to this chapter or chapter 456 for treatment
56 rendered to the patient and performed in violation of such
57 chapter. One of the purposes of this section is to ensure that
58 the responsibility for each patient is assigned to one dentist
59 in a multidentist practice of any nature and to assign primary
60 responsibility to the dentist for treatment rendered by a dental
61 hygienist, dental therapist, or dental assistant under her or
62 his supervision. This section shall not be construed to assign
63 any responsibility to a dentist of record for treatment rendered
64 pursuant to a proper referral to another dentist who does not in
65 practice with the dentist of record or to prohibit a patient
66 from voluntarily selecting a new dentist without permission of
67 the dentist of record.
68 Section 14. Section 466.0225, Florida Statutes, is created
69 to read:
70 466.0225 Examination of dental therapists; licensing.—
71 (1) Any person desiring to be licensed as a dental
72 therapist shall apply to the department to take the licensure
73 examinations and shall verify the information required on the
74 application by oath. The application must include two recent
75 photographs of the applicant.
76 (2) An applicant is entitled to take the examinations
77 required in this section and receive licensure to practice
78 dental therapy in this state if the applicant:
79 (a) Is 18 years of age or older;
80 (b) Is a graduate of a dental therapy college or school
81 accredited by the American Dental Association Commission on
82 Dental Accreditation or its successor entity, if any, or any
83 other dental therapy accrediting entity recognized by the United
84 States Department of Education. For applicants applying for a
85 dental therapy license before January 1, 2024, the board shall
86 approve the applicant’s dental therapy education program if the
87 program was administered by a college or school that operates an
88 accredited dental or dental hygiene program and the college or
89 school certifies to the board that the applicant’s education
90 substantially conformed to the education standards established
91 by the American Dental Association Commission on Dental
93 (c) Has successfully completed a dental therapy practical
94 or clinical examination produced by the American Board of Dental
95 Examiners, Inc., (ADEX) or its successor entity, if any, if the
96 board finds that the successor entity’s examination meets or
97 exceeds the provisions of this section. If an applicant fails to
98 pass the ADEX Dental Therapy Examination after three attempts,
99 the applicant is not eligible to retake the examination unless
100 the applicant completes additional education requirements as
101 specified by the board. If a dental therapy examination has not
102 been established by the ADEX, the board shall administer or
103 approve an alternative examination;
104 (d) Has not been disciplined by a board, except for
105 citation offenses or minor violations;
106 (e) Has not been convicted of or pled nolo contendere to,
107 regardless of adjudication, any felony or misdemeanor related to
108 the practice of a health care profession; and
109 (f) Has successfully completed a written examination on the
110 laws and rules of this state regulating the practice of dental
112 (3) An applicant who meets the requirements of this
113 section, and who has successfully completed the examinations
114 identified in paragraph (2)(c) in a jurisdiction other than this
115 state, or who has successfully completed comparable examinations
116 administered or approved by the licensing authority in a
117 jurisdiction other than this state shall be licensed to practice
118 dental therapy in this state if the board determines that the
119 other jurisdiction’s examinations and scope of practice are
120 substantially similar to those identified in paragraph (2)(c).
121 Section 15. Section 466.0227, Florida Statutes, is created
122 to read:
123 466.0227 Dental therapists; scope and area of practice.—
124 (1) The Legislature finds that authorizing licensed dental
125 therapists to perform the services specified in subsection (3)
126 would improve access to high-quality affordable oral health
127 services for all residents in this state. The Legislature
128 intends to rapidly improve such access for low-income,
129 uninsured, and underserved patients and communities. To further
130 this intent, a dental therapist licensed under this chapter is
131 limited to practicing dental therapy in the following settings:
132 (a) A health access setting, as defined in s. 466.003(16).
133 (b) A community health center, including an off-site care
135 (c) A nursing facility.
136 (d) A military or veterans’ hospital or clinic, including
137 an off-site care setting.
138 (e) A governmental or public health clinic, including an
139 off-site care setting.
140 (f) A school, Head Start program, or school-based
141 prevention program, as defined in s. 466.003(17).
142 (g) An oral health education institution, including an off
143 site care setting.
144 (h) A hospital.
145 (i) A geographic area designated as a dental health
146 professional shortage area by the state or the Federal
147 Government which is not located within a federally designated
148 metropolitan statistical area.
149 (2) Except as otherwise provided in this chapter, a dental
150 therapist may perform the dental therapy services as specified
151 in subsection (3) under the direct or indirect supervision of a
152 dentist to the extent authorized by the supervising dentist and
153 provided within the terms of a written collaborative management
154 agreement signed by the dental therapist and the supervising
155 dentist which meets the requirements of subsection (4). For
156 purposes of this section, the term:
157 (a) “Direct supervision” means supervision whereby a
158 dentist diagnoses the condition to be treated, a dentist
159 authorizes the procedure to be performed, a dentist remains on
160 the premises while the procedures are performed, and a dentist
161 approves the work performed before dismissal of the patient.
