Den 100 - 601

CHAPTER Den 100 ORGANIZATIONAL RULES

Statutory Authority: RSA 317-A:12

PART Den 101 DEFINITIONS

Den 101.01 “Active license” means a New Hampshire license which has not been suspended, inactivated, revoked, or lapsed.

Source. #287.2 eff 1-17-74; ss by #2981, eff 2-28-85; ss by #5110, eff 4-4-91, EXPIRED: 4-4-97

New. #6908, eff 12-9-98

Den 101.02 “Addiction” means a primary, chronic, neurobiologic disease with genetic, psychosocial, and environmental factors influencing its development and manifestations. It is characterized by behaviors that include impaired control over drug use, craving, compulsive use, or continued use despite harm. The term does not include physical dependence and tolerance, which are normal physiological consequences of extended opioid therapy for pain.

Source. #14140, eff 1-31-25

Den 101.03 “Administer” means an act whereby a single dose of a drug is instilled into the body of, applied to the body of, or otherwise given to a person for immediate consumption or use.

Source. #14140, eff 1-31-25

Den 101.04 “Base” means a replacement material for lost dentin tooth structure. https://gencourt.state.nh.us/rules/filing_history/sourceden.html

Source. #2981, eff 2-28-85; renumbered by #14140 (formerly Den 101.02)

Den 101.05 “Board” means the New Hampshire board of dental examiners established pursuant to RSA 317-A:2.

Source. #287.2 eff 1-17-74; ss by #2981, eff 2-28-85; ss by #5110, eff 4-4-91, EXPIRED: 4-4-97

New. #6908, eff 12-9-98; renumbered by #14140 (formerly Den 101.03)

Den 101.06 “Certification” means the process attesting that an individual has met certain predetermined standards specified by the certifying body.

Source. #7969, eff 10-10-03; renumbered by #14140 (formerly Den 101.04)

Den 101.07 “Certified dental assistant” means a dental assistant who holds current certified dental assistant certification from the Dental Assisting National Board (DANB).

Source. #12427, eff 12-6-17; renumbered by #14140 (formerly Den 101.05)

Den 101.08 “Clinical” means having to do with the direct observation and treatment of patients.

Source. #8224, eff 12-8-04; renumbered by #12427 (formerly Den 101.05); renumbered by #14140 (formerly Den 101.06)

Den 101.09 “Dental assistant” means any person who assists the dentist in carrying out the clinical duties of a dental office.

Source. #287.2 eff 1-17-74; ss by #2981, eff 2-28-85; ss by #5110, eff 4-4-91, EXPIRED: 4-4-97

New. #6908, eff 12-9-98; ss by #9777-A, eff 9-3-10; ss by #9956, eff 7-16-11; renumbered by #12427 (formerly Den 101.06); renumbered by #14140 (formerly Den 101.07)

Den 101.10 “Dental hygienist” means a person holding a current license issued by the board under RSA 317-A:21.

Source. #4298, eff 7-28-87; ss by #5110, eff 4-4-91, EXPIRED: 4-4-97

New. #6908, eff 12-9-98; renumbered by #12427 (formerly Den 101.07); renumbered by #14140 (formerly Den 101.08)

Den 101.11 “Dentist” means a person holding a current license issued by the board under RSA 317-A:7 and RSA 317-A:20.

Source. #287.2 eff 1-17-74; ss by #2981, eff 2-28-85; ss by #5110, eff 4-4-91, EXPIRED: 4-4-97

New. #6908, eff 12-9-98; renumbered by #12427 (formerly Den 101.08); renumbered by #14140 (formerly Den 101.09)

Den 101.12 “Diagnosis” means the identification of a disease from its signs and symptoms.

Source. #287.2 eff 1-17-74; ss by #2981, eff 2-28-85; ss by #5110, eff 4-4-91, EXPIRED: 4-4-97

New. #6908, eff 12-9-98; ss by #7556, eff 9-20-01; renumbered by #12427 (formerly Den 101.09); renumbered by #14140 (formerly Den 101.10)

Den 101.13 “Direct supervision” means a dentist with an active license is in the dental office, authorizes the procedure and remains in the dental office while the procedures are being performed and evaluates the performance of the dental hygienist or dental assistant before dismissal of the patient.

Source. #287.2 eff 1-17-74; ss by #2981, eff 2-28-85; ss by #5110, eff 4-4-91, EXPIRED: 4-4-97

New. #6908, eff 12-9-98; ss by #10990, eff 12-9-15; renumbered by #12427 (formerly Den 101.10); renumbered by #14140 (formerly Den 101.11)

Den 101.14 “Dose unit” means one pill, one capsule, one patch, or one liquid dose.

Source. #14140, eff 1-31-25

Den 101.15 “General supervision” means a dentist with an active license has authorized the procedures, and the procedures are being carried out in accordance with their diagnosis and treatment plan, and the procedures will be personally evaluated and reviewed by the dentist with the patient at least once in a 12 month period.

Source. #287.2 eff 1-17-74; ss by #2981, eff 2-28-85; ss by #5110, eff 4-4-91, EXPIRED: 4-4-97

New. #6908, eff 12-9-98; renumbered by #12427 (formerly Den 101.11); renumbered by #14140 (formerly Den 101.12)

Den 101.16 “Graduate dental assistant” means a dental assistant who has graduated from a Commission on Dental Accreditation (CODA) accredited school of dental assisting.

Source. #12427, eff 12-6-17; renumbered by #14140 (formerly Den 101.13)

Den 101.17 “Indirect supervision” means a dentist with an active license is in the dental office, authorizes the procedures, and remains in the dental office while the procedures are being performed by the dental hygienist or dental assistant and evaluates the performance of the dental hygienist or dental assistant at a subsequent appointment.

Source. #287.2 eff 1-17-74; ss by #2981, eff 2-28-85; ss by #5110, eff 4-4-91, EXPIRED: 4-4-97

New. #6908, eff 12-9-98; renumbered by #12427 (formerly Den 101.12); renumbered by #14140 (formerly Den 101.14)

Den 101.18 “Letter of concern” means a written letter from the board drawing the licensee’s attention to specific acts or omissions that could place the licensee at risk of future disciplinary action. A letter of concern is non-disciplinary and is sent to the licensee following a communication of alleged misconduct, complaint, or investigation.

Source. #12427, eff 12-6-17; renumbered by #14140 (formerly Den 101.15)

Den 101.19 “Licensure” means the process by which the board, to protect the public, grants written permission to persons meeting qualifications set forth in these rules to engage in the practice of dentistry or dental hygiene.

Source. #7969, eff 10-10-03; renumbered by #12427 (formerly Den 101.13); renumbered by #14140 (formerly Den 101.16)

Den 101.20 “Licensure by endorsement certification” means granting a license to practice dentistry or to provide dental hygiene services in New Hampshire based upon compliance with the applicable requirements of Den 300, and holding a current, unsuspended, unrestricted license to practice in another state.

Source. #4298, eff 7-28-87; ss by #5110, eff 4-4-91, EXPIRED: 4-4-97

New. #6908, eff 12-9-98; ss by #12427 (from Den 101.14); renumbered by #14140 (formerly Den 101.17)

Den 101.21 “Licensure by examination” means granting a license to practice dentistry or to provide dental hygiene services in New Hampshire based upon compliance with the applicable requirements of Den 300, and passage of the American Board of Dental Examiners (ADEX) or any similar national or regional testing agency.

Source. #287.2 eff 1-17-74; ss by #2981, eff 2-28-85; ss by #5110, eff 4-4-91, EXPIRED: 4-4-97

New. #6908, eff 12-9-98; ss by #10688, eff 10-7-14; renumbered by #12427 (formerly Den 101.15); renumbered by #14140 (formerly Den 101.18)

Den 101.22 “Liner” means a material placed in a tooth for reasons other than to replace tooth structure.

Source. #8099, eff 6-11-04; renumbered by #12427 (formerly Den 101.16); renumbered by #14140 (formerly Den 101.19)

Den 101.23 “Monitor” means to observe for a special purpose.

Source. #8099, eff 6-11-04; renumbered by #12427 (formerly Den 101.17); renumbered by #14140 (formerly den 101.20)

Den 101.24 “Moral turpitude” means baseness, vileness, or dishonesty to a high degree.

Source. #8962, eff 8-16-07; renumbered by #12427 (formerly Den 101.18); renumbered by #14140 (formerly 101.21)

Den 101.25 “Personally evaluated” means that a dentist with an active license performs an oral exam on the patient once in a 12 month period.

Source. #12427, eff 12-6-17; renumbered by #14140 (formerly Den 101.22)

Den 101.26 “Prescription” means a verbal, written, facsimile, or electronically transmitted order for medications for self-administration by an individual patient.

Source. #14140, eff 1-31-25

Den 101.27 “President” means president of the board chosen pursuant to RSA 317-A:4.

Source. #287.2 eff 1-17-74; ss by #2981, eff 2-28-85; ss by #4262-a, eff 5-19-87; ss by #5110, eff 4-4-91; amd by #5722, eff 10-15-93; ss by #6908, eff 12-9-98; renumbered by #12427 (formerly 101.19); renumbered by #14140 (formerly Den 101.23)

Den 101.28 “Public health supervision” means a dentist with an active license authorizes procedures which are to be carried out by a dental hygienist with an active license practicing in a school, hospital or other institution, or for a homebound person without the dentist having to be present provided the dentist reviews the records once in a 12 month period.

Source. #6097, eff 9-29-95; ss by #6908, eff 12-9-98; ss by #10328-A, eff 5-7-13; renumbered by #12427 (formerly Den 101.20); renumbered by #14140 (formerly Den 101.24)

Den 101.29 "Qualified" means meeting the requirements of Den 302.05.

Source. #6097, eff 9-29-95; ss by #6908, eff 12-9-98; renumbered by #12427 (formerly Den 101.21); renumbered by #14140 (formerly Den 101.25)

Den 101.30 “Registration” means to secure official entry on the roster of persons having a dental or dental hygiene license in New Hampshire.

Source. #7671, eff 4-4-02; ss and moved by #8224, eff 12-8-04 (formerly Den 101.19); renumbered by #12427 (formerly Den 101.22); renumbered by #14140 (formerly Den 101.26)

Den 101.31 “Supervision” means oversight by a dentist of the performance of duties authorized by the board to dental hygienists and dental assistants.

Source. #6908, eff 12-9-98; renumbered by #12427 (formerly Den 101.23); renumbered by #14140 (formerly Den 101.27)

Den 101.32 “Temporary dental restoration” means a substance placed as an interim restoration to sedate or seal a tooth.

Source. #8099, eff 6-11-04; renumbered by #12427 (formerly Den 101.24); renumbered by #14140 (formerly Den 101.28)

Den 101.33 “Traditional dental assistant” means a dental assistant who is neither a certified dental assistant nor a graduate dental assistant.

Source. #12427, eff 12-6-17; renumbered by #14140 (formerly Den 101.29)

Den 101.34 “Treatment plan” means a written plan that reflects the particular benefits and risks of opioid use for each individual patient and establishes goals, expectations, methods, and time course for treatment.

Source. #14140, eff 1-31-25

Den 101.35 “Vice president” means the vice president of the board chosen pursuant to RSA 317-A:4.

Source. #8224, eff 12-8-04; renumbered by #12427 (formerly Den 101.25); renumbered by #14140 (formerly Den 101.30)

Den 101.36 “Volunteer” means an individual who provides dental care without pay or compensation for work or service performed.

Source. #8224, eff 12-8-04; renumbered by #12427 (formerly Den 101.26); renumbered by #14140 (formerly Den 101.31)

PART Den 102 DESCRIPTION OF BOARD

Den 102.01 Organization of Board.

(a) The board of dental examiners consists of 9 members, including 6 dentists, 2 hygienists, and one public member. One of these shall serve as president and one as vice-president. The board shall establish the criteria for the examination, registration, and licensure of applicants to be qualified to practice dentistry or dental hygiene in this state. All board members, pursuant to RSA 317-A:3, shall be residents of the state. The 6 dentist members shall be licensed to practice dentistry in this state one of which shall hold a current permit to administer general anesthesia and deep sedation. The 2 dental hygienist members shall be licensed to practice dental hygiene in this state.

(b) As a board member's term expires, the governor shall appoint a replacement, with the advice and consent of the council, for a period of 5 years and a limit of 2 consecutive terms, or until their successors are appointed and qualified.

(d) The board shall meet annually and at such times as its business requires.

(e) The board shall choose one of its members as its president and one of its members as vice-president. A true record of all their official acts shall be preserved by the office of professional licensure and certification (OPLC). The public records shall be open to inspection on the board's website once approved by the board and during office hours at the OPLC. Notice of meetings shall be posted in accordance with RSA 91-A and RSA 310:5.

(f) The board rules shall govern the conduct, ethical standards, and qualifications of dentists, dental hygienists, and dental assistants, and establish requirements for continuing education as a prerequisite for renewal of licenses of dentists and dental hygienists, including expanded function dental auxiliary permits. The board shall be responsible for the administration of the practice of dental auxiliaries assisting licensed dentists practicing in the state.

(g) There shall be established the following standing committees to facilitate meeting the requirements of RSA 317-A:

(1) A dental hygienist committee to develop and propose the administrative rules regarding the practice, education, examination, and licensure of dental hygienists pursuant to RSA 317-A:2-a, II; and

(2) An anesthesia and sedation committee to develop and propose administrative rules regarding the practice, discipline, education, examination, and permitting of dentists and facilities authorized to administer anesthesia in a dental practice pursuant to RSA 317-A:2-b, II.

Source. #287.2, eff 1-17-74; ss by #2981, eff 2-28-85; ss by #5110, eff 4-4-91, EXPIRED: 4-4-97

New. #6908, eff 12-9-98; amd by #7671, eff 4-4-02; ss by 9408-A, eff 3-10-09; amd by #9777-A, eff 9-3-10; ss by #10688, eff 10-7-14; ss by #10990, eff 12-9-15; ss by #14140, eff 1-31-25; ss by #14610, eff 6-8-26

PART Den 103 ACCESS TO PUBLIC INFORMATION

Den 103.01 Record of Official Actions. Minutes shall be kept of all board meetings and all official actions taken by the board. These minutes shall record those members who participate in each vote and shall separately record the position of any members who choose to dissent, abstain, or concur. Board minutes shall be public records and shall be available for inspection during the OPLC’s ordinary office hours within 5 business days of the date of the meeting or the vote in question.

Source. #6908, eff 12-9-98; ss by #14140, eff 1-31-25

Den 103.02 Custodian of Records. The OPLC shall be the custodian of the board’s records.

Source. #6908, eff 12-9-98; ss by #14140, eff 1-31-25

Den 103.03 Copies of Records. Persons desiring copies of board records shall request those records in accordance with Plc 103.

Source. #6908, eff 12-9-98; ss by #14140, eff 1-31-25

CHAPTER Den 200 RULES OF PRACTICE AND PROCEDURE

REVISION NOTE #1:

Document #8884-A & #8884-B, effective 5-17-07, made extensive changes to the wording, format, structure, and numbering of rules in Chapter Den 200. Document #8884-A and #8884-B supersede all prior filings for the sections in this chapter. The prior filings for former Chapter Den 200 include the following documents:

#287.2, eff 1-17-74

#2981, eff 2-28-85

#4509, 10-25-88

#5110, eff 4-4-91, EXPIRED: 4-4-97

#6541, eff 7-18-97

#6909, eff 12-9-98 , EXPIRED: 12-9-06

#7270, eff 5-12-00

#7660, eff 3-13-02

#7777, eff 10-10-02

#8513, eff 12-13-05

REVISION NOTE #2:

Document #13919, effective 5-31-24, repealed Part Den 201 through Part Den 216 in Chapter Den 200, titled “Practice and Procedure”, and renamed the chapter as “Rules of Practice and Procedure”. Document #13919 also adopted a new Part Den 201 titled “Applicability and Waiver of Substantive Rules”, containing Den 201.01 titled “Rules of Practice and Procedure” and Den 201.02 titled “Waiver of Administrative Rules.”

