Section 1107 - RDH Course in Periodontal Soft Tissue Curettage, Local Anesthesia, and Nitrous Oxide-Oxygen Analgesia (Sln)(a) Approval of Course. The Board shall approve only those educational courses of instruction in local anesthetic, nitrous oxide-oxygen analgesia and periodontal soft tissue curettage that continuously meet all course requirements. Continuation of approval will be contingent upon compliance with these requirements. (1) A course in local anesthesia, nitrous oxide-oxygen analgesia and periodontal soft tissue curettage is a course that provides instruction in the following duties: (A) Administration of local anesthetic agents, infiltration and conductive, limited to the oral cavity;(B) Administration of nitrous oxide and oxygen when used as an analgesic; utilizing fail-safe machines with scavenger systems containing no other general anesthetic agents; and(C) Periodontal soft tissue curettage.(2) An applicant course provider shall submit an "Application for Approval of a Course in Soft Tissue Curettage, Local Anesthesia, and Nitrous Oxide-Oxygen Analgesia (SLN)" (DHBC SLN-01 (03/2021)) hereby incorporated by reference, accompanied by the appropriate fee, and shall receive approval prior to enrollment of students.(3) All courses shall be at the postsecondary educational level.(4) Each approved course shall be subject to review by the Board at any time.(5) Each approved course shall submit a biennial report "Periodontal Soft Tissue Curettage, Local Anesthesia, and Nitrous Oxide-Oxygen Analgesia (SLN) Course Provider Biennial Report" (DHBC SLN-03 (03/2021)) hereby incorporated by reference.(b) Requirements for Approval. In order to be approved, a course shall provide the resources necessary to accomplish education as specified in this section. Course providers shall be responsible for informing the Board of any changes to the course content, physical facilities, and faculty, within 10 days of such changes. (1) Administration. The course provider shall require course applicants to possess current certification in Basic Life Support for health care providers as required by Title 16, Division 10, Chapter 1, Article 4, Section 1016 (b)(1)(C) of the California Code of Regulations in order to be eligible for admission to the course, and one of the following: (A) Possess a valid active license to practice dental hygiene issued by the Board; or,(B) Have graduated from an educational program for dental hygienists approved by the Commission on Dental Accreditation or an equivalent accrediting body approved by the Board; or(C) Provide a letter of certification from the dean or program director of an educational program accredited by the Commission on Dental Accreditation that the course applicant is in his or her final academic term and is expected to meet all educational requirements for graduation. The school seal must be affixed to the letter with the name of the program.(2) Faculty. Preclinical and clinical faculty, including course director and supervising dentistry), shall: (A) Possess a valid, active California license to practice dentistry or dental hygiene for at least two (2) years immediately preceding any provision of course instruction;(B) Provide preclinical and clinical instruction only in procedures within the scope of practice of their respective licenses.(C) Complete an educational methodology course immediately preceding any provision of course instruction and every two years thereafter; and,(D) Be calibrated in instruction and grading by the course provider.(E) Submit to the Board a "DHBC Faculty Biosketch" (3/2021), hereby incorporated by reference, prior to providing instructions in SLN duties.(3) Facilities and Equipment. Preclinical and clinical instruction shall be held at a physical facility. Physical facilities and equipment shall be maintained and replaced in a manner designed to provide students with a course designed to meet the educational objectives set forth in this section. A physical facility shall have all of the following: (A) A lecture classroom, a patient clinic area, a sterilization facility and a radiology area for use by the students.(B) Access for all students to equipment necessary to develop dental hygiene skills in these duties.(C) Infection control equipment shall be provided according to the requirements of CCR Title 16, Division 10, Chapter 1, Article 1, Section 1005.(D) At least one complete nitrous oxide-oxygen unit shall be provided for each six (6) students enrolled in the course and shall include a fail-safe flowmeter, functional scavenger system and disposable or sterilizable nasal hoods for each laboratory partner or patient. All tubing, hoses and reservoir bags shall be maintained and replaced at regular intervals to prevent leakage of gases. When not attached to a nitrous oxide-oxygen unit, all gas cylinders shall be maintained in an upright position, secured with a chain or in a cart designed for storage of gas cylinders.