162 (b) “Indirect supervision” means supervision whereby a
163 dentist authorizes the procedure and a dentist is on the
164 premises while the procedure is performed.
165 (3) Dental therapy services include all of the following:
166 (a) All services, treatments, and competencies identified
167 by the American Dental Association Commission on Dental
168 Accreditation in its Dental Therapy Education Accreditation
170 (b) The following state-specific services, if the dental
171 therapist’s education included curriculum content satisfying the
172 American Dental Association Commission on Dental Accreditation
173 criteria for state-specific dental therapy services:
174 1. Evaluating radiographs.
175 2. Placement of space maintainers.
176 3. Pulpotomies on primary teeth.
177 4. Dispensing and administering nonopioid analgesics
178 including nitrous oxide, anti-inflammatories, and antibiotics as
179 authorized by the supervising dentist and within the parameters
180 of the collaborative management agreement.
181 5. Oral evaluation and assessment of dental disease and
182 formulation of an individualized treatment plan if authorized by
183 a supervising dentist and subject to any conditions,
184 limitations, and protocols specified by the supervising dentist
185 in the collaborative management agreement.
186 (4) Before performing any of the services authorized in
187 subsection (3), a dental therapist must enter into a written
188 collaborative management agreement with a supervising dentist.
189 The agreement must be signed by the dental therapist and the
190 supervising dentist and must include:
191 (a) Practice settings where services may be provided by the
192 dental therapist and the populations to be served by the dental
194 (b) Any limitations on the services that may be provided by
195 the dental therapist, including the level of supervision
196 required by the supervising dentist.
197 (c) Age- and procedure-specific practice protocols for the
198 dental therapist, including case selection criteria, assessment
199 guidelines, and imaging frequency.
200 (d) A procedure for creating and maintaining dental records
201 for the patients who are treated by the dental therapist.
202 (e) A plan to manage medical emergencies in each practice
203 setting where the dental therapist provides care.
204 (f) A quality assurance plan for monitoring care provided
205 by the dental therapist, including patient care review, referral
206 followup, and a quality assurance chart review.
207 (g) Protocols for the dental therapist to administer and
208 dispense medications, including the specific conditions and
209 circumstances under which the medications are to be dispensed
210 and administered.
211 (h) Criteria relating to the provision of care by the
212 dental therapist to patients with specific medical conditions or
213 complex medication histories, including requirements for
214 consultation before the initiation of care.
215 (i) Supervision criteria of dental therapists.
216 (j) A plan for the provision of clinical resources and
217 referrals in situations that are beyond the capabilities of the
218 dental therapist.
219 (5) A supervising dentist may restrict or limit the dental
220 therapist’s practice in a collaborative management agreement to
221 be less than the full scope of practice for dental therapists
222 which is authorized in subsection (3).
223 (6) A supervising dentist may authorize a dental therapist
224 to provide dental therapy services to a patient before the
225 dentist examines or diagnoses the patient if the authority,
226 conditions, and protocols are established in a written
227 collaborative management agreement and if the patient is
228 subsequently referred to a dentist for any needed additional
229 services that exceed the dental therapist’s scope of practice or
230 authorization under the collaborative management agreement.
231 (7) A supervising dentist must be licensed and practicing
233 ================= T I T L E A M E N D M E N T ================
234 And the title is amended as follows:
235 Delete lines 48 - 72
236 and insert:
237 direct or indirect supervision of a dentist to
238 administer local anesthesia and utilize an X-ray
239 machine, expose dental X-ray films, and interpret or
240 read such films if specified requirements are met;
241 correcting a term; amending s. 466.018, F.S.;
242 providing that a dentist remains primarily responsible
243 for the dental treatment of a patient regardless of
244 whether the treatment is provided by a dental
245 therapist; requiring the initials of a dental
246 therapist who renders treatment to a patient to be
247 placed in the record of the patient; creating s.
248 466.0225, F.S.; providing application requirements and
249 examination and licensure qualifications for dental
250 therapists; creating s. 466.0227, F.S.; providing
251 legislative findings and intent; limiting the practice
252 of dental therapy to specified settings; authorizing a
253 dental therapist to perform specified services under
254 the direct or indirect supervision of a dentist under
255 certain conditions; defining the terms “direct
256 supervision” and “indirect supervision”; specifying
257 state-specific dental therapy services; requiring a
258 collaborative management agreement to be signed by a
259 supervising dentist and a dental therapist and to
260 include certain information;