Document #13919 replaces all prior filings affecting the rules in the former Chapter Den 200. The prior filings beginning with Document #8884-A and Document #884-B included the following documents. Italics indicate the rules were subject to expiration only pursuant to RSA 541-A:17, II:

#8884-A, eff 5-17-07 (See Revision Note at chapter heading for Den 200)

#8884-B, eff 5-17-07

#9408-A, eff 3-10-09

#9777-B, eff 9-3-10

#10793-A, eff 3-7-15

#10793-B, eff 3-7-15

#10990, eff 12-9-15

As practice and procedure rules, the rules in Document #13919 will not expire except pursuant to RSA 541-A:17, II.

PART Den 201 APPLICABILITY AND WAIVER OF SUBSTANTIVE RULES

Den 201.01 Rules of Practice and Procedure. The Plc 200 rules shall govern with regards to all procedures for:

(a) Adjudicatory proceedings;

(b) Rulemaking submissions, considerations, and dispositions of rulemaking;

(d) Declaratory rulings;

(e) All statements of policy and interpretation;

(f) Explanation of adopted rules; and

(g) Voluntary surrender of licenses.

Source. (See Revision Note #1 and Revision Note #2 at chapter heading for Den 200) #13919, eff 5-31-24

Den 201.02 Waiver of Administrative Rules.

(a) The board shall initiate a waiver of a substantive rule upon its own motion by providing affected parties with notice and opportunity to be heard, and issuing an order which finds that waiver would be necessary to advance the purpose of the rules of the board.

(b) Individuals who wish to request a waiver of a rule shall submit a written request to the board, which includes:

(1) The rule for which a waiver is requested;

(2) The anticipated length of time the requested waiver will be needed;

(3) The reason for requesting the waiver;

(4) Evidence of how the waiver will provide for the health and safety of the consumer or licensee;

(5) A time-limited written compliance plan which sets forth plans to achieve compliance including an estimated date of compliance; and

(6) The signature of the applicant.

(1) If adherence to the rule would cause the petitioner unnecessary or undue hardship;

(2) If the requested waiver is necessary because of any neglect or misfeasance on the part of the practitioner;

(3) If enforcement of the rule would injure a third person(s); and

(4) If waiver of the rule would injure a third person(s).

(d) The board shall approve a waiver of an administrative rule request only if:

(1) Granting a waiver does not have the effect of waiving or modifying a provision of RSA 317-A;

(2) The petitioner shows or has shown good cause exists to waive the rule; and

(3) The board determines that the individual’s plans for compliance with the rule includes an estimated date of compliance and eventual compliance.

(e) If the board, after receiving and reviewing a request for a waiver, requires further information or documentation to grant or deny the waiver, the board shall:

(1) Notify the applicant in writing within 30 days; and

(2) Specify the information or documentation the board requires.

(f) The board shall issue a written approval or denial of the waiver within 60 days of the date the request is received, unless additional information or documentation is required. If additional information and documentation is required, then the board shall issue a written approval or denial within 60 days of receiving the requested information or documentation.

Source. (See Revision Note #1 and Revision Note #2 at chapter heading for Den 200) #13919, eff 5-31-24

CHAPTER Den 300 LICENSING REQUIREMENTS

REVISION NOTE:

The Governor declared a State of Emergency in Executive Order 2020-04, which was effective 3-13-20. The declaration and subsequent Emergency Orders issued pursuant to Executive Order 2020-04 affected various rules and statutes governing licensing under Chapter Den 300, such as Exhibit N to Emergency Order #29, effective 7-29-20, which amended Den 101.06 defining “clinical”, Den 301.01(a)(8)b. in Den 301.01 titled “Application for Dental Hygienist Licensure”, and Den 301.02(a)(8)b. in Den 301.02 titled “Application for Dental Licensure.” These amendments remained in effect until December 31, 2020. Exhibit Z of Emergency Order #29, effective April 14, 2021, subsequently amended these rules again. The State of Emergency terminated at midnight on 6-11-21, and rules or statutes amended during the State of Emergency were restored. To determine what rules in Den 300 were applicable during the State of Emergency, the user should check not only the source notes of the rules but also the Emergency Orders in effect at the time in question.

Document #13232, effective 7-15-21, amended Den 301.01(a)(8)b. in Den 301.01 titled “Application for Dental Hygienist Licensure” as an emergency rule. Pursuant to RSA 541-A:18, V, the emergency rule expired 1-11-22, and Den 303.01(a)(8)b. was effective again in its original form in Document #12428, effective 12-6-17.

Document #13233, effective 7-15-21, amended Den 301.02(a)(8)b. in Den 301.02 titled “Application for Dental Licensure” as an emergency rule. Pursuant to RSA 541-A:18, V, the emergency rule expired 1-11-22, and Den 301.02 was effective again in its original form in Document #12428, effective 12-6-17.

Document #13251, effective 8-11-21, amended Den 304.05(f) in Den 304.05 titled “General Anesthesia, Deep Sedation and Moderate Sedation, and Moderate Sedation Only Permit Application Procedures and Evaluations” as an emergency rule. Pursuant to RSA 541-A:18, V, the emergency rule expired 2-7-22, and Den 304.05 was effective again in its original form in Document #12428, eff 12-6-17.

Document #13367, effective 4-19-22, readopted with amendment Den 301.01, Den 301.02, Den 301.06 titled “License Activation”, Den 301.08 titled “Board Fees”, and Den 301.12 titled “Reinstatement of Lapsed Licenses” as regular rules.

PART Den 301 APPLICATION PROCEDURE

Den 301.01 Application for Dental Hygienist Licensure.

(a) Each applicant for a license to practice dental hygiene in the state of New Hampshire shall complete and submit the “Universal Application for Initial Licensure” as required by Plc 304.01(a)(1).

(b) In addition to the information required by (a) above the applicant for licensure shall provide and submit the following information on the “Dental Hygienist Addendum to the Universal Application for Initial Licensure”:

(1) Any other names by which the applicant has ever been known; and

(2) Whether the applicant has taken and passed the following examinations of the:

a. Joint Commission on National Dental Examinations; and

b. American Board of Dental Examiners (ADEX) dental hygiene examination or other equivalent U.S. regional or state board which includes clinical procedure components or manikin examination.

(1) One of the following:

a. An original or certified copy of the applicant's birth certificate written in English or translated to English;

b. A certified copy of the applicant’s valid passport written in English or translated to English; or

c. A driver’s license or other state issued identification;

(2) At least 3 “Statement of Professional Character” forms completed by at least one licensed dentist in good standing and at least one licensed dental hygienist in good standing if the applicant has previous dental employment. The dentist or dental hygienist shall sign and complete the “Statement of Professional Character” form within 4 months of the date of submission of the initial application which shall include:

a. Placing that applicant’s name within the following statement:

“I am personally acquainted with ________________________________ and attest that to the best of my knowledge they are of good professional character and recommend them for licensure in the State of New Hampshire.”

b. Signature of the individual attesting to the statement in a. above;

c. Address of the individual attesting to the statement in a. above;

d. Printed name of the individual attesting to the statement in a. above;

e. Occupation, license number, state of licensure, and the length of time the individual attesting to the statement in a. above has known the applicant; and

f. The applicant’s name and complete address in the “Return this completed form to:” section;

(3) Signed certification of graduation or, if not more than 3 months prior to the date the degree will be conferred, a certification of completion by the dean or registrar of the school of dental hygiene granting the applicant a degree;

(4) Proof of current basic life support for healthcare providers (BLS-HCP), if applicable;

(5) A criminal offender record check provided in accordance with Plc 304.01(b);

(6) An official copy of the applicant's school of dental hygiene transcript bearing the registrar's original signature and the school's seal;

(7) The applicant's original grade card denoting successful completion of the examination of the Joint Commission on National Dental Examinations and the American Board of Dental Examiners (ADEX) or other equivalent examination described in (b)(2)b., above;

(8) A certified statement from the dental examining board of each state in which the applicant has been licensed as to whether the applicant's license to practice in that state, based on the records of the board;

a. Has been subject to disciplinary action;

b. Has disciplinary action pending;

c. Has been under stayed probation; or

d. Is under investigation; and

(9) The fee required pursuant to Plc 1002.11.

(d) Applicants shall have successfully passed their regional boards and provide verification directly to OPLC from the CDCA or equivalent regional or state board showing that they have taken and passed the examination, including a clinical procedure component, within the 3 years immediately prior to submitting the application.

(e) Applicants for endorsement certification shall have taken and passed the ADEX dental hygiene examination, or other similar U.S. regional or state board for dental hygienists examination, including a clinical procedure component or manikin examination, with a passing score on each part of the examination and have documentation of successful completion sent directly to OPLC’s office.

(f) An applicant shall be a graduate of a dental hygiene program which:

(1) Is of at least 2 academic years in duration;

(2) Is accredited by a national accrediting agency recognized by the United States Department of Education and the CODA; and

(3) Awards the minimum degree of Associates in Science with a major in dental hygiene.

(g) When the required materials have been approved by the OPLC, the applicant shall take a jurisprudence exam on the contents of RSA 317-A Dental Practice Act, administrative rules Den 100 through Den 500, the American Dental Association’s Principles of Ethics and Code of Professional Conduct, and the American Dental Hygienists’ Association Code of Ethics for Dental Hygienists.

(h) The passing score on the jurisprudence exam shall be 75% or higher.

(i) After passage of the jurisprudence exam in (g) above, an active New Hampshire dental hygiene license shall be issued.

Source. Editorial Addition; ss by #2981, eff 2-28-85; ss by #5110, eff 4-4-91; ss by #5755, eff 12-14-93; amd by #6186, eff 2-17-96; ss by #6909, eff 12-9-98; amd by #7557, eff 9-20-01; amd by #7661, eff 3-13-02; amd by #7778, eff 10-10-02; amd by #7929, eff 8-6-03; amd by #7970, eff 10-10-03; amd by #8260, eff 1-19-05; amd by #8584, eff 3-16-06; amd by #8694, eff 7-27-06; ss by #8838, eff 3-9-07; amd by #8963, eff 8-16-07; amd by #9256, eff 9-10-08; amd by #9408-B, eff 3-10-09; amd by #10068, eff 1-10-12; amd by #10328-B, eff 5-7-13; ss by #10689, eff 10-7-14; ss by #10824, eff 5-6-15; ss by #10991, eff 12-9-15; ss by #12428, eff 12-6-17; amd by #13232, EMERGENCY RULE, eff 7-15-21, EXPIRED: 1-11-22; ss by #13367, eff 4-19-22 (see Revision Note at chapter heading for Den 300); ss by #14187, eff 4-4-25

Den 301.02 Application for Dental License.

(a) Each applicant for a license to practice dentistry in the state of New Hampshire shall complete and submit the “Universal Application for Initial Licensure” required by Plc 304.01(a)(1).

(b) In addition to the information required by (a) above the applicant for dental license shall provide and submit the following information on the “Dentist Addendum to the Universal Application for Initial Licensure”:

(1) Any other names by which the applicant has been known;

(2) Whether the applicant has taken and passed the examinations of the:

a. Joint Commission on National Dental Examinations; and

b. ADEX examination, or other equivalent U.S. regional or state board clinical examination for dentists, including a clinical periodontal scaling component or the manikin examination; and

(3) Has ever had a Drug Enforcement Administration (DEA) license revoked, suspended, denied, placed on probation, restricted, or otherwise sanctioned by a state or federal licensing regulatory board or agency, or which is currently involved in an investigation or disciplinary process.

(1) At least 3 “Statement of Professional Character” forms, as described in Den 301.01(c)(2), completed by at least 2 licensed dentists in good standing if the applicant has previous dental employment. The dentist shall sign and complete the “Statement of Professional Character” form within 4 months of the date of submission of the application;

(2) Signed certification of graduation or, if not more than 3 months prior to the date the degree will be conferred, a certification of completion by the dean or registrar of the dental college granting the applicant a degree;

(3) One of the following:

a. An original or certified copy of the applicant's birth certificate written in English or translated to English;

b. A certified copy of the applicant’s valid passport written in English or translated to English; or

c. A driver’s license or other state issued identification;

(4) Proof of current basic life support for healthcare providers (BLS-HCP), if applicable;

(5) A criminal offender record check provided in accordance with Plc 304.01(b);

(6) An official copy of the applicant's dental school transcript and, if applicable, a copy of a specialty training certificate bearing the registrar's original signature and the school's seal or a letter on school letterhead sent directly to OPLC. An unofficial transcript and a diploma stamped with the dental school seal may be provided until the official transcript is ready;

(8) A certified statement from the dental examining board of each state in which the applicant has been licensed as to whether the applicant's license to practice in that state based on the records of the board, as follows:

a. Has been subject to disciplinary action;

b. Has disciplinary action pending;

c. Has been under stayed probation; or

d. Is under investigation; and

(9) The fee required pursuant to Plc 1002.11.

(d) Applicants shall have successfully passed their regional boards and provide verification directly to OPLC from the CDCA or other equivalent U.S. regional or state board that the applicant has taken and passed the board clinical examination or manikin examination for dentists, including a clinical periodontal scaling component, within the 3 years immediately prior to submitting the application.

(e) Endorsement certification shall be considered for each applicant in accordance with Plc 313.22.

(f) The education requirements specified in RSA 317-A:8 shall apply to all applicants for licensure under this section.

(g) An applicant shall be a graduate of a dental school general dentistry program which:

(1) Is of at least 2 academic years in duration;

(2) Is accredited by the Commission on Dental Accreditation (CODA); and

(3) Awards the degree of Doctor of Dental Medicine (DMD) or Doctor of Dental Surgery (DDS).

(h) When the required materials have been approved by the OPLC, the applicant shall take a jurisprudence exam on the contents of RSA 317-A Dental Practice Act, administrative rules Den 100 through Den 500, the American Dental Association’s Principles of Ethics and Code of Professional Conduct, and the American Dental Hygienists’ Association Code of Ethics for Dental Hygienists.

(i) The passing score on the jurisprudence exam shall be 75% or higher.

(j) After passage of the jurisprudence exam in (h) above, the OPLC shall issue an active New Hampshire dental license.

(k) When an applicant possesses a DEA number to prescribe schedules II-IV controlled substances pursuant to RSA 318-B:41, I(a), the applicant for licensure shall register with the New Hampshire Controlled Drug Prescription Health and Safety Program (PDMP), pursuant to RSA 126-A:91. If the applicant possesses a DEA number, the applicant shall provide it to the OPLC. Failure to register within 90 days of the initial issuance of a license shall constitute professional misconduct within the meaning of RSA 317-A:17, II and shall be grounds for disciplinary action. A licensee shall not engage in the prescribing or dispensing of controlled substances in schedules II-IV without having registered with the New Hampshire PDMP.