(4) Health and Safety. A course provider shall comply with local, state, and federal health and safety laws and regulations. (A) All students shall have access to the course's hazardous waste management plan for the disposal of needles, cartridges, medical waste and storage of oxygen and nitrous oxide tanks.(B) All students shall have access to the course's clinic and radiation hazardous communication plan.(C) All students shall receive a copy of the course's bloodborne and infectious diseases exposure control plan, which shall include emergency needlestick information.(5) Clinical Education. As of January 1, 2016, each course's clinical training shall be given at a dental or dental hygiene school or facility approved by the Board, which has a written contract for such training. Such written contract shall include a description of the settings in which the clinical training may be received and shall provide for direct supervision of such training by faculty designated by the course provider. A facility shall not include a dental office unless such office is an extramural facility of an educational program approved by the Board.(6) Recordkeeping. A course provider shall possess and maintain the following for a period of not less than 5 years:(A) A copy of each approved curriculum, containing a course syllabus.(B) A copy of completed written examinations, clinic rubrics, and completed competency evaluations.(C) A copy of faculty calibration plan, faculty credentials, licenses, and certifications including documented background in educational methodology immediately preceding any provision of course instruction and every two years thereafter.(D) Individual student records, including those necessary to establish satisfactory completion of the course.(E) A copy of student course evaluations and a summation thereof.(7) Curriculum Organization and Learning Resources. (A) The organization of the curriculum for the course shall be flexible, creating opportunities for adjustments to and research of advances in the administration of local anesthetic, nitrous oxide-oxygen analgesia and periodontal soft tissue curettage as provided in the section of this article on Requirements for RDH Programs.(B) Curriculum shall provide students with an understanding of these procedures as provided in the section of this article on Requirements for RDH Programs and an ability to perform each procedure with competence and judgment.(C) Curriculum shall prepare the student to assess, plan, implement, and evaluate these procedures as provided and in accordance with the section of this article on Requirements for RDH Programs.(D) Curriculum shall include a remediation policy, and procedures outlining course guidelines for students who fail to successfully complete the course.(E) Students shall be provided a course syllabus that contains:(i) Course learning outcomes,(ii) Titles of references used for course materials,(iii) Content objectives,(iv) Grading criteria which includes competency evaluations and clinic rubrics to include problem solving and critical thinking skills that reflect course learning outcomes, and(v) A remediation policy and procedures.(F) Students shall have reasonable access to dental and medical reference textbooks, current scientific journals, audio visual materials and other relevant resources.(8) General Curriculum Content. Areas of didactic, preclinical and clinical instruction shall include: (A) Indications and contraindications for all patients of:(i) periodontal soft tissue curettage;(ii) administration and reversal of local anesthetic agents;(iii) nitrous oxide-oxygen analgesia agents(B) Head and neck anatomy;(C) Physical and psychological evaluation procedures;(D) Review of body systems related to course topics;(E) Theory and psychological aspects of pain and anxiety control;(F) Selection of pain control modalities;(G) Pharmacological considerations such as action of anesthetics and vasoconstrictors, local anesthetic reversal agents and nitrous oxide-oxygen analgesia;(H) Recovery from and post-procedure evaluation of periodontal soft tissue curettage, local anesthesia and nitrous oxide/oxygen analgesia;(I) Complications and management of periodontal soft tissue curettage, local anesthesia and nitrous oxide-oxygen analgesia emergencies;(J) Armamentarium required and current technology available for local anesthesia, nitrous oxide-oxygen analgesia and periodontal soft tissue curettage;(K) Techniques of administration of maxillary and mandibular local infiltrations, field blocks and nerve blocks, nitrous oxide-oxygen analgesia and performance of periodontal soft tissue curettage;(L) Proper infection control procedures according to the provisions of Title 16, Division 10, Chapter 1, Article 4, Section 1005 of the California Code of Regulations;(M) Patient documentation that meets the standard of care, including, but not limited to, computation of maximum recommended dosages for local anesthetics and the tidal volume, percentage and amount of the gases and duration of administration of nitrous oxide-oxygen analgesia;(N) Medical and legal considerations including patient consent, standard of care, and patient privacy;(O) Student course evaluation mechanism.