Scope of Practice of Licensed Dental Hygienist;
Administration of Local Anesthesia by Licensed Dental Hygienist

Adopted: August 6, 2008 by the New Jersey State Board of Dentistry, Maxine Feinberg, D.D.S., President.
Filed: October 28, 2008 as R.2008 d.357, with a technical change not requiring additional public notice and comment (see N.J.A.C. 1:30-6.3).

Authority: N.J.S.A. 45:1-15.1 and 45:6-50.
Effective Date: December 1, 2008.
Expiration Date: August 16, 2010.

Federal Standards Statement

A Federal standards analysis is not required because the adopted amendment and new rule are governed by N.J.S.A. 45:6-48 et seq., and are not subject to any Federal requirements or standards.

Full text of the adoption follows (addition to the proposal indicated in boldface with asterisks *thus*; deletion from the proposal indicated in brackets with asterisks *[thus]*):

13:30-1A.2 Scope of practice of licensed dental hygienist

(a) (No change.)

(b) A licensed dental hygienist practicing under the direct supervision of a licensed dentist may:

1.-34. (No change.)

35. Apply hot or cold packs pursuant to the direction of a licensed dentist;

36. Assist a licensed dentist in the administration of nitrous oxide, provided the licensed dentist is physically present in the operatory at all times during the procedure; and

37. Administer local anesthesia provided he or she satisfies the requirements set forth in N.J.A.C. 13:30-1A.3.

13:30-1A.3 Administration of local anesthesia by licensed dental hygienists

(a) A licensed dental hygienist may administer local anesthesia if the minimum standards of training and procedure set forth in this section are followed. For purposes of this section "local anesthesia" is defined as the elimination of sensation, especially pain, in the oral cavity by the regional injection of an anesthetic agent.

(b) No licensed dental hygienist shall administer local anesthesia unless he or she possesses a local anesthesia permit issued by the Board of Dentistry.

(c) A licensed dental hygienist who has been issued a permit to administer local anesthesia may do so only under the direct supervision of a New Jersey licensed dentist who shall determine which anesthetic agent shall be administered by the hygienist. The licensed hygienist may utilize only the following types of injections: infiltration in the maxilla and mandible; mandibular nerve block; mental nerve block; and long buccal nerve block.

(d) A licensed dental hygienist applying for a Board permit to administer local anesthesia shall satisfy the following requirements:

1. *[Completion]* *Successful completion* of a Board-approved course in the administration of local anesthesia offered in a dental hygiene program approved by the Commission on Dental Accreditation, or in an accredited college or university, teaching hospital or other training institution or facility approved pursuant to N.J.S.A. 45:6-2.

i. The course outline, content and objectives, and curriculum vitae of course instructors shall be submitted to the Board for review and approval.

ii. The course shall include instruction in: head and neck anatomy; pharmacology of anesthetic and analgesic agents; patient pre-evaluation, including medical and dental history considerations; recognition of adverse events, emergency procedures and basic life support; and selection of appropriate armamentarium, agents and techniques.

iii. The course shall consist of 20 hours of didactic training and 12 hours of clinical training. The clinical training shall include 20 monitored administrations of local anesthesia, with a minimum of five administrations of each of the following injections: infiltrations in the maxilla and mandible, mandibular nerve block, mental nerve block, and long buccal nerve block; and

[page=6817] 2. Passage of the written examination in the administration of local anesthesia administered by the Northeast Regional Board of Dental Examiners (NERB).

(e) A licensed dental hygienist who holds a permit to administer local anesthesia under the direct supervision of a licensed dentist shall complete four hours of continuing education in the administration of local anesthesia in every other biennial renewal period, consistent with the requirements of N.J.A.C. 13:30-5.2.

(f) The administration of local anesthesia by a licensed dental hygienist without a permit shall constitute a deviation from normal standards of practice required of a licensee.

(g) A licensed dental hygienist who administers local anesthesia without a permit and without direct supervision shall be deemed to be engaging in the unauthorized practice of dental hygiene and shall be subject to the penalties set forth in N.J.S.A. 45:6-58 and 45:1-25.

(h) A licensed dentist who permits a licensed dental hygienist to administer local anesthesia without a permit or without direct supervision shall be subject to the penalties set forth in N.J.S.A. 45:1-25 and shall be deemed to have engaged in willful and gross malpractice or willful and gross neglect in the practice of dentistry pursuant to N.J.S.A. 45:6-62.