Source. #287.2, eff 1-17-74; ss by #2981, eff 2-28-85; amd by #4257, eff 4-15-87; ss by #5110, eff 4-4-91; rpld by #5755, eff 12-14-93

New. #5755, eff 12-14-93 (from Den 301.04); amd by #6186, eff 2-17-96; amd by #6541, eff 7-18-97; ss by #6909, eff 12-9-98; amd by #7270, eff 5-12-00; amd by #7557, eff 9-20-01; amd by #7661, eff 3-13-02; amd by #7778, eff 10-10-02; amd by #7929, eff 8-6-03; amd by #7970, eff 10-10-03; amd by #8260, eff 1-19-05; amd by #8584, eff 3-16-06; amd by #8694, eff 7-27-06; ss by #8838, eff 3-9-07; amd by #8963, eff 8-16-07; amd by #9256, eff 9-10-08; amd by #9408-B, eff 3-10-09; amd by #10068, eff 1-10-12; amd by #10328-B, eff 5-7-13; ss by #10689, eff 10-7-14; ss by #10824, eff 5-6-15; ss by #10991, eff 12-9-15; ss by #12428, eff 12-6-17; amd by #13233, EMERGENCY RULE, eff 7-15-21, EXPIRED: 1-11-22; ss by #13367, eff 4-19-22 (see Revision Note at chapter heading for Den 300); ss by #14187, eff 4-4-25

Den 301.03 Application for Temporary Licensure.

(a) A temporary dental or dental hygiene license shall be granted on an individual request basis for a professional education program using dental clinical procedures.

(b) A temporary license shall be granted on an individual request basis for research projects having a clinical dental component.

(c) Applicants shall meet the minimum requirements for licensure by examination or licensure by endorsement certification process in New Hampshire.

(d) If the applicant does not meet the minimum requirements, the board shall require the applicant to obtain a license through the process utilizing the CDCA or other regional board clinical performance test or the endorsement certification application process.

(e) A temporary license shall be valid for one year or the length of an educational program or research project, whichever occurs first.

Source. Editorial Addition; ss by #2981, eff 2-28-85; ss by #5110, eff 4-4-91; rpld by #5755, eff 12-14-93

New. #5755, eff 12-14-93 (from Den 301.06); amd by #6186, eff 2-17-96; ss by #6909, eff 12-9-98; amd by #8260, eff 1-19-05; ss by #8838, eff 3-9-07; amd by #8963, eff 8-16-07; renumbered by #10068; ss by #10689, eff 10-7-14; ss by #10794, eff 3-7-15; ss by #10824, eff 5-6-15; ss by #10991, eff 12-9-15; renumbered by #14187 (formerly Den 301.05)

Den 301.04 License Activation. Pursuant to RSA 317-A:16, any dentist or dental hygienist holding an inactive license shall be restored to active status by the board upon:

(a) Filing a written request with the board;

(b) Furnishing evidence of continuing professional character and competence as follows:

(1) Having a letter of good standing sent directly to the New Hampshire dental board from any dental board where the applicant has practiced; and

(2) If the applicant has not been practicing for:

a. Three years or less, submitting evidence of current continuing education equivalent to 20 hours per year for dentists and 10 hours per year for dental hygienists;

b. More than 3 years but less than 5 years, submitting evidence of current continuing education and completion of a refresher course approved by the board; and

c. Five years or more, the applicant shall pass the entire American Board of Dental Examiners (ADEX) examination, including a periodontal scaling exam, within 6 months prior to license activation; and

(d) A completed criminal history records check and fingerprint card, seeking both a New Hampshire and a federal records check, in accordance with the procedure and payment requirements specified by the NH department of safety at Saf-C 5700, and if the federal criminal history records check shows the existence of a criminal record in another state, the applicant shall obtain a detailed criminal record check directly from that state and provide it to the board.

Source. #6909, eff 12-9-98; ss by #6975, eff 4-10-99; ss by #7270, eff 5-12-00; ss by #7929, eff 8-6-03; ss by #8260, eff 1-19-05; ss by #8838, eff 3-9-07; amd and renumbered by #10068, eff 1-10-12 (from Den 301.04); ss by #10689, eff 10-7-14; ss by #13367, eff 4-19-22 (see Revision Note at chapter heading for Den 300); renumbered by #14187 (formerly Den 301.06)

Den 301.05 Application for Temporary Licensure to Provide Voluntary Services.

(a) A license shall be granted on an individual request basis for the provision of voluntary dental or dental hygiene services.

(b) Pursuant to RSA 317-A:8 II, the applicant shall complete and submit an “Application for Registration and License Renewal – Volunteer” form, effective November 2017.

(1) Only for the provision of voluntary services without pay or compensation for work or service performed; and

(2) For specific programs and locations.

(d) A license to provide volunteer services shall be valid for not more than one year, and shall expire on May 1.

(e) Applicants for subsequent licenses to provide volunteer services shall comply with (b) above to the extent the information originally provided is no longer complete or accurate.

(f) There shall be no fees relative to licensure to provide voluntary services.

(g) There shall be no continuing education requirements, except that applicants shall maintain BLS-HCP certification and shall have taken 2 CEU’s in infection control each biennium.

(h) Retired dentists and retired dental hygienists seeking a license to provide voluntary services shall have had all their dental licenses or dental hygiene licenses in good standing at the time they retired.

Source. #7661, eff 3-13-02; ss by #8260, eff 1-19-05; ss by #8838, eff 3-9-07; amd by #9973, eff 8-9-11; renumbered by #10068 (from Den 301.05); EXPIRED 3-9-15 (paras. (a)-(c) & (e)-(h)); ss by #11053, eff 3-10-16; ss by #12428, eff 12-6-17; renumbered by #14187 (formerly Den 301.07)

Den 301.06 Change in Name or Address.

(a) All persons licensed to practice dentistry or dental hygiene in this state shall notify the board in writing within 30 days of a name change and provide the board a copy of the documentation that legally changed the name, if any.

(b) All persons licensed to practice dentistry or dental hygiene in this state shall notify the board in writing within 30 days of any change of business, residential, or email address.

(c) All persons licensed to practice dentistry or dental hygiene in this state who fail to notify the board in writing within 30 days of any change of business, residential, or email address shall be issued a letter of concern.

Source. #8260, eff 1-19-05 (from Saf-C 301.05); ss by #8838, eff 3-9-07; renumbered by #10068 (from Den 301.07); ss by #10794, eff 3-7-15; ss by #12428, eff 12-6-17; renumbered by #14187 (formerly Den 301.09)

Den 301.07 Military Service Active License. Active dental or dental hygiene licensure shall be granted to persons holding an inactive New Hampshire dental or dental hygiene license while on active military duty, upon request by the licensee.

Source. #8260, eff 1-19-05 (from Saf-C 301.06); ss by #8838, eff 3-9-07; renumbered by #10068 (from Den 301.08); ss by #10794, eff 3-7-15; renumbered by #14187 (formerly Den 301.10)

Den 301.08 Reinstatement of Lapsed Licenses.

(a) When a license has lapsed as a result of failure of the applicant to submit a completed renewal application, the applicant shall, no later than November 1 of the year the license lapsed, print or type on the reinstatement the following:

(1) For dental hygienist reinstatement, the ination required for initial dental hygienist licensure, pursuant to Den 301.01 (a)(1) - (7), (9) - (12), and (16), Den 301.01 (b), (c), (d), and documentation showing that the applicant has completed 20 CEUs for the biennium; and

(2) For dentist reinstatement, the ination required by initial dentist licensure, pursuant to Den 301.02 (a)(1) - (7), (9) - (11), (15), Den 301.02 (b), (c), (d), and documentation showing that the applicant has completed 40 CEUs for the biennium.

(b) The applicant shall submit a registration fee and reinstatement fee with the reinstatement application, as set forth in Den 301.08.

Source. #9408-B, eff 3-10-09; amd by #9973, eff 8-9-11; renumbered by #10068 (from Den 301.10); ss by #10991, eff 12-9-15; ss by #10689, eff 10-7-14; ss by #12428, eff 12-6-17; ss by #13367, eff 4-19-22 (see Revision Note at chapter heading for Den 300); renumbered by #14187 (formerly Den 301.12)

Den 301.09 Restricted License.

(a) A restricted license shall limit a dentist or dental hygienist to performing those procedures specified by the board.

(b) Restricted licenses shall be issued:

(1) To dentists and dental hygienists who are limited to performing some, but not all, procedures to acceptable professional standards thereby protecting the public; and

(2) To dentists and dental hygienists who are in need of remedial training in specific areas to reach professional standards that protect the public welfare.

Source. #9408-B, eff 3-10-09; renumbered by #10068 (from Den 301.11); ss by #10991, eff 12-9-15; ); renumbered by #14187 (formerly Den 301.13)

PART Den 302 QUALIFICATIONS AND SUPERVISION

Den 302.01 Purpose. The purpose of this section is to establish the qualification requirements for dentists, dental hygienists and dental assistants pursuant to RSA 317-A:12, XII-b.

Source. #287.2, eff 1-17-74; ss by #2981, eff 2-28-85; ss by #5110, eff 4-4-91; ss by #6186, eff 2-17-96; ss by #6909, eff 12-9-98, EXPIRED: 12-9-06

New. #8838, eff 3-9-07; ss by #10794, eff 3-7-15

Den 302.02 Supervision.

(a) “Direct supervision” means a dentist with an active license is in the dental office, authorizes the procedure, and remains in the dental office while the procedures are being performed, and evaluates the performance of the dental hygienist or dental assistant before dismissal of the patient.

(b) “Indirect supervision” means a dentist with an active license is in the dental office, authorizes the procedures, and remains in the dental office while the procedures are being performed by the dental hygienist or dental assistant, and evaluates the performance of the dental hygienist or dental assistant at a subsequent appointment.

(c) “General supervision” means a dentist with an active license has authorized the procedures, and the procedures are being carried out in accordance with the dentist’s diagnosis and treatment plan, and the procedures will be personally evaluated and reviewed by the dentist with the patient at least once in a 12 month period.

(d) “Public health supervision” means a dentist with an active license authorizes procedures which are to be carried out by:

(1) A dental hygienist with an active license practicing in a school, hospital or other institution, or for a homebound person without the dentist having to be present, provided the dentist has reviewed the records once in a 12 month period; or

(2) A dental assistant in a school, hospital or other institution, or for a homebound person who shall be supervised by a CPHDH as set forth in Den 401.01 (d).

(e) For purposes of (c) above, at the time the procedures performed under general supervision are evaluated, dentists shall use their professional judgment to determine whether a more extensive oral examination is appropriate.

Source. #287.2, eff 1-17-74; ss by #2981, eff 2-28-85; ss by #5110, eff 4-4-91; ss by #6186, eff 2-17-96; ss by #6909, eff 12-9-98; amd by #7929, eff 8-6-03; amd by #8260, eff 1-19-05; amd by #8584, eff 3-16-06; amd by #8694, eff 7-27-06; ss by #8838, eff 3-9-07; amd by #10068, eff 1-10-12; amd by #10328-B, eff 5-7-13; EXPIRED: 3-9-15 (paras. (a)-(c) & (e)); ss by #10991, eff 12-9-15

Den 302.03 Dental Hygienist Qualifications. In addition to the qualifications included in RSA 317-A:21, an applicant for examination and registration as a dental hygienist in the state of New Hampshire shall have taken and passed the American Board of Dental Examiners (ADEX) dental hygiene examination, or other similar U.S. regional or state board examination for dental hygienists, including clinical procedure components. The applicant shall complete the examination within the 3 year period prior to the completion of the licensing process in New Hampshire, unless the applicant seeks licensure by endorsement certification as provided in Den 301.01 (h) pursuant to RSA 317-A:12 III, in which circumstance the 3 year period shall not apply.

Source. #287.2, eff 1-17-74; ss by #2981, eff 2-28-85; ss by #4298, eff 7-28-87; ss by #5110, eff 4-4-91; amd by #5699, eff 9-14-93; amd by #6186, eff 2-17-96; ss by #6909, eff 12-9-98; ss by #7270, eff 5-12-00; ss by #8838, eff 3-9-07; ss by #9408-B, eff 3-10-09; ss by #10437, eff 10-8-13); ss by #10991, eff 12-9-15

Den 302.04 Dentist Qualifications.

(a) In addition to the qualifications included in RSA 317-A:8, an applicant for dental licensure by examination in the state of New Hampshire shall have taken and passed the American Board of Dental Examiners (ADEX) examination, or other similar U.S. regional or state board clinical examination for dentist, including a clinical periodontal/scaling component. The examination shall be completed within the 3 year period prior to the completion of the licensing process in New Hampshire, unless the applicant seeks licensure by endorsement certification as provided in Den 301.02 (h), pursuant to RSA 317-A:12 III, in which circumstance the 3 year period shall not apply.

(b) Dentists announcing specialization and limitation of practice shall adhere to section 5-H of the American Dental Association Principles of Ethics and Code of Professional Conduct, as amended 2016, and referenced in Appendix II, except as provided in (c) below.

(c) Dentists may announce diplomate status granted by a bona fide national organization which is not recognized as a certifying board by the American Dental Association but grants diplomate status based upon the dentist’s postgraduate education, experience and written and oral examinations based upon psychometric principles. The announcement, if made by a general dentist, shall indicate that he or she is a general dentist.

(d) Dentists who wish to perform botulinum toxin or dermafiller procedures shall submit documentation to the board that demonstrates completion of at least 8 hours of hands-on training prior to performing such procedures.

Source. #6909, eff 12-9-98; amd by #7270, eff 5-12-00; amd by #7778, eff 10-10-02; amd by #8584, eff 3-16-06; ss by #8838, eff 3-9-07; amd by #9973, eff 8-9-11; amd by #10068, eff 1-10-12; ss by #10437, eff 10-8-13; ss by #10991, eff 12-9-15; ss by #12428, eff 12-6-17; amd by #12549, eff 6-15-18

Den 302.05 Dental Hygienist Qualification in Specific Area.

(a) Any dental hygienist shall be considered qualified in a specific area if he or she has successfully completed an expanded duty course, or successfully challenged an examination in same, or both, as stated in Den 302.05 (a) through (q). Course records, pursuant to Den 403.06, and a certificate of course completion shall be retained by the course participant and provided to the board upon request by the board.

(b) Any dental hygienist may petition the board for approval of an expanded duty course or equivalent training course. The petition shall include all information that the petitioner wishes the board to consider in evaluating the proposed course, such as the entity giving the course, an outline of the topics to be covered, the number of hours of lectures and hours of practical experience and the textbooks to be used.

(c) No dental hygienist shall be considered qualified prior to the date that he or she is officially informed by the course or examination provider that he or she has successfully completed an expanded duty course approved by the board.

(d) Any dental hygienist shall be considered qualified in provisional crown and bridge restorations after successfully completing an expanded duty course in provisional crown and bridge restorations which:

(1) Is offered by a continuing education provider as defined in Den 403.07(a)(1);

(2) Is a minimum of 8 hours;

(3) Includes at least the following:

a. Provisional restoration anatomy;

b. Occlusal requirements; and

c. Cementation; and

(4) Provides to the dental hygienist written evidence certifying that the course has been successfully completed and which is signed by the course provider.

(e) If qualification in provisional crown and bridge restorations is determined, the duty shall be performed with the following conditions:

(1) A dental hygienist qualified in provisional crown and bridge restorations shall perform this service only under the direct supervision of a licensed dentist;

(2) The provisional restoration may be fabricated intraorally, however all occlusal adjustments and modifications shall be completed extraorally; and

(3) The completed provisional restoration shall be examined by the dentist prior to cementation by a qualified dental hygienist.