(9) Specific Curriculum Content. (A) Local anesthetic agents curriculum must include at least thirty (30) hours of instruction, including at least fifteen (15) hours of didactic and preclinical instruction and at least fifteen (15) hours of clinical instruction. Preclinical instruction shall include a minimum of two (2) experiences per injection, which may be on another student. Clinical instruction shall include at least four (4) clinical experiences per injection to include two (2) experiences on the right side of a patient and two (2) experiences on the left side of a patient, of which only one (1) may be on another student. Curriculum must include maxillary and mandibular anesthesia techniques for local infiltration, field blocks and nerve blocks to include anterior superior alveolar (ASA), middle superior alveolar (MSA), anterior middle superior alveolar (AMSA), posterior superior alveolar (PSA), greater palatine, supraperiosteal, inferior alveolar (IA), lingual, and buccal injections. Clinical instruction for the mental and incisive injections shall include at least two (2) clinical experiences per injection to include one (1) experience on the right side of a patient and one (1) experience on the left side of a patient, of which only one (1) may be on another student. Clinical instruction for the nasopalatine injection shall include four (4) clinical experiences, of which only one (1) may be on another student. One clinical experience per injection shall be used to determine clinical competency in the course. The competency evaluation for each injection and technique must be achieved at a minimum of 75%. | Injection Type | Didactic Instruction | Clinical Instruction | Required Preclinical Injections | Required Clinical Injections |
| (At least 15 hours of instruction required.) | (At least 15 hours of instruction required.) | (Injections may be on another student.) | Injections to include two (2) experiences on the right side of a patient and two (2) experiences on the left side of a patient. |
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| | | | Only one (1) experience may be on another student. |
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| Anterior Superior Alveolar (ASA) | Yes | Yes | 2 | 4 |
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| Middle Superior Alveolar (MSA) | Yes | Yes | 2 | 4 |
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| Anterior Middle Superior Alveolar (AMSA) | Yes | Yes | 2 | 4 |
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| Posterior Superior Alveolar (PSA) | Yes | Yes | 2 | 4 |
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| Greater Palatine (GP) | Yes | Yes | 2 | 4 |
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| Supraperiosteal | Yes | Yes | 2 | 4 |
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| Inferior Alveolar (IA) | Yes | Yes | 2 | 4 |
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| Lingual | Yes | Yes | 2 | 4 |
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| Buccal | Yes | Yes | 2 | 4 |
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| Competency evaluation for each injection and technique must be achieved at a minimum of 75%. |
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| Injection | Didactic Instruction | Clinical Instruction | Required Preclinical Injections | Required Clinical Injections |
| At least 15 hours of instruction required | At least 15 hours of instruction required | Injections may be on another student | |
| | | | |
| Nasopalatine | Yes | Yes | 2 | 4 |
| | | | |
| Mental | Yes | Yes | 2 | 1. One (1) experience on the right side of a patient |
| | | | 2. One (1) experience on the left side of a patient |
| | | | 3. Only one (1) expereince may be on another student. |
| | | | |
| Incisive | Yes | Yes | 2 | 1. One (1) experience on the right side of a patient |
| | | | 2. One (1) experience on the left side of a patient |
| | | | 3. Only one (1) experience may be on another student. |
| Compentency evaluation for each injection and technique must be achieved at a minimum of 75%. |
(B) Nitrous oxide-oxygen analgesia curriculum must include at least eight (8) hours of instruction, including at least four (4) hours of didactic and preclinical instruction and at least four (4) hours of clinical instruction. This includes at least two (2) preclinical experiences on patients, both of which may be on another student, and at least three (3) clinical experiences on patients, of which only one may be on another student and one of which will be used to determine clinical competency in the course. Each clinical experience shall include the performance of a dental hygiene procedure while administering at least twenty (20) minutes of nitrous oxide-oxygen analgesia, from the beginning of titration of nitrous oxide-oxygen to the discontinuation of nitrous oxide and beginning of final oxygenation. The competency evaluation must be achieved at a minimum of 75%. | Nitrous Oxide-Oxygen Sedation Requirements | Didactic and Preclinical Instruction | Clinical Instruction | Required Preclinical Experiences | Required Clinical Experiences |
