Section 12-220-503 - What constitutes practicing unsupervised dental hygiene - rules(1) Unless licensed to practice dentistry, a person is deemed to be practicing unsupervised dental hygiene when the person, within the scope of the person's education, training, and experience: (a) Removes deposits, accretions, and stains by scaling with hand, ultrasonic, or other devices from all surfaces of the tooth and smooths and polishes natural and restored tooth surfaces, including root planing;(b) Removes granulation and degenerated tissue from the gingival wall of a periodontal pocket;(c) Provides preventive measures including the application of fluorides, sealants, and other recognized topical agents for the prevention of oral disease;(d) Gathers and assembles information including, but not limited to: (I) Fact-finding and patient history;(II) Preparation of study casts for the purpose of fabricating a permanent record of the patient's present condition; as a visual aid for patient education, dental hygiene diagnosis, and dental hygiene treatment planning; and to provide assistance during forensic examination;(III) Extra- and intra-oral inspection;(IV) Dental and periodontal charting; and(V) Radiographic and X-ray survey for the purpose of assessing and diagnosing dental hygiene-related conditions for treatment planning for dental hygiene services as described in this section and identifying dental abnormalities for immediate referral to a dentist;(e) Administers a topical anesthetic to a patient in the course of providing dental care;(f) Performs dental hygiene assessment, dental hygiene diagnosis, and dental hygiene treatment planning for dental hygiene services as described in this section and identifies dental abnormalities for immediate referral to a dentist; or(g)(I) Prescribes, administers, and dispenses fluoride, fluoride varnish, silver diamine fluoride in accordance with subsection (1)(g)(IV) of this section, antimicrobial solutions for mouth rinsing, other nonsystemic antimicrobial agents, and related emergency drugs and reversal agents in collaboration with a licensed dentist. The board, by rule, may further define the permissible and appropriate emergency drugs and reversal agents. An articulated plan with a collaborating dentist for dental hygiene prescribing must describe any protocols, restrictions or limitations, follow-up and referral mechanisms, notification and disclosure requirements, and any other requirements established by the board by rule. Dental hygienists shall maintain clear documentation in the patient record of the drug or agent prescribed, administered, or dispensed; the date of the action; and the rationale for prescribing, administering, or dispensing the drug or agent.(II) A dental hygienist shall not prescribe, administer, or dispense the following:(A) Drugs whose primary effect is systemic, with the exception of fluoride supplements permitted under subsection (1)(g)(III)(A) of this section; and(B) Dangerous drugs or controlled substances, as defined in section 18-18-102 (5).(III) A dental hygienist may prescribe the following:(A) Fluoride supplements as follows, all using sodium fluoride: Tablets: 0.5 mg, 1.1 mg, or 2.2 mg; lozenges: 2.21 mg; and drops: 1.1 mL;(B) Topical anti-caries treatments as follows, all using sodium fluoride unless otherwise indicated: Toothpastes: 1.1% or less (or stannous fluoride 0.4%); topical gels: 1.1% or less (or stannous fluoride 0.4%); oral rinses: 0.05%, 0.2%, 0.44%, or 0.5%; oral rinse concentrate used in periodontal disease: 0.63% stannous fluoride; fluoride varnish: 5%; silver diamine fluoride: 38%; and prophy pastes containing approximately 1.23% sodium fluoride and used for polishing procedures as part of professional dental prophylaxis treatment;(C) Topical anti-infectives as follows: Chlorhexidine gluconate rinses: 0.12%; chlorhexidine gluconate periodontal chips for subgingival insertion into a periodontal pocket/sulcus; tetracycline impregnated fibers, inserted subgingivally into a periodontal pocket/sulcus; doxycycline hyclate periodontal gel, inserted subgingivally into a periodontal pocket/sulcus; and minocycline hydrochloride periodontal powder, inserted subgingivally into a periodontal pocket/sulcus; and(D) Related emergency drugs and reversal agents as authorized by the collaborating dentist.(IV) A dental hygienist may prescribe and apply silver diamine fluoride upon completion of a postsecondary course or continuing education course developed at the postsecondary level that satisfies the requirements established by the board and provides instructions on the use and limitations of applying silver diamine fluoride. A dental hygienist may complete the course described in this subsection (1)(g)(IV) through: (A) A live and interactive course presentation;(B) An on-demand webinar with a completion quiz component to verify participation prior to the issuance of a certificate; or(C) Any other format approved by the board.(2) A dental hygienist shall state in writing and require a patient to acknowledge by signature that any diagnosis or assessment is for the purpose of determining necessary dental hygiene services only and that it is recommended by the American Dental Association, or any successor organizations, that a thorough dental examination be performed by a dentist twice each year.(3) Unsupervised dental hygiene may be performed by licensed dental hygienists without the supervision of a licensed dentist.(4)(a) Notwithstanding section 12-220-104 (13) or 12-220-305 (1)(b), a dental hygienist may be the proprietor of a place where supervised or unsupervised dental hygiene is performed and may purchase, own, or lease equipment necessary to perform supervised or unsupervised dental hygiene.(b) A dental hygienist proprietor, or a professional corporation or professional limited liability corporation of dental hygienists, in addition to providing dental hygiene services, may enter into an agreement with one or more dentists for the lease or rental of equipment or office space in the same physical location as the dental hygiene practice, but only if the determination of necessary dental services provided by the dentist and professional responsibility for those services, including but not limited to dental records, appropriate medication, and patient payment, remain with the treating dentist. It is the responsibility of the dental hygienist to inform the patient as to whether there is a supervisory relationship between the dentist and the dental hygienist. An agreement under this subsection (4)(b) does not constitute employment and does not constitute cause for discipline pursuant to section 12-220-201 (1)(h).Amended by 2021 Ch. 31, § 6, eff. 9/1/2021.Renumbered from C.R.S. § 12-220-122 and amended by 2020 Ch. 64, § 1, eff. 9/14/2020.Renumbered from C.R.S. § 12-35-124 and amended by 2019 Ch. 136, § 1, eff. 10/1/2019.Amended by 2017 Ch. 13, § 2, eff. 8/9/2017.Amended by 2014 Ch. 363, § 28, eff. 7/1/2014.This section is similar to former § 12-220-122 as it existed prior to 2020.