(f) Any dental hygienist shall be considered qualified in orthodontic duties after successfully completing an expanded duty course in orthodontic duties which:

(1) Is offered by a continuing education provider as defined in Den 403.07(a)(1);

(2) Is a minimum of 8 hours;

(3) Includes at least the following:

a. Placement and removal of orthodontic separators;

b. Preparation of teeth for bonding of brackets;

c. Removal of orthodontic bands or brackets;

d. Trial fitting of orthodontic bands;

e. Using hand instruments to remove excess cement from bands on the coronal surfaces of the teeth;

f. Trial fitting of head gear;

g. Simple emergency adjustment of orthodontic appliances to relieve pain;

h. Taking impressions for orthodontic appliances;

i. Attachment or tying in and removal of orthodontic wires; and

j. Bending arch wires; and

(4) Provides to the dental hygienist written evidence certifying that the course has been successfully completed and which is signed by the course provider.

(g) If qualification in orthodontics is determined, the duty shall be performed with the following conditions:

(1) A dental hygienist qualified in orthodontic duties shall perform this service only under the direct supervision of a licensed dentist.

(h) The duty of placing dental sealants shall be performed under the general supervision or public health supervision of a licensed dentist.

(i) Any dental hygienist shall be considered qualified in local anesthesia only after successfully completing an expanded duty course in local anesthesia which:

(1) Is offered by an institution accredited by CODA;

(2) Is a minimum of 20 didactic hours and 12 clinical hours;

(3) Entails passing the local anesthesia examination given by the CDCA;

(4) Includes at least the following topics:

a. Neurophysiology of pain and pain control;

b. Pharmacology of local anesthetic solutions and drug interactions;

c. Potential local and systemic complications;

d. Medical and dental indications and contraindications;

e. Medical and dental history assessment;

f. Safely assembling and handling a syringe;

g. Locating anatomical landmarks associated with local anesthesia;

h. Injection techniques;

i. Hands-on experience with maxillary and mandibular injections by administering at least 6 infiltration and 6 block injections; and

j. Legal issues associated with local anesthesia administration by a dental hygienist; and

(5) Provides to the dental hygienist written evidence certifying that the course has been successfully completed and which is signed by the course provider.

(j) If qualification in local anesthesia is determined, the duty shall be performed with the following conditions:

(1) A dental hygienist qualified in local anesthesia shall:

a. Administer local anesthesia only under the direct supervision of a dentist; and

b. Display at his or her place of practice proof of anesthesia qualification approved by the board;

(2) Any hygienist graduating from a CODA accredited school of dental hygiene shall comply with (i) above if a local anesthesia course meeting the foregoing requirements was not part of the school curriculum;

(3) A dental hygienist who has qualified to administer local anesthesia in another jurisdiction may qualify for endorsement by the board to perform that function by presenting written documentation of training equivalent to (i) above and a letter from a supervising dentist attesting to the hygienist's experience administering local anesthesia within the previous 2 years; and

(4) Students enrolled in a CODA accredited school of dental hygiene, who have passed a local anesthesia course as part of the school curriculum, shall not be in violation of this rule if they administer local anesthesia as part of a dental hygiene examination.

(k) To obtain a local anesthesia permit, a dental hygienist qualified to administer local anesthesia shall provide to the board:

(1) A written request and a certified check or money order made payable to the "Treasurer, State of New Hampshire" for the local anesthesia fee specified in Den 301.08, or if presented in person, the payment may be in cash;

(2) Proof of course completion. Applicants whose course was taken out of state shall also provide a copy of the course syllabus; and

(3) His or her CDCA score.

(l) Any dental hygienist shall be considered qualified to monitor the administration of nitrous oxide (N₂O) to patients after successfully completing an expanded duty course in monitoring the administration of nitrous oxide which:

(1) Is offered by a course provider as defined in Den 403.07(a)(1);

(2) Is a minimum of 6 hours;

(3) Includes at least the following:

a. Aspects of pain and anxiety;

b. Anatomy and physiology of respiration;

c. Stages of drug induced central nervous system depression;

d. Pharmacology and physiological effects of nitrous oxide;

e. Advantages and disadvantages of inhalation sedation using nitrous oxide;

f. Medical assessment of patient prior to using nitrous oxide; and

g. Proper administration of nitrous oxide to include:

1. Description and use of inhalation equipment;

2. Patient monitoring;

3. Possible reactions of patients under nitrous oxide;

4. Hazards of nitrous oxide for patients and operator; and

5. Management of complications;

(4) Requires the passing of a written test administered by the course provider; and

(5) Provides to the dental hygienist written evidence certifying that the course has been successfully completed and which is signed by the course provider.

(m) If qualification in monitoring the administration of nitrous oxide (N₂O) is determined, the duty shall be performed with the following conditions:

(1) A dental hygienist qualified in the monitoring of nitrous oxide shall monitor nitrous oxide only under the direct supervision of a dentist;

(2) A dental hygienist qualified to monitor the administration of nitrous oxide shall monitor only after a dentist has initiated the administration and brought the patient to the intended level of nitrous oxide inhalation sedation;

(3) A dental hygienist qualified to monitor the administration of nitrous oxide shall be currently certified in BLS-HCP; and

(4) A dental hygienist who has qualified to monitor nitrous oxide in another jurisdiction may qualify for endorsement by the board to perform that function by presenting written documentation of training equivalent to (l) above and a letter from a supervising dentist attesting to the hygienist's experience monitoring nitrous oxide within the previous 2 years.

(n) Any dental hygienist shall be considered qualified to administer nitrous oxide (N₂O) for minimal sedation of patients after successfully completing an expanded duty course in the monitoring and administration of nitrous oxide which:

(1) Is offered by an institution accredited by CODA;

(2) Is a minimum of 8 didactic hours and 6 clinical hours;

(3) Includes at least the following:

a. Physiological and psychological aspects of pain and anxiety;

b. Stages of drug induced central nervous system depression;

c. Anatomy and physiology as they relate to inhalation sedation;

d. Indications and contraindications of inhalation sedation;

e. Pharmacology and physiological effects of nitrous oxide, including drug interactions;

f. Medical assessment of patient prior to using nitrous oxide;

g. Description and use of inhalation sedation equipment;

h. Monitoring of patient’s vital functions;

i. Preventing, recognizing and managing possible complications of inhalation sedation;

j. Health hazards and techniques to limit occupational exposure;

k. Abuse potential of nitrous oxide; and

l. Maintenance of proper records;

(4) Requires the passing of a written test administered by the course provider;

(5) Requires successfully completing a clinical evaluation by the course provider; and

(6) Provides to the dental hygienist written evidence certifying that the course has been successfully completed and which is signed by the course provider.

(o) If qualification in the administration of nitrous oxide (N₂O) is determined, the duty shall be performed with the following conditions:

(1) A dental hygienist qualified in the administration of nitrous oxide shall:

a. Administer nitrous oxide only under the direct supervision of a dentist; and

b. Display at his or her place of practice proof of a nitrous oxide qualification course approved by the board;

(2) Any hygienist graduating from CODA accredited school of dental hygiene shall comply with (l) above if a nitrous oxide course meeting the foregoing requirements was not part of the school curriculum;

(3) A dental hygienist who has qualified to administer nitrous oxide in another jurisdiction may qualify for endorsement by the board to perform that function by presenting written documentation of training equivalent to (l) above and a letter from a supervising dentist attesting to the hygienist's experience administering nitrous oxide within the previous 2 years; and

(4) Students enrolled in a CODA accredited school of dental hygiene, who have passed a nitrous oxide course as part of the school curriculum, shall not be in violation of this rule if they administer nitrous oxide as part of a dental hygiene examination.

(p) Those individuals who qualify in the administration of nitrous oxide on or after January 1, 2018 shall be issued a permit upon submission of the following:

(1) Proof of course completion and, if the course was taken out of state, a copy of the course syllabus;

(2) A written request; and

(3) A check or money order made payable to the "Treasurer, State of New Hampshire" for the application fee specified in Den 301.08, or if presented in person, the payment may be in cash.

(q) In-office tooth whitening shall be performed under general supervision.

Source. #6909, eff 12-9-98; amd by #7270, eff 5-12-00; amd by #7778, eff 10-10-02; amd by #7818, eff 1-9-03; amd by #7929, eff 8-6-03; amd by #7970, eff 10-10-03; amd by #8100, eff 6-11-04; amd by #8260, eff 1-19-05; amd by #8584, eff 3-16-06; amd by #8694, eff 7-27-06; ss by #8838, eff 3-9-07; amd by #8963, eff 8-16-07; amd by #9256, eff 9-10-08; ss by 9408-B, eff 3-10-09; amd by #9778, eff 9-3-10; amd by #9973, eff 8-9-11; amd by #10328-B, eff 5-7-13; amd by #10437, eff 10-8-13; ss by #10689, eff 10-7-14; ss by #10991, eff 12-9-15; ss by #12428, eff 12-6-17

Den 302.06 Dental Assistant Qualification in Specific Area.

(a) Any dental assistant who is 18 years of age or older shall be considered qualified in a specific area if he or she has successfully completed an expanded duty course, or successfully challenged an examination in same, or both, as stated in Den 302.06 (a) through (ac). A course or exam given by an entity other than the board itself shall include the passing grade or other standard for successful completion of said course or exam set by the entity giving said course or exam. Course records, pursuant to Den 403.06, and a certificate of course completion shall be retained by the course participant and provided to the board upon request by the board. Traditional dental assistants, before qualifying in any other area addressed in Den 302.06, shall have taken and passed an introduction to dental assisting course and qualify for infection control in the dental office as stated in Den 302.06(b)(1)c.

(b) Traditional dental assistants shall qualify in infection control in the dental office after successfully completing a course in the topic, as follows:

(1) The expanded duty course shall:

a. Be offered by a course provider as defined in Den 403.07(a)(1);

b. Be a minimum of 4 hours;

c. Pursuant to RSA 317-A:17, II (g), follow the current Centers for Disease Control “Infection Control Recommendations for the Dental Office and the Dental Laboratory”; and

d. Require the passing of a written exam administered by the continuing education provider; and

(2) Written evidence certifying that the infection control course has been successfully completed shall be signed by the course provider and given to the dental assistant.

(c) Any dental assistant may petition the board for approval of an expanded duty course or equivalent training course. The petition shall include all information that the petitioner wishes the board to consider in evaluating the proposed course, such as the entity giving the course, an outline of the topics to be covered, the number of hours of lectures and hours of practical experience and the textbooks to be used. The board shall, within 60 days of receipt of such petition, send written notice of approval or a written request for further information from the petitioner.

(d) No dental assistant shall be considered qualified prior to the date that he or she is officially informed by the course or examination provider that he or she has successfully completed an expanded duty course approved by the board.

(e) A traditional dental assistant shall have 200 hours of experience in clinical dental assisting in order to qualify to take a course in introduction to dental assisting, which course shall be a prerequisite to any other expanded duty course described in this section.

(f) Any introduction to dental assisting course shall:

(1) Be offered by a course provider as defined in Den 403.07(a)(1);

(2) Be a minimum of 6 hours;

(3) Contain at least the following subjects:

a. The taking of medical and dental histories;

b. Obtaining and reading vital signs;

c. Oral and dental anatomy;

d. Charting existing restorations and teeth;

e. Inspection of the oral cavity; and

f. The Health Insurance Portability and Accountability Act of 1996 (HIPAA);

(4) Require the passing of a written examination administered by the continuing education provider; and

(5) Provide to the dental assistant written evidence certifying that the course has been successfully completed, which is signed by the course provider.

(g) Any dental assistant who successfully completes the introduction to dental assisting course shall be qualified to perform those duties set forth in Den 401.01 and Den 401.02.

(h) Any traditional dental assistant shall have 200 hours of experience in clinical dental assisting in order to qualify to take a radiology course.

(i) Any dental assistant shall be considered qualified in dental radiology after successfully completing an expanded duty course in dental radiology which:

(1) Is offered by a continuing education provider as specified in Den 403.07(a)(1);

(2) Is a minimum of 8 lecture hours, which may be taken online, and 8 laboratory hours;

(3) Includes at least the following:

a. Asepsis, radiation safety;

b. Parallel and bi-secting techniques;

c. Full mouth projections, panoramic projections, projections, and extra-oral projections;

d. Dark room procedures;

e. Radiographic landmarks, interpretation, and mounting;

f. Passing the radiology written examination of the Dental Assisting National Board, provided that dental assistants who have been practicing since before December 9, 1998 shall be exempt from taking and passing the DANB exam; and

g. Passing of a written exam administered by the continuing education provider; and

(4) Provides to the dental assistant written evidence certifying that the course has been successfully completed and which is signed by the course provider.

(j) The duty of dental radiology shall be performed only under the direct supervision of a licensed dentist.

(k) Any traditional dental assistant shall have 200 hours of experience in clinical dental assisting in order to qualify to take a course in provision crown and bridge restorations.

(l) Any dental assistant shall be considered qualified in provisional crown and bridge restorations after successfully completing an expanded duty course in provisional crown and bridge restorations which:

(1) Is offered by a continuing education provider as defined in Den 403.07(a)(1);

(2) Is a minimum of 8 hours;

(3) Includes at least the following:

a. Provisional restoration anatomy;

b. Occlusal requirements;

c. Cementation; and

d. Passing of a written exam administered by the continuing education provider; and

(4) Provides to the dental assistant written evidence certifying that the course has been successfully completed and which is signed by the course provider.

(m) The duty of provisional crown and bridge restorations shall be performed with the following conditions:

(1) A dental assistant qualified in provisional crown and bridge restorations shall perform this service only under the direct supervision of a licensed dentist;

(2) The provisional restoration may be fabricated intraorally, however all occlusal adjustments and modifications shall be completed extraorally; and

(3) The completed provisional restoration shall be examined by the dentist prior to cementation by a qualified dental assistant.

(n) Any traditional dental assistant shall have at least 200 hours of experience in clinical dental assisting in order to qualify to take a course in orthodontics.

(o) Any traditional dental assistant shall be considered qualified in orthodontic duties after successfully completing an expanded duty course in orthodontic duties which:

(1) Is offered by a continuing education provider as defined in Den 403.07(a)(1);

(2) Is a minimum of 8 hours;

(3) Includes at least the following:

a. Placement and removal of orthodontic separators;

b. Preparation of teeth for bonding of brackets;

c. Removal of orthodontic bands or brackets;

d. Trial fitting of orthodontic bands;

e. Using hand instruments to remove excess cement from bands on the coronal surfaces of the teeth;

f. Trial fitting of head gear;

g. Simple emergency adjustment of orthodontic appliances to relieve pain;

h. Taking impressions for orthodontic appliances;

i. Attachment or tying in and removal of orthodontic wires;

j. Bending arch wires; and

k. Passing of a written exam administered by the continuing education provider; and

(4) Provides to the dental assistant written evidence certifying that the course has been successfully completed and which is signed by the course provider.

(p) The duty of orthodontics shall only be performed under the direct supervision of a licensed dentist.

(q) Any traditional dental assistant shall have at 400 hours of experience in clinical dental assisting in order to qualify to take a sealants course.

(r) Any traditional dental assistant shall be considered qualified in dental sealants after successfully completing an expanded duty course in dental sealants which:

(1) Is offered by a continuing education provider as specified in Den 403.07(a)(1);

(2) Is a minimum of 8 hours;

(3) Includes at least the following:

a. Use of chemical and light cured sealants;

b. Proper techniques of applying sealants;

c. Isolation techniques;

d. Practice in applying sealants in a laboratory setting;

e. Application of sealants on an actual patient in a clinical setting; and

f. Passing an exam administered by the continuing education provider; and

(4) Provides to the dental assistant written evidence certifying that the course has been successfully completed and which is signed by the course provider.

(s) The duty of dental sealants shall only be performed under the direct supervision of a licensed dentist.

(t) Traditional dental assistants shall have experience consisting of at least 400 hours in clinical dental assisting in order to qualify to take a course in coronal polishing.