| | | | |
| Minimum 8 hours of instruction | Yes | Yes | 1. Minimum two experiences | 1. Minimum three experiences |
| Minimum 4 hours instruction | Minimum 4 hours instruction | 2. Both experiences may be on another student | 2. One experience may be on another student |
| | | | 3. One experience must be used to determine competency |
| | | | 4. Minimum of 20 minutes of nitrous oxide-oxygen exposure for each experience |
| | | | 5. Competency evaluation must be achieved at a minimum of 75%. |
(C) Periodontal soft tissue curettage curriculum must include at least six (6) hours of instruction, including at least three (3) hours of didactic and preclinical instruction and at least three (3) hours of clinical instruction. Education may include use of a laser approved for soft tissue curettage. This includes at least three (3) clinical experiences on patients, of which only one may be on another student and one of which will be used to determine clinical competency in the course. The competency evaluation for this procedure must be achieved at a minimum of 75%.(10) Certificate of Completion. A course provider shall issue a certificate of completion "Certification in Administration of Periodontal Soft Tissue Curettage, Local Anesthesia, and Nitrous Oxide-Oxygen Analgesia" (DHBC SLN-02 (03/2021)), hereby incorporated by reference, only after a student has achieved clinical competency of the three procedures.(c) Appeals. (1) The Board may deny or withdraw its approval of a course. If the Board denies or withdraws approval of a course, the reasons for withdrawal or denial will be provided in writing within ninety (90) days.(2) Any course provider whose approval is denied or withdrawn shall be granted an informal conference before the Executive Officer or his or her designee prior to the effective date of such action. The course provider shall be given at least ten days' notice of the time and place of such informal conference and the specific grounds for the proposed action.(3) The course provider may contest the denial or withdrawal of approval by either: (A) Appearing at the informal conference. The Executive Officer shall notify the course provider of the final decision of the Executive Officer within ten days of the informal conference. Based on the outcome of the informal conference, the course provider may then request a hearing to contest the Executive Officer's final decision. A course provider shall request a hearing by written notice to the Board within 30 calendar days of the postmark date of the letter of the Executive Officer's final decision after informal conference. Hearings shall be held pursuant to the provisions of Chapter 5 (commencing with Section 11500) of Part 1 of Division 3 of Title 2 of the Government Code. Or;(B) Notifying the Board in writing the course provider's election to forego the informal conference and to proceed with a hearing pursuant to the provisions of Chapter 5 (commencing with Section 11500) of Part 1 of Division 3 of Title 2 of the Government Code. Such notification shall be made to the Board before the date of the informal conference.Cal. Code Regs. Tit. 16, § 1107
1. New section filed 8-4-2014; operative 8-4-2014 pursuant to Government Code section 11343.4(b)(3) (Register 2014, No. 32).
2. Change without regulatory effect amending subsections (b)(9)(A)-(B) filed 8-30-2017 pursuant to section 100, title 1, California Code of Regulations (Register 2017, No. 35).
3. Amendment of section heading and section filed 4-20-2021; operative 7-1-2021 (Register 2021, No. 17). Filing deadline specified in Government Code section 11349.3(a) extended 60 calendar days pursuant to Executive Order N-40-20 and an additional 60 calendar days pursuant to Executive Order N-71-20. Note: Authority cited: Sections 1905, 1906, 1909 and 1944, Business and Professions Code. Reference: Sections 1905, 1909, 1917 and 1944, Business and Professions Code.
1. New section filed 8-4-2014; operative 8/4/2014 pursuant to Government Code section 11343.4(b)(3) (Register 2014, No. 32).
2. Change without regulatory effect amending subsections (b)(9)(A)-(B) filed 8-30-2017 pursuant to section 100, title 1, California Code of Regulations (Register 2017, No. 35).
3. Amendment of section heading and section filed 4-20-2021; operative 7/1/2021 (Register 2021, No. 17). Filing deadline specified in Government Code section 11349.3(a) extended 60 calendar days pursuant to Executive Order N-40-20 and an additional 60 calendar days pursuant to Executive Order N-71-20.