(u) Any dental assistant other than a graduate dental assistant shall be considered qualified in coronal polishing after meeting the eligibility requirements and successfully completing an expanded duty course in coronal polishing which:

(1) Is offered by a continuing education provider as set forth in Den 403.07 (a);

(2) Is a minimum of 8 hours; and

(3) Includes at least the following subjects:

a. Handpiece maintenance and sterilization;

b. Polishing agents;

c. Polishing techniques;

d. Infection control;

e. Medical and dental history indications and contraindications;

f. Hands-on polishing in a clinical setting; and

g. Passing of a written examination administered by the continuing education provider; and

(4) Provides to the dental assistant written evidence certifying that the course has been successfully completed and which is signed by the course provider.

(v) The duty of coronal polishing shall be performed with the following conditions:

(1) Coronal polishing by dental assistants shall be accomplished by a combination of slow speed handpiece, not to exceed 10,000 rpm, and appropriate polishing agents with a rubber cup or bristle brush;

(2) Coronal polishing shall be accomplished by dental assistants only after a dentist or dental hygienist has determined that the teeth are free of calculus;

(3) A dental assistant qualified in coronal polishing shall perform this service only under the direct supervision of a licensed dentist or dental hygienist; and

(4) Coronal polishing shall in no way be represented as a prophylaxis unless a dentist or dental hygienist has determined the teeth are free of calculus immediately prior to the polishing.

(w) Any traditional dental assistant shall have 400 hours of experience in clinical dental assisting prior to taking an expanded duty course in monitoring the administration of nitrous oxide anesthesia.

(x) Any traditional dental assistant shall be considered qualified to monitor the administration of nitrous oxide (N₂O) to patients after successfully completing an expanded duty course in monitoring the administration of nitrous oxide which:

(1) Is offered by a course provider as defined in Den 403.07(a)(1);

(2) Is a minimum of 6 hours;

(3) Includes at least the following:

a. Aspects of pain and anxiety;

b. Anatomy and physiology of respiration;

c. Stages of drug induced central nervous system depression;

d. Pharmacology and physiological effects of nitrous oxide;

e. Advantages and disadvantages of inhalation sedation using nitrous oxide;

f. Medical assessment of patient prior to using nitrous oxide; and

g. Proper administration of nitrous oxide to include:

1. Description and use of inhalation equipment;

2. Patient monitoring;

3. Possible reactions of patients under nitrous oxide;

4. Hazards of nitrous oxide for patients and operator; and

5. Management of complications;

(4) Requires the passing of a written examination administered by the continuing education provider; and

(5) Provides to the dental assistant written evidence certifying that the course has been successfully completed and which is signed by the course provider.

(y) If qualification in monitoring the administration of nitrous oxide is determined, the duty shall be performed with the following conditions:

(1) A dental assistant qualified in the monitoring of nitrous oxide shall monitor nitrous oxide only under the direct supervision of a dentist;

(2) A dental assistant qualified to monitor the administration of nitrous oxide shall monitor only after a dentist has initiated the administration and brought the patient to the intended level of nitrous oxide inhalation sedation; and

(3) A dental assistant qualified to monitor the administration of nitrous oxide shall be currently certified in BHLS-HCP; and

(4) A dental assistant who has qualified to monitor nitrous oxide in another jurisdiction shall qualify for endorsement by the board to perform that function by presenting written documentation of training equivalent to (x) above and a letter from a supervising dentist attesting to the assistant's experience monitoring nitrous oxide within the previous 2 years.

(z) Any traditional dental assistant shall have at least 400 hours in clinical dental assisting in order to qualify to take a course in office whitening.

(aa) A dental assistant shall be qualified to perform in-office tooth whitening after successfully completing an expanded duty course in in-office tooth whitening which:

(1) Is offered by a course provider as defined in Den 403.07(a)(1);

(2) Is a minimum of 4 hours;

(3) Includes at least the following;

a. An overview of prescription and non-prescription whitening systems;

b. Mechanisms of action;

c. Treatment methods;

d. Safety considerations, including:

1. Contraindications; and

2. Side effects; and

e. Passing of a written examination administered by the continuing education provider; and

(4) Provides to the dental assistant written evidence certifying that the course has been successfully completed and which is signed by the course provider.

(ab) The duty of in-office tooth whitening shall only be performed under the direct supervision of a licensed dentist.

Source. #12428, eff 12-6-17; ss by #13445, eff 9-14-22

Den 302.07 Expanded Function Dental Auxiliary (EFDA).

(a) Any dental hygienist, or certified or graduate dental assistant as defined in Den 401.02, shall be considered qualified to place, contour and adjust direct restorative materials within the oral cavity after successfully completing an expanded function dental auxiliary (EFDA) course in dental restorations, as follows:

(1) The direct dental restorations course shall have the following prerequisites:

a. Course candidates shall be a registered dental hygienist, or a dental assistant who is certified by the Dental Assistant National Board or is a graduate of a CODA accredited school of dental assisting;

b. All candidates shall have a minimum of 4,500 hours of dental clinical experience;

c. All candidates shall be recommended for the course by a dentist with an active NH dental license;

d. Dental assistants, other than graduate dental assistants, shall be qualified to perform a preliminary inspection of the oral cavity, pursuant to Den 302.05 (d); and

e. All candidates shall be currently certified in BLS-HCP; and

(2) The EFDA course in direct dental restorations shall:

a. Be offered by an institution accredited by CODA;

b. Be a minimum of 50 didactic hours and 100 hours of pre-clinical training in a curriculum approved by the board;

c. Include at least the following subjects:

1. Dental materials;

2. Use of the low speed hand piece and high speed hand piece;

3. Placement and finishing of amalgams, and composite resins;

4. Dental occlusion; and

5. Dental jurisprudence;

d. Include assessment certifying successful course completion and provide written evidence signed by the course provider and given to the hygienist or dental assistant; and

e. Be followed by 6 weeks, minimum of 120 hours, of training in a dental office under the direct supervision and monitoring by the faculty of a school accredited by CODA or its designate.

(b) The following shall apply to all EFDA's:

(1) The EFDA shall register with the board and submit proof of the required EFDA training and experience, as well as a fee to obtain an EFDA permit from the board;

(2) The EFDA shall renew the EFDA permit in odd numbered years before May 1^st, if EFDA employment is continued;

(3) The EFDA shall prominently display the permit where the EFDA works;

(4) A maximum of 2 EFDA’s shall be employed in a dental practice regardless of the number of dentists;

(5) Dentists shall inform the board of EFDA’s employed within 10 days of employment;

(6) EFDA’s shall complete 10 CEU’s each biennium in restorative dentistry;

(7) A dental auxiliary who has qualified in the placement, contouring and adjustment of direct dental restorations in another jurisdiction may qualify for endorsement by the board to perform that function by presenting written documentation of training equivalent to (a) above and a letter from a supervising dentist attesting to the auxiliary’s experience with direct restorations within the previous 2 years; and

(8) EFDA’s shall practice under the direct supervision of a New Hampshire licensed dentist.

Source. #10991, eff 12-9-15; ss by #12428, eff 12-6-17 (formerly Den 302.06)

Den 302.08 Certified Public Health Dental Hygienist (CPHDH).

(a) Any dental hygienist shall be considered qualified as a CPHDH after:

(1) Obtaining a bachelor’s degree in dental hygiene with a minimum of 6 semester hours in community dental health;

(2) Obtaining a master’s degree in public health; or

(3) Successfully completing the following courses which are offered by a continuing education provider as defined in Den 403.07(a)(1) and by successful completion of an examination by the course provider:

a. Caries stabilization in the public health setting which:

1. Is a minimum of 6 hours; and

2. Includes at least the following:

(i) Indications for interim therapeutic restorations (ITRs);

(ii) Appropriate technique for placing ITRs;

(iii) Variables that influence the success of ITRs;

(iv) Selection of intermediary materials for specific restoration; and

(v) Characteristics and handling of intermediary materials and follow-up coding;

b. Evidence based dentistry which:

1. Is a minimum of 4 hours; and

2. Includes at least the following:

(i) Evidence based approach to dental treatment;

(ii) Applying evidence based theory to public health practice; and

(iii) Hands-on computer experience relevant to practice;

c. Infection control in public health settings which:

1. Is a minimum of 4 hours; and

2. Includes at least the following:

(i) Lecture and hands on experience;

(ii) Review of latest infection control procedures in dentistry; and

(iii) Proper asepsis techniques while working in non-traditional settings;

d. Medical management in public health dental settings which:

1. Is a minimum of 6 hours; and

2. Includes at least the following:

(i) Both lecture and hands-on learning;

(ii) Systemic conditions and diseases with emphasis on dental hygiene treatment planning;

(iii) Management of dental and medical emergencies in alternative dental settings; and

(iv) Pharmacology review of current therapy for the most common disease states with an emphasis on high-risk patients; and

e. Management of medical records which:

1. Is a minimum of 4 hours; and

2. Includes at least the following:

(i) Legal requirements for medical records;

(ii) Family Educational Rights and Privacy Act (FERPA);

(iii) Guidance in drafting a Privacy Impact Assessment (PIA); and

(iv) New Hampshire law for reporting patient abuse.

(b) The following shall apply to qualification as a CPHDH:

(1) All CPHDHs shall have:

a. Practiced as a dental hygienist for 3200 hours, 1600 hours of which shall be within the 2 years prior to certification;

b. Completed a course in caries stabilization that is a minimum of 6 hours as outlined in (a)(3)a; and

c. Qualified in dental sealants pursuant to Den 302.05(h), if similar training was not received as part of the dental hygiene school curriculum;

(2) Hygienists qualifying as a CPHDH by completing the courses specified in (a)(3) above shall complete the courses within the 4 years prior to certification, or if they are already working in a public health setting, within 4 years of this rule becoming effective;

(3) Documented proof of the completion of all requirements shall be retained by both the collaborating dentist and hygienist, and submitted to the board for certification;

(4) Hygienists who have qualified as a CPHDH, prior to practicing as such, shall have a written collaborative agreement with a dentist with an active New Hampshire dental license to practice under the dentist’s supervision;

(5) Hygienists who have qualified as a CPHDH, prior to practicing as such, shall register with the board and submit proof of the required training and experience, as well as a fee to obtain certification from the board;

(6) CPHDHs shall comply with duties listed in RSA 317-A:21-e;

(7) CPHDHs shall display at his or her place of practice proof of certification approved by the board;

(8) Hygienists who have been granted certification as a CPHDH shall renew certification in odd-numbered years before May 1^st;

(9) CPHDHs who fail to renew their certification before May 1^st of odd-numbered years, pursuant to RSA 317-A:13, shall be subject to a late fee pursuant to Den 301.08; and

(10) CPHDHs who fail to renew their certification before May 1^st of odd-numbered years, pursuant to RSA 317-A:13, shall be subject to a reinstatement fee for lapsed certification pursuant to Den 301.08.

(c) Each applicant for certification to practice as a CPHDH in the state of New Hampshire shall provide the following on the "Application for CPHDH Certification" form:

(1) Applicant's name;

(2) Applicant's date of birth;

(3) Applicant's place of birth;

(4) Applicant's social security number, pursuant to RSA 161-B:11, VI-a;

(5) Any other name by which the applicant has been known;

(6) Applicant's current business and residential addresses, telephone numbers, and primary email address, either business or personal;

(7) Name of supervising dentist;

(8) Whether the applicant's BLS-HCP certification is current, and if so, provide proof;

(9) Applicant's level of education including:

a. Original transcripts of master's degree in public health, and certificates of completion showing compliance with course requirements set forth in Den 302.08 (a);

b. Original transcripts of bachelor's degree in dental hygiene, with a minimum of 6 hours in community dental health, and certificates of completion showing compliance with course requirements set forth in Den 302.08 (a); or

c. Registered dental hygienist, without either a master's degree in public health or bachelor's degree in dental hygiene, shall submit certificates of completion for those courses required by Den 302.08 (a) and (b);

(10) Applicant's educational background, including proof that the applicant has:

a. Practiced as a dental hygienist for 3200 hours, 1600 hours of which shall be within the 2 years prior to certification;

b. Completed a course in caries stabilization that is a minimum of 6 hours as outlined in Den 302.08(a)(3)(a);

c. Qualified in dental sealants pursuant to Den 302.05(h), if similar training was not received as part of the dental hygiene school curriculum; and

d. Completed an approved course in infection control in public health settings as outlined in Den 302.08(a)(3)c.; and

(11) An unmounted passport-type photograph of the applicant shall be:

a. Attached to the form;

b. Taken not more than 6 months before the date on the application; and

c. No smaller than 2 and 1/2 inches square.

(d) The form shall be signed by the applicant, notarized, and filed with the board. Deceptive or false statements, knowingly made by the applicant, shall result in denial of a CPHDH certificate. By signing the form, the applicant shall waive any confidentiality regarding disclosure to the board from any other jurisdiction about any pending complaints or action being taken against the applicant's license to practice as a CPHDH.

(e) The form shall be accompanied by the following documents:

(1) A check or money order made payable to the "Treasurer, State of New Hampshire" for the application fee specified in Den 301.08, or if presented in person, the payment may be in cash; and

(2) A letter confirming whether the applicant has a written collaborative agreement with a dentist with an active New Hampshire dental license to practice under the dentist's supervision.

Source. #10991, eff 12-9-15; ss by #12428, eff 12-6-17 (formerly Den 302.07)

PART Den 303 EXAMINATION

Den 303.01 Dental Examination. Each applicant for a license to practice dentistry in the state of New Hampshire shall be examined by the board on the contents of RSA 317-A and its accompanying rules.

Source. #287.2, eff 1-17-74; ss by #2981, eff 2-28-85; ss by #5110, eff 4-4-91, EXPIRED: 4-4-97

New. #6909, eff 12-9-98, EXPIRED: 12-9-06

New. #8838, eff 3-9-07; ss by #10794, eff 3-7-15

Den 303.02 Dental Hygienist Examination. Each applicant for a license to practice as a dental hygienist in the state of New Hampshire shall be examined by the board on the contents of RSA 317-A and its accompanying rules.

Source. #287.2, eff 1-17-74; ss by #2981, eff 2-28-85; ss by #5110, eff 4-4-91, EXPIRED: 4-4-97

New. #6909, eff 12-9-98, EXPIRED: 12-9-06

New. #8838, eff 3-9-07; ss by #10794, eff 3-7-15

Den 303.03 Jurisprudence Exam.

(a) Each applicant for initial licensure to practice as a dentist or registered dental hygienist shall be examined by the board of dental examiners on the contents of RSA 317-A Dental Practice Act, administrative rules Den 100 through 500, the American Dental Association’s Principles of Ethics and Code of Professional Conduct, and the American Dental Hygienists’ Association Code of Ethics for Dental Hygienists.

(b) The examination shall be:

(1) Taken at home electronically on a secure website provided to the applicant by the OPLC or, if requested by the applicant, using pen and paper; and

(2) Open book.

Source. #4037, eff 4-9-86; amd by #4105, eff 8-1-86; ss by #5110, eff 4-4-91, EXPIRED: 4-4-97

New. #6909, eff 12-9-98, EXPIRED: 12-9-06

New. #8838, eff 3-9-07; ss by #9408-B, eff 3-10-09; ss by #10689, eff 10-7-14; ss by #14187, eff 4-4-25

PART Den 304 USE OF GENERAL ANESTHESIA AND SEDATION BY DENTISTS

Den 304.01 Definitions.

(a) “Deep sedation" means a drug-induced depression of consciousness during which patients cannot be easily aroused but respond purposefully following repeated or painful stimulation. The ability to independently maintain ventilatory function might be impaired. Patients might require assistance in maintaining a patient airway, and spontaneous ventilation might be inadequate. Cardiovascular function is usually maintained.

(b) “Facility hosting permit” means a permit for a dental facility at which a qualified provider, other than the dentist holding the permit, administers general anesthesia, deep sedation, or moderate sedation, and the qualified provider brings additional anesthesia equipment, drugs, and supplies to the site beyond what is specified in Den 304.07(a).

(c) “Facility inspection” means an evaluation of a dental facility for either a facility permit or a facility hosting permit including inspection of equipment, drugs, and paperwork being supplied by the facility hosting an anesthesia qualified provider or for a qualified dentist delivering general anesthesia, deep sedation, and moderate sedation or for a qualified dentist delivering moderate sedation only.

(d) “Facility permit” means a permit for a dental facility at which the permit holder is a qualified dentist who administers general anesthesia, deep sedation, and moderate sedation, moderate sedation only, or moderate sedation with pediatric qualification at the same facility and maintains additional anesthesia equipment, drugs, and supplies on site as specified in Den 304.07.

(e) "General anesthesia" means a drug-induced loss of consciousness during which patients are not arousable, even by painful stimulation. The ability to independently maintain ventilatory function is often impaired. Patients often require assistance in maintaining a patent airway, and positive pressure ventilation might be required because of depressed spontaneous ventilation or drug-induced depression of neuromuscular function. Cardiovascular function might be impaired.

(f) “General anesthesia, deep sedation, and moderate sedation permit” means a permit issued by the office of professional licensure and certification (OPLC) authorizing a qualified dentist to administer general anesthesia, deep sedation, and moderate sedation at a permitted dental facility to patients of all ages.

(g) “Hosting dentist” means a dentist whose name is on a particular facility permit or facility hosting permit and therefore holds that permit and is responsible for that facility.

(h) “Minimal sedation”, formerly known as “anxiolysis”, means a minimally depressed level of consciousness, produced by a pharmacological method, that retains the patient’s ability to independently and continuously maintain an airway and respond normally to tactile stimulation and verbal command. Although cognitive function and coordination might be impaired, ventilatory and cardiovascular functions are unaffected. Patients whose only response is reflex withdrawal from repeated painful stimuli are not considered to be in a state of minimal sedation.

(i) "Moderate sedation”, formerly known as “conscious sedation”, means a drug-induced depression of consciousness during which patients respond purposefully to verbal commands, either alone or accompanied by light tactile stimulation. No interventions are required to maintain a patent airway, and spontaneous ventilation is adequate. Cardiovascular function is usually maintained.

(j) “Moderate sedation only permit” means a permit issued by the OPLC authorizing a qualified dentist to administer moderate sedation only at a permitted dental facility and only to patients 13 years of age and older.

(k) “Moderate sedation permit with pediatric qualification” means a permit issued by the OPLC authorizing a qualified dentist to administer moderate sedation only at a permitted dental facility to patients of all ages.

(l) “Operating dentist” means the dentist with the primary responsibility of performing a dental procedure while a separate qualified provider administers general anesthesia, deep sedation, or moderate sedation on the patient.

(m) “Pediatric minimal sedation permit” means a permit issued by the OPLC authorizing a dentist to administer minimal sedation only at a dental facility in the state of NH to patients under 13 years of age.

(n) “Qualified consultant” means a qualified provider contracted by the OPLC to serve as an advisory examiner to the board for determining compliance with the statutory and regulatory provisions of this chapter.

(o) “Qualified dentist” means a dentist with a permit to administer general anesthesia, deep sedation, and moderate sedation, moderate sedation only, or moderate sedation with pediatric qualification in the state of New Hampshire (NH).

(p) “Qualified provider” means a qualified dentist, a physician anesthesiologist licensed under RSA 329, or a nurse anesthetist licensed under RSA 326-B:18 delivering general anesthesia, deep sedation, or moderate sedation in dental facilities in the state of NH.

(q) “Simulated emergency management evaluation” means an evaluation of the applicant for a permit to administer deep sedation, general anesthesia, and moderate sedation, moderate sedation only, or moderate sedation with pediatric qualification on emergency management based on the protocols for emergencies outlined in Appendix 3 of the American Association of Oral and Maxillofacial Surgeons (AAOMS) “Office Anesthesia Evaluation Manual”, 9th Edition, revised 2018, available as noted in Appendix II.

(r) “Single dose” means an initial dose, a repeated dose, or a maintenance dose as recommended by the manufacturer guidelines as found in the Food and Drug Administration (FDA) “Online Label Repository” located at labels.fda.gov.

Source. #4298, eff 7-28-87; ss by #5110, eff 4-4-91, EXPIRED: 4-4-97

New. #6909, eff 12-9-98; ss by #7304, eff 6-9-00; amd by #8694, eff 7-27-06; ss by #8838, eff 3-9-07; ss by #9256, eff 9-10-08; ss by #10991, eff 12-9-15; ss by #14246, eff 8-3-25, EXPIRES: 8-3-35

Den 304.02 Requirements for Permits Issued Under This Chapter.

(a) Any dentist licensed to practice dentistry in NH pursuant to RSA 317-A who seeks to hold a general anesthesia, deep sedation, and moderate sedation permit, a moderate sedation only permit, or a moderate sedation permit with pediatric qualification shall first pass a simulated emergency management evaluation conducted by a qualified consultant at a dental facility in the state of NH before a permit is issued.

(b) Any dentist licensed to practice dentistry in NH pursuant to RSA 317-A and holding a general anesthesia, deep sedation, and moderate sedation permit, a moderate sedation only permit, or a moderate sedation permit with pediatric qualification shall only be authorized to administer general anesthesia, deep sedation, and moderate sedation or moderate sedation only as authorized by their permit type at a dental facility that has been issued a corresponding facility or facility hosting permit by the OPLC.

(c) Each facility seeking to obtain a facility or facility hosting permit shall first pass a facility inspection conducted by a qualified consultant before a permit is issued.

(d) Each dentist who holds a general anesthesia, deep sedation, and moderate sedation permit, a moderate sedation only permit, or a moderate sedation permit with pediatric qualification shall undergo a simulated emergency management evaluation every 3^rd biennial dental license renewal.

(e) Each facility holding a facility or facility hosting permit shall undergo a facility inspection every 3^rd biennial certification renewal.

Source. #14246, eff 8-3-25, EXPIRES: 8-3-35

Den 304.03 Permit Types.

(a) The OPLC shall issue the following permits to dentists or facilities who meet the qualifications for permitting as required in Den 304.04, complete and submit the appropriate permits’ applications as required in Den 304.05, and pay the applicable fees as required in Plc 1002.11:

(1) Facility permits authorizing the administration of one or all of the following levels of sedation, which shall be stated on the permit and include the facility site:

a. General anesthesia, deep sedation, and moderate sedation;

b. Moderate sedation only; or

c. Moderate sedation with pediatric qualification;

(2) Facility hosting permits authorizing the administration of one or all of the following, which shall be stated on the permit and include the hosting facility site:

a. General anesthesia, deep sedation, and moderate sedation;

b. Moderate sedation only; or

c. Moderate sedation with pediatric qualification;

(3) General anesthesia, deep sedation, and moderate sedation permits which authorize a qualified dentist, licensed by the state of NH, to administer general anesthesia, deep sedation, and moderate sedation, to patients of all ages in a dental facility that has the required facility permit or facility hosting permit;

(4) Moderate sedation only permits which authorize a qualified dentist, licensed by the state of NH, to administer moderate sedation only to patients 13 years of age and older in a dental facility that has the required facility permit or facility hosting permit;

(5) Moderate sedation permits with pediatric qualification which authorize a qualified dentist, with additional training in pediatric sedation, licensed by the state of NH, to administer moderate sedation only to patients of all ages in a dental facility that has the required facility permit or facility hosting permit; and

(6) Pediatric minimal sedation permits which authorize a dentist, licensed by the state of NH, to administer minimal sedation to patients under 13 years of age in a dental facility.

(b) A facility described in (a)(1) or (2) above shall be permitted to host a qualified provider and shall not host a provider to administer anesthesia at a level higher than the permit the facility holds.

Source. #14246, eff 8-3-25, EXPIRES: 8-3-35

Den 304.04 Qualifications for Permitting. Applicants shall qualify for the type of permit being applied for as follows:

(a) For a facility permit the qualified dentist of the facility shall:

(1) Hold a NH license to practice pursuant to RSA 317-A;

(2) Hold a general anesthesia, deep sedation, and moderate sedation permit, a moderate sedation only permit, or a moderate sedation permit with pediatric qualification issued by the OPLC; and

(3) Have successfully completed an on-site facility inspection performed by a qualified consultant contracted by the OPLC;

(b) For a facility hosting permit the hosting dentist of the facility shall:

(1) Hold a NH license to practice pursuant to RSA 317-A; and

(2) Have successfully completed an on-site facility inspection performed by a qualified consultant contracted by the OPLC;

(1) Hold a NH license to practice dentistry pursuant to RSA 317-A;

(2) Have completed one of the following:

a. Advanced training in anesthesiology and related academic subjects beyond the undergraduate dental school level in a training program as described in Part III C. of the American Dental Association “Guidelines for the Use of Sedation and General Anesthesia by Dentists”, revised 2016, as specified in Appendix II; or

b. An advanced dental education program in either dental anesthesiology or oral and maxillofacial surgery as described in the Commission on Dental Accreditation (CODA) requirements for each advanced program;

(3) Hold a current Advanced Cardiovascular Life Support (ACLS) and Pediatric Advanced Life Support (PALS) certification; and

(4) Have successfully completed a simulated emergency management evaluation performed by a qualified consultant contracted by the OPLC;

(d) For a permit to administer moderate sedation only, the applicant shall:

(1) Hold a NH license to practice dentistry pursuant to RSA 317-A;

(2) Meet the requirements as described in Part III B. of the American Dental Association “Guidelines for the Use of Sedation and General Anesthesia by Dentists” revised 2016, as specified in Appendix II;

(3) Hold a current ACLS certification; and

(4) Have successfully completed a simulated emergency management evaluation performed by a qualified consultant contracted by the OPLC;

(e) For a permit to administer moderate sedation with pediatric qualification the applicant shall:

(1) Meet the requirements set forth in (d) above, except for (d)(3);

(2) Hold a current ACLS certification, PALS certification, or both consistent with the age demographic of the patients being treated; and

(3) Have completed the educational objectives as described in Part V of the American Dental Association “Guidelines for Teaching Pediatric Pain Control and Sedation to Dentists and Dental Students” approved 2021, as specified in Appendix II; or

(f) For a permit to administer pediatric minimal sedation, the applicant shall:

(1) Hold a NH license to practice dentistry pursuant to RSA 317-A;

(2) Meet the requirements as described in Part III A. of the American Dental Association “Guidelines for the Use of Sedation and General Anesthesia by Dentists”, revised 2016, as specified in Appendix II; and

(3) Have completed the educational objectives for inhalation and enteral minimal sedation training as described in Part IV of the American Dental Association “Guidelines for Teaching Pediatric Pain Control and Sedation to Dentists and Dental Students” approved 2021, including training in airway management and patient rescue from moderate sedation.

Source. #14246, eff 8-3-25, EXPIRES: 8-3-35

Den 304.05 Applications and Permit Procedures.

(a) Applications for permits described in Den 304.03 shall be processed in accordance with Plc 304.06 through Plc 304.10.

(b) Applicants shall submit documents and fees as described below for the type of permit being applied for:

(1) For a facility permit the applicant shall:

a. Complete and submit an application required by Den 304.05(c)(1);

b. Pay the applicable fees required by Plc 1002.11; and

c. Have successfully completed the on-site facility inspection performed by a qualified consultant, as defined in Den 304.01(m), and required by Den 304.04(a)(3);

(2) For a facility hosting permit, the applicant shall:

a. Complete and submit the application required by Den 304.05(c)(1);

b. Pay the applicable fees required by Plc 1002.11; and

c. Have successfully completed the on-site facility evaluation performed by a qualified consultant, as defined in Den 304.01(m), and required by Den 304.04(b)(2);

(3) For a general anesthesia, deep sedation, and moderate sedation permit, the applicant shall:

a. Complete and submit the application required by Den 304.05(c)(2);

b. Pay the applicable fees required by Plc 1002.11;

c. Submit one of the following:

1. Evidence of completion of an advanced training in anesthesiology and related academic subjects beyond the undergraduate dental school level in a training program as described in Part III C. of the American Dental Association “Guidelines for the Use of Sedation and General Anesthesia by Dentists”, revised 2016, as specified in Appendix II; or

2. Evidence of completion of an advanced dental education program in either dental anesthesiology or oral and maxillofacial surgery as described in the CODA requirements for each advanced program;

d. Submit proof of current ACLS and PALS certification; and

e. Have successfully completed the simulated emergency management evaluation performed by a qualified consultant, as defined in Den 304.01(m), and required by Den 304.04(c)(4);

(4) For a moderate sedation only permit, the applicant shall:

a. Complete and submit an application required by Den 304.05(c)(2);

b. Pay the applicable fees required by Plc 1002.11;

c. Submit evidence of meeting the requirements as described in Part III B. of the American Dental Association “Guidelines for the Use of Sedation and General Anesthesia by Dentists” revised 2016, as specified in Appendix II;

d. Submit proof of current ACLS certification; and

e. Have successfully completed the simulated emergency management evaluation performed by a qualified consultant, as defined in Den 304.01(m), and required by Den 304.04(d)(4);

(5) For a moderate sedation with pediatric qualification permit, the applicant shall:

a. Complete and submit an application required by Den 304.05(c)(2);

b. Pay the applicable fees as required by Plc 1002.11;

d. Submit proof of current ACLS certification, PALS certification, or both consistent with the age demographic of the patients being treated;

e. Have successfully completed the simulated emergency management evaluation performed by a qualified consultant, as defined in Den 304.01(m), and required by Den 304.04(e)(1); and

f. Submit to the OPLC a letter of verification, certificate of completion, or official transcript demonstrating successful completion of the educational objectives as described in Part V of the American Dental Association “Guidelines for Teaching Pediatric Pain Control and Sedation to Dentists and Dental Students” approved 2021, as specified in Appendix II; or

(6) For a pediatric minimal sedation permit, the applicant shall:

a. Complete and submit an application required by Den 304.05(c)(2);

b. Pay the applicable fees as required by Plc 1002.11;

c. Submit evidence of meeting the requirements as described in Part III A. of the American Dental Association “Guidelines for the Use of Sedation and General Anesthesia by Dentists”, revised 2016, as specified in Appendix II; and

d. Submit to the OPLC a letter of verification, certificate of completion, or official transcript demonstrating successful completion of the educational objectives for inhalation and enteral minimal sedation training as described in Part IV of the American Dental Association “Guidelines for Teaching Pediatric Pain Control and Sedation to Dentists and Dental Students” approved 2021, including training in airway management and patient rescue from moderate sedation.

(1) The “Application for Facility or Facility Hosting Permit” requiring the following information:

a. Check which of the following is being applied for:

1. Facility permit; or

2. Facility hosting permit;

b. Dental practice name;

c. Hosting dentist’s or qualified dentist’s full legal name;

d. List the name(s) of all qualified providers administering general anesthesia, deep sedation, or moderate sedation at the facility including their NH license type(s) and number(s);

e. Facility physical address;

f. Facility mailing address;

g. Facility primary e-mail address;

h. Facility phone number;

i. Answer yes or no to the question “Is either general anesthesia, deep sedation, or moderate sedation administered at this facility?”; and

j. Answer yes or no to the question “Is moderate sedation only administered at this facility?”;

(2) The “Application for Permit to Administer General Anesthesia, Deep Sedation, and Moderate Sedation, Moderate Sedation Only, Moderate Sedation with Pediatric Qualification, or Pediatric Minimal Sedation” requiring the following information:

a. Check the type of permit being applied for from the following list:

1. General anesthesia, deep sedation, and moderate sedation;

2. Moderate sedation;

3. Moderate sedation with pediatric qualification; or

4. Pediatric minimal sedation;

b. Name of applicant;

c. Applicant’s license type;

d. Applicant’s license number;

e. Applicant’s home mailing address;

f. Applicant’s primary e-mail address:

g. Applicant’s home or cell phone number;

h. The following information for each facility where the dentist intends to provide services;

1. Facility name;

2. Facility’s physical address;

3. Facility’s permit type, if applicable;

4. Facility’s permit number, if applicable; and

5. If facility application has been submitted to obtain a permit, the date of submission;

i. If applying for a general anesthesia, deep sedation, and moderate sedation permit complete the following:

1. Check one of the following:

(i) “I am applying for this permit based on completion of advanced training in anesthesiology and related academic subjects beyond the undergraduate dental school level in a training program as described in Part III C. of the American Dental Association “Guidelines for the Use of Sedation and General Anesthesia by Dentists”, revised 2016, as specified in Appendix II”; or

(ii) “I am applying for this permit based on completion of an advanced dental education program in either dental anesthesiology or oral and maxillofacial surgery as described in the CODA requirements for each advanced program”;

j. Answer yes or no to the following certificate(s) held by the applicant and if yes, provide the expiration date:

1. Basic life support for healthcare providers (BLS-HCP);

2. Advanced cardiovascular life support (ACLS); and

3. Pediatric advanced life support (PALS);

k. List each clinical staff member(s) involved in patient care and include the following for each:

1. Name and job title;

2. Whether the individual has completed BLS-HCP;

3. Date BLS-HCP initial certification received or date renewed and date of expiration;

4. Whether the individual has completed ACLS;

5. Date ACLS initial certification received or date renewed and date of expiration;

6. Whether the individual has completed PALS; and

7. Date PALS initial certification received or date renewed and date of expiration;

l. If applying for a moderate sedation only permit or a moderate sedation permit with pediatric qualification, complete the following:

1. Answer yes or no to the question “I am applying for this permit based on evidence of meeting the requirements as described in Part III B. of the American Dental Association “Guidelines for the Use of Sedation and General Anesthesia by Dentists” revised 2016, as specified in Appendix II”; and

2. Answer yes or no to the question “I have successfully completed the educational objectives as described in Part V of the American Dental Association “Guidelines for Teaching Pediatric Pain Control and Sedation to Dentists and Dental Students” approved 2021, as specified in Appendix II; and

m. If applying for a pediatric minimal sedation permit, complete the following:

1. Answer yes or no to the question “I am applying for this permit based on evidence of meeting the requirements as described in Part III A. of the American Dental Association “Guidelines for the Use of Sedation and General Anesthesia by Dentists”, revised 2016, as specified in Appendix II; and

2. Answer yes or no to the question “I have successfully completed the educational objectives for inhalation and enteral minimal sedation training as described in Part IV of the American Dental Association “Guidelines for Teaching Pediatric Pain Control and Sedation to Dentists and Dental Students” approved 2021, as specified in Appendix II, including training in airway management and patient rescue from moderate sedation”; and

(3) Each applicant shall sign and date the application described in (1) or (2) above below the following attestation:

“I am not under investigation by any professional licensing board and my credentials have not been suspended or revoked by any professional licensing board. The information and documentation provided are true, complete, and not misleading to the best of my knowledge and belief, I understand that providing false or misleading information constitutes grounds for denial, suspension, or revocation of a license, and that knowingly providing false material information constitutes a misdemeanor under RSA 641:3 relative to falsification in official matters.”

Source. #14246, eff 8-3-25, EXPIRES: 8-3-35

Den 304.06 Administration of General Anesthesia or Sedation Exclusively by a Separate Dedicated Qualified Provider. Dentists shall not be obligated to obtain a sedation or anesthesia permit pursuant to this part if general anesthesia, deep sedation, or moderate sedation is being administered exclusively by a separate dedicated qualified provider, so long as the hosting dentist obtains an anesthesia facility permit or facility hosting permit as described in Den 304.03.

Source. #12428, eff 12-6-17; ss by #14246, eff 8-3-25, EXPIRES: 8-3-35 (formerly Den 304.02)

Den 304.07 Facility or Facility Hosting Requirements.

(a) Each facility applying for a facility or a facility hosting permit shall have equipment and supplies on-site and proper staffing as follows:

(1) Oxygen delivery systems as follows:

a. Portable oxygen tank;

b. Bag valve mask such as ambu bag with connector tubing able to be connected to oxygen tank; and

c. Nasal cannula or oxygen mask with connector tubing able to be connected to oxygen tank;

(2) Suction equipment as follows:

a. Suction unit or vacuum system connected to all operatories and recovery rooms; and

b. Yankauer suction tip with connector tubing able to be connected to suction unit or vacuum system;

(3) Wheelchair;

(4) Vital signs monitoring equipment in all operatories where moderate sedation, deep sedation, or general anesthesia is administered and recovery rooms as follows:

a. Continuous pulse oximeter; and

b. Blood pressure monitor with cuffs of various sizes for adult patients, as well as for pediatric patients if patients under age 13 years are treated at the facility;

(5) Defibrillator equipment as follows:

a. Manual or automated external defibrillator (AED);

b. Unexpired batteries for defibrillator, if the defibrillator is battery powered;

c. Log maintained documenting monthly inspections for proper defibrillator functioning; and

d. Unexpired adult defibrillator pads that connect to the facility’s defibrillator equipment, as well as unexpired pediatric defibrillator pads that connect to the facility’s defibrillator equipment if patients under age 8 years are treated at the facility;

(6) Auxiliary light source capable of use during power failure, such as battery powered headlight, flashlight, or generator;

(7) Rigid CPR board; and

(8) Staffing for procedures under moderate sedation, deep sedation, or general anesthesia, in addition to the qualified provider, shall be as follows:

a. The operating dentist, if separate from the qualified provider, maintains a current PALS certification if patients under the age of 13 years are treated at the facility;

b. A dental assistant with current BLS certification on staff at the time of procedure;

c. Additional personnel available when needed for calling emergency 911; and

d. Staffing on site, as described in Den 304.08, appropriate for the procedure being performed.

(b) In addition to the requirements specified in Den 304.07(a), at the time that a qualified provider is administering moderate sedation, deep sedation, or general anesthesia, the facility shall have the following additional equipment and supplies on-site:

(1) Oxygen and gas delivery systems as follows:

a. Oxygen fail-safe valve on anesthesia machine or nitrous oxide flowmeter if administered; and

b. Size-dissimilar fittings, varied hose sizes, and colored tubing and hoses for oxygen, nitrous oxide, and medical air if used;

(2) Suction systems as follows:

a. Pulmonary suction catheter with connector tubing able to be connected to suction unit or vacuum system; and

b. Portable suction device able to be used during power failure;

(3) Airway devices as follows:

a. Endotracheal tubes (ETTs) of various sizes with stylets for adult patients, as well as for pediatric patients if patients under age 13 years are treated at the facility;

b. Syringe for ETT cuff inflation;

c. Ambu bag and connector tubing to enable ETT to be connected to oxygen tank and deliver positive pressure;

d. If deep sedation or general anesthesia is provided at the facility, video laryngoscope with blades of various sizes for adult patients, as well as for pediatric patients if patients under age 13 years are treated at the facility;

e. Extra batteries for laryngoscope;

f. Extra bulbs for laryngoscope, if applicable;

g. Magill forceps;

h. Tongue grasping forceps;

i. Oral airways of various sizes for adult patients, as well as for pediatric patients if patients under age 13 years are treated at facility;

j. Nasopharyngeal airways of various sizes for adult patients, as well as for pediatric patients if patients under age 13 years are treated at facility:

k. Supraglottic airways, such as Laryngeal Mask Airways or King Airways, of various sizes for adult patients, as well as for pediatric patients if patients under age 13 years are treated at facility; and

l. If deep sedation or general anesthesia is provided at the facility, emergency cricothyrotomy kit with connector tubing able to be connected to bag valve mask and oxygen tank;

(4) Vital signs monitoring equipment in all operatories where moderate sedation, deep sedation, or general anesthesia is administered also with:

a. Continuous electrocardiogram;

b. Capnography; and

c. Stethoscope; and

(5) Accessory supplies and emergency medications as follows:

a. Disposable angiocatheters, tourniquets, and tape for IV catheter placement;

b. IV tubing and IV fluids;

c. Disposable needles and syringes for medication draw up and delivery;

d. Epinephrine 1:10,000 for cardiac arrest;

e. Epinephrine 1:1,000 for allergic reaction;

f. Direct or indirect acting pressor for hypotension;

g. Antiarrhythmic for cardiac arrest;

h. Adenosine for tachycardia;

i. Naloxone for opioid reversal;

j. Flumazenil for benzodiazepine reversal;

k. Antihypertensive for acute hypertension;

l. Steroid injection for allergic reaction;

m. Dextrose injection for hypoglycemic reversal;

n. Atropine for bradycardia;

o. Diphenhydramine injection for allergic reaction;

p. Neuromuscular blocker with rapid onset for laryngospasm;

q. Albuterol inhaler for bronchospasm;

r. Benzodiazepine injection for seizure;

s. Immediate-release non-enteric coated aspirin for acute coronary syndrome; and

t. Sublingual nitroglycerin for acute coronary syndrome.

(c) In addition to the requirements specified in Den 304.07(b), at the time that a qualified provider is administering inhaled volatile anesthetics, or succinylcholine if administered on a routine basis, the facility shall have the following additional equipment and supplies on-site:

(1) Oxygen and gas delivery system also with anesthetic gas analyzer if inhaled volatile anesthetics are used;

(2) Dantrolene injection for malignant hyperthermia; and

(3) Sterile water for dantrolene diluent;

Source. #14246, eff 8-3-25, EXPIRES: 8-3-35

Den 304.08 Administering General Anesthesia, Deep Sedation, or Moderate Sedation.

(a) Qualified dentist or operating dentist shall ensure that administered general anesthesia, deep sedation, or moderate sedation follows the clinical guidelines set forth in Part IV B. or C., as appropriate, of the American Dental Association “Guidelines for the Use of Sedation and General Anesthesia by Dentists” revised 2016, as specified in Appendix II or in the American Academy of Pediatrics “Guidelines for Monitoring and Management of Pediatric Patients Before, During, and After Sedation for Diagnostic and Therapeutic Procedures” revised 2019, as specified in Appendix II, including for patient history, pre-operative evaluation, and preparation, specific to the age demographic of the patient being treated.

(b) For administration of general anesthesia, deep sedation, or moderate sedation, an intravenous catheter shall be in place prior to administration or the equipment necessary to establish either intravascular or intraosseous access shall be immediately available until the patient meets discharge status.

(c) For administration of moderate sedation, with or without inhalation sedation, agents shall be limited to a single dose, as defined in Den 304.01(r), of one or more drugs, or multiple doses of a single drug, using manufacturer guidelines as found in the FDA “Online Label Repository” found at labels.fda.gov.

(d) A dentist shall not delegate to a dental assistant or hygienist any task that is outside of their scopes of practice, as defined in Den 404, Den 405, and Den 501.01(b), such as placement of an intravenous catheter, drawing up medications, or administering medications. PALS certification shall not supersede the duty restrictions outlined in Den 404, Den 405, and Den 501.01(b).

(e) When treating patients under 13 years of age by administering general anesthesia or deep sedation, the qualified dentist or operating dentist shall:

(1) Obtain informed consent that includes the statement that the procedure may be alternatively performed in a hospital setting with additional anesthesia personnel; and

(2) Ensure that in addition to the dentist performing the procedure there shall be a separate dedicated anesthesia qualified provider present to monitor the procedure and recovery from anesthesia.

(f) Qualified dentists who are board eligible or board certified by either the American Dental Board of Anesthesiology (ADBA) or the American Board of Oral and Maxillofacial Surgery (ABOMS) may apply to the board for exemption from the requirement for a separate dedicated anesthesia provider when treating patients under 13 years of age with administration of general anesthesia or deep sedation pursuant to RSA 317-A:12, XII-a(h)(1), and shall:

(1) Have completed an advanced airway course with hands-on training within the previous 6 years;

(2) When the qualified dentist is administering general anesthesia or deep sedation without a separate dedicated anesthesia provider present:

a. Document a pre-operative physical examination of the patient’s airway consistent with the “2022 American Society of Anesthesiologists (ASA) Practice Guidelines for Management of the Difficult Airway”, as specified in Appendix II; and

b. Ensure that a designated staff member currently certified in PALS or who has completed 36 hours of didactic instruction taught by an organization listed under Den 406.06(a)(1) in the underlying physiology and interpretation of monitoring used for patients under deep sedation and general anesthesia and principles of office-based anesthesia and anesthesia equipment is present during the procedure with the sole responsibility to constantly observe the patient’s vital signs, airway patency, and adequacy of ventilation.

(3) Have completed the “Application for Exemption from the Requirement for a Separate Dedicated Anesthesia Provider When Treating Patients Under 13 Years of Age With General Anesthesia or Deep Sedation” by providing the following information:

a. Applicant’s full legal name;

b. Applicant’s NH dental license number;

c. Applicant’s primary facility’s name;

d. Primary facility’s physical address;

e. Primary facility’s phone number;

f. Applicant’s e-mail address;

g. Answer yes or no to “I have completed an advanced airway course with hands-on training, within the previous 6 years.”;

h. Answer yes or no to “Do you intend to treat patients under 13 years of age with administration of general anesthesia or deep sedation without a separate dedicated anesthesia provider?”;

i. Answer yes or no to “Do you intend to treat patients 8 years of age or under with the administration of general anesthesia or deep sedation without a separate dedicated anesthesia provider?”; and

j. Answer yes or no to “Are you board eligible or board certified by either the American Dental Board of Anesthesiology (ADBA) or the American Board of Oral and Maxillofacial Surgery (ABOMS)?”;

(4) Each applicant for exemption shall sign and date the application below the following attestation:

(5) When submitting the application described in (3) above, provide a copy of the document showing completion of an advanced airway course with hands-on training within the previous 6 years;

(6) When submitting the application described in (3) above and answering “yes” to the question “Do you intend to treat patients 8 years of age or under with the administration of general anesthesia or deep sedation without a separate dedicated anesthesia provider?” provide the following:

a. Evidence of successful completion of a CODA accredited dental anesthesiology residency program within the previous 2 years including documentation of supervision of your personal administration of deep sedation or general anesthesia to at least 20 patients who are 8 years of age or younger that occurred during the training;

b. Evidence of successful completion of a CODA accredited oral and maxillofacial surgery residency program within the previous 2 years with documentation of supervision of your personal administration of deep sedation or general anesthesia to at least 20 patients who are 8 years of age or younger that occurred during the training; or

c. For dentists who currently possess a permit for use of general anesthesia, deep sedation, and moderate sedation documentation that you personally administered deep sedation or general anesthesia to at least 20 patients 8 years of age or younger during the previous 2 years; and

(7) Applicants who lack the required 20 pediatric cases within the previous 2 years in a manner described in (6) shall, if they wish to seek the exemption:

a. Administer deep sedation or general anesthesia to patients 8 years of age or under, while not performing the surgical procedure, under the direct supervision of a dentist who holds a general anesthesia, deep sedation, and moderate sedation permit and has been granted the exemption described in Den 304.08(f); and

b. Complete the requirement documenting administration of deep sedation or general anesthesia under direct supervision to at least 20 patients under 8 years of age over the span of no more than 2 years.

(g) When administering general anesthesia or deep sedation to patients 8 years of age or younger, without a separate dedicated anesthesia provider present, the qualified dentist shall:

(1) Possess an exemption from the requirement for a separate dedicated anesthesia provider as required by Den 304.08(f) and have met the requirements in Den 304.08(f)(6)a., (6)b., (6)c., or (7); or

(2) If general anesthesia or deep sedation was administered on an emergency basis the dentist shall complete and submit to the OPLC an “Emergency Exemption From the Requirement for a Separate Dedicated Anesthesia Provider Form” within 15 working days following the treatment of the patient. The dentist shall provide the following information:

a. The dentist’s full legal name;

b. The dentist’s NH dental license number;

c. The name of the facility where general anesthesia or deep sedation was administered;

d. The facility’s physical address;

e. The facility’s phone number;

f. The dentist’s e-mail address;

g. A description of the dental procedure(s);

h. A description of the pre-operative physical condition of the patient;

i. A list of all personnel who assisted with the emergency dental procedure;

j. A description of drug(s) and dosage(s) administered;

k. A description of the techniques used in administering the drug(s);

l. A description of any adverse occurrence(s), including but not limited to:

1. Patient’s signs and symptoms;

2. Treatment instituted in response to adverse occurrence(s); and

3. Patient’s response to the treatment(s);

m. The patient’s condition on termination of any procedure(s) undertaken; and

n. The signature of the dentist and date the dentist signed the form.

(h) The report described in (g) above shall not identify the patient for whom the report is being submitted.

Source. #14246, eff 8-3-25, EXPIRES: 8-3-35

Den 304.09 Facility or Facility Hosting Documentation Requirements.

(a) Each facility holding a facility or facility hosting permit shall maintain the following documentation:

(1) Written anesthesia consent;

(2) Anesthesia record including the following:

a. Date of procedure;

b. Nothing by mouth (NPO) status;

c. Availability of responsible adult escort;

d. Vital signs pursuant to the incorporated requirements in Den 304.08(a), including time-oriented monitoring of oxygenation, ventilation, and circulation; and

e. Drugs and doses administered pursuant to the incorporated requirements in Den 304.08(a) listing administration times;

(3) Anesthetic emergency record including the following:

a. Date;

b. Diagnosis of critical event such as laryngospasm or cardiac arrest;

c. Medical history;

d. Time of onset;

e. Vital signs at time of onset and continuous monitoring;

f. Administered drugs;

g. Drug doses;

h. Route and time of administration;

i. When cardiopulmonary resuscitation (CPR) began and ended;

j. Time of transfer and by whom; and

k. Vital signs at transfer;

(4) Emergency patient transfer form that is site specific for each location;

(5) Scripted scenario for emergency 911 contact;

(6) Plan describing the role and responsibility for each team member in an emergency; and

(7) Post-anesthesia instructions.

(b) At a dental facility hosting a qualified provider in the manner described in Den 304.01(b), the facility shall, in addition to the requirements of Den 304.09(a) above, have:

(1) A dated and signed attestation described in Den 403.01(e) from the qualified provider;

(2) An updated attestation required by Den 403.01(c) and (d) above from the provider each biennium thereafter;

(3) Documentation that the attestations required by (1) and (2) above have been submitted to the OPLC; and

(4) If the relationship between the dental facility, hosting a qualified provider in the manner described in Den 304.01(b), and the qualified provider is terminated, documentation that the hosting facility has notified the OPLC of that termination in accordance with Den 403.01(g).

Source. #14246, eff 8-3-25, EXPIRES: 8-3-35

Den 304.10 Facility or Facility Hosting Inspections.

(a) Each facility holding a facility or facility hosting permit shall have completed a facility inspection by a qualified consultant before the administration of general anesthesia, deep sedation, or moderate sedation of any type. The initial inspection shall be conducted in accordance with Plc 404.

(b) Each facility holding a facility or facility hosting permit shall be inspected every 3^rd biennial license renewal, as outlined in RSA 310:6, II, after the initial inspection. The renewal inspection shall be conducted in accordance with Plc 405.

Source. #14246, eff 8-3-25, EXPIRES: 8-3-35

Den 304.11 Minimal Sedation.

(a) Dentists administering minimal sedation shall:

(1) Follow the clinical guidelines set forth in Part IV A. of the American Dental Association “Guidelines for the Use of Sedation and General Anesthesia by Dentists” revised 2016 or in the American Academy of Pediatrics “Guidelines for Monitoring and Management of Pediatric Patients Before, During and After Sedation for Diagnostic and Therapeutic Procedures” revised 2019, as specified in Appendix II including having a properly staffed and equipped facility and reversal agents available for any enteral drugs administered, specific to the age demographic of the patient being treated; and

(2) Hold a current pediatric minimal sedation permit when treating patients under 13 years of age.

(b) The following routes of administration shall apply to the use of minimal sedation:

(1) Inhalation using nitrous oxide;

(2) A single dose, as defined in Den 304.01(r), of one enteral drug establishing a margin of safety wide enough to render unintended loss of consciousness unlikely, using manufacturer guidelines as found in the FDA “Online Label Repository” found at labels.fda.gov; or

(3) If the patient is 13 years of age or older a combination inhalation-enteral, as above in (1) and (2).

(c) A minimum of one staff member trained in the monitoring and resuscitation of pediatric patient, in addition to the dentist administering minimal sedation, shall be present for administration of minimal sedation to patients under 13 years of age, pursuant to RSA 317-A:12, XII-c(f).

Source. #12428, eff 12-6-17; amd by #12549, eff 6-15-18; ss by #14246, eff 8-3-25, EXPIRES: 8-3-35 (formerly Den 304.06)

Den 304.12 Initial Inspections and Evaluations.

(a) Each dental facility holding either a facility permit or a facility hosting permit authorizing the administration of general anesthesia, deep sedation, or moderate sedation on their premises shall be inspected before the initial permit is issued.

(b) Each dentist applying for an initial permit to administer general anesthesia, deep sedation, or moderate sedation, moderate sedation only, or moderate sedation with pediatric qualification shall:

(1) Pass a simulated emergency management evaluation of their emergency procedures through scenario based drills with a qualified consultant contracted by the OPLC;

(2) Be evaluated upon completion of no less than 5 scenario based drills; and

(3) Pass a simulated emergency management evaluation assessing the following:

a. The dentist’s response to the scenario presented; and

b. The staff assignment(s) and role(s) during the simulated emergency management evaluation;

(c) The facility or hosting facility issued a permit to administer general anesthesia, deep sedation, or moderate sedation, moderate sedation only, or moderate sedation with pediatric qualification shall be inspected by a qualified consultant contracted by the OPLC to ensure all requirements described in Den 304.07 are available on site and to verify documentation has been completed consistent with the requirements described in Den 304.09.

Source. #14246, eff 8-3-25, EXPIRES: 8-3-35

Den 304.13 Morbidity and Mortality Reports.

(a) Any dentist licensed pursuant to this chapter shall report to the board the occurrence of any adverse health care events resulting in death, brain damage, or hospitalization, occurring in the dentist's office or facility while utilizing general anesthesia, deep sedation, moderate sedation, or minimal sedation.

(b) The morbidity and mortality report shall be submitted to the board through the OPLC as soon as is reasonably and practically possible, but no later than 15 working days after discovery of the event.

(1) Dental procedure(s);

(2) Pre-operative physical condition of the patient;

(3) Drug(s) and dosage(s) administered;

(4) Techniques used in administering the drug(s);

(5) Any adverse occurrence, including:

a. Patient’s signs and symptoms;

b. Treatment instituted in response to adverse occurrences; and

c. Patient’s response to the treatment; and

(6) Patient’s condition on termination of any procedures undertaken.

(d) The report described in (c) above shall not identify any of the dental professionals, facility employees, or patients involved.

(e) After receiving a report of an adverse health care event, the board shall conduct a root cause analysis of the event utilizing the OPLC enforcement division.

(f) The board shall issue to the dentist the root cause analysis report.

(g) Following the root cause analysis, the dentist shall provide a corrective action plan to implement the findings of the analysis to the board and if for any reason the facility did not take corrective action, the plan shall contain the reasons for not taking the corrective action within 60 days of the event.

(h) If the dentist conducted a root cause analysis at the time of the event and implemented a corrective action plan, then the dentist shall report the findings of the analysis and the corrective action taken with the report described in (c) above.

(i) All proceedings related to the root cause analysis and implementation of a corrective action plan shall be considered privileged and not subject to discovery or subpoena. All information and data made available to the board and the OPLC under this section shall be confidential and shall be held in accordance with RSA 91-A.

Source. #12428, eff 12-6-17; ss by #14246, eff 8-3-25, EXPIRES: 8-3-35 (formerly Den 304.07)

CHAPTER Den 400 DENTAL ASSISTANTS AND HYGIENISTS DUTIES

REVISION NOTE #1:

Document #13341, effective 2-8-22, amended paragraph (f) in Den 403.07 titled “Categories of Credit” as an emergency rule. Document #13366, effective 4-19-22, subsequently readopted with amendment Den 403.07 as a regular rule before the emergency rule would have expired on 8-7-22 pursuant to RSA 541-A:18, V.

REVISION NOTE #2:

Document #14398, effective 12-2-25, adopted, repealed, or readopted with amendment various rules in Chapter Den 400. The new rules adopted were Part Den 401 titled “Dentist and Dental Hygienist License Renewal”, Part Den 402 titled “Permit Renewal and Inspection”, and Part Den 403 titled “Hosting Facility Ongoing Requirements”. The existing rule Den 403.04 titled “Renewal and Monitoring” in Part Den 403 titled “Continuing Education” was repealed. The remaining existing rules in Part Den 401, Part Den 402, and Part Den 403 were readopted with amendment and renumbered as rules in Part Den 404, Den 405, and Den 406 as indicated in the source notes. These actions necessitated the renumbering of the existing Part Den 404 as Part Den 407, which was otherwise not included in Document #14398.

The prior filings affecting the repealed rule Den 403.04 included the following documents:

#5332, eff 4-1-92 (from Den 304.02); paragraph (b) EXPIRED: 4-1-98

#6186, eff 2-17-96

#6909, eff 12-9-98

#7970, eff 10-10-03

#8838, eff 3-9-07

#9256, eff 9-10-08

#9633, eff 1-7-10

#9973, eff 8-9-11

#11053, eff 3-10-16

PART Den 401 DENTIST AND DENTAL HYGIENIST LICENSE RENEWAL

Den 401.01 License Renewal Procedure.

(a) All applications for license renewal shall be processed in accordance with Plc 308.09 through Plc 308.12.

(b) A dentist wishing to renew their license shall have completed 40 hours of maintenance of continuing competence as required by Den 406.03(b).

(c) A dental hygienist wishing to renew their license shall have completed 20 hours of maintenance of continuing competence as required by Den 406.03(a).

(d) Renewal applicants whose licenses have lapsed shall not practice as a dentist or dental hygienist until their licenses have been reinstated by the OPLC.

Source. #14398, eff 12-2-25, EXPIRES: 12-2-35

Den 401.02 License Renewal Required Documents. Applicants for license renewal shall:

(a) If applying to renew a dentist license submit:

(1) A completed “Universal Application for License Renewal” as required by Plc 308.05(b)(1);

(2) A completed “Dentist Addendum to the Universal Application for License Renewal”;

(3) If holding a permit to administer general anesthesia, deep sedation and moderate sedation, moderate sedation only, or moderate sedation with a pediatric qualification, a current copy of the applicant’s certificate for advanced cardiac life support (ACLS), pediatric advanced life support (PALS), or both as appropriate for the type of permit being renewed; and

(4) A current copy of the applicant’s Basic Life Support for Health Care Providers (BLS-HCP) certificate;

(b) If applying to renew a dental hygienist license submit:

(1) A completed “Universal Application for License Renewal” as required by Plc 308.05(b)(1);

(2) A completed “Dental Hygienist Addendum to the Universal Application for License Renewal”; and

(3) A current copy of the applicant’s BLS-HCP certificate; and

Source. #14398, eff 12-2-25, EXPIRES: 12-2-35

Den 401.03 Application for Dental License Renewal.

(a) Each applicant for renewal of a license to practice as a dentist in the state of New Hampshire shall complete and submit the “Universal Application for License Renewal” as required by Plc 308.05(b)(1).

(b) Pursuant to RSA 126-A:5, XVIII-a (a) and RSA 317-A:12-a, dentists shall complete, as part of their renewal application, the New Hampshire division of public health service’s health professions survey issued by the state office of rural health and primary care, department of health and human services, pursuant to He-C 801.

(d) Dentist’s choosing to opt-out of the survey shall submit a completed NH department of health and human services form as required by He-C 801.04(b).

(e) In addition to the information required in the (a) above the applicant shall provide the following information on the “Dentist Addendum to the Universal Application for License Renewal”, revised October 2025:

(1) Whether the applicant’s license is active or inactive;

(2) Whether the applicant has practiced in the current biennium, and if not, whether the applicant understands that their license will be placed on inactive status pursuant to RSA 317-A:16;

(3) Whether the applicant practices as a specialist;

(4) Whether the applicant has completed 40 hours of continuing education as required by Den 406.03(b);

(5) Whether the applicant holds a permit to administer general anesthesia, deep sedation and moderate sedation, moderate sedation only, or moderate sedation with a pediatric qualification and if yes, whether the applicant has provided a current copy of their certificate(s) for advanced cardiac life support (ACLS), pediatric advanced life support (PALS), or both as appropriate for the type of permit being renewed;

(6) Whether the applicant has provided a copy of the current BLS-HCP certificate; and

(7) The applicant’s printed name and dated signature.

Source. #14398, eff 12-2-25, EXPIRES: 12-2-35

Den 401.04 Application for Dental Hygienist License Renewal.

(a) Each applicant for renewal of a license to practice dental hygiene in the state of New Hampshire shall complete and submit the "Universal Application for License Renewal" as required by Plc 308.05(b)(1).

(b) Pursuant to RSA 126-A:5, XVIII-a (a) and RSA 317-A:12-a, hygienists shall complete, as part of their renewal application, the New Hampshire division of public health service’s health professions survey issued by the state office of rural health and primary care, department of health and human services, pursuant to He-C 801.

(d) Dental hygienists choosing to opt-out of the survey shall submit a completed NH department of health and human services form as required by He-C 801.04(b).

(e) In addition to the information required in (a) above the applicant shall provide the following information on the “Dental Hygienist Addendum to the Universal Application for License Renewal” revised October 2025:

(1) Whether the applicant’s hygienist license is active or inactive;

(2) Whether the applicant has practiced in the current biennium, and if not, whether the applicant understands that their license will be placed on inactive status pursuant to RSA 317-A:16;

(3) Whether the applicant has provided a copy of their current BLS-HCP certificate;

(4) Whether the applicant practices under public health supervision, pursuant to Den 302.02(d)(1), and the name of the program;

(5) Whether the applicant administers nitrous oxide for dental patients in New Hampshire, and if yes, whether the applicant received a certification showing they are qualified to administer nitrous oxide;

(6) Whether the applicant has completed 20 hours of continuing education as required by Den 406.03(a);

(7) Whether the applicant is an expanded function dental auxiliary (EFDA) pursuant to Den 302.07, and if yes, has completed 10 CEU’s in this biennium in restorative dentistry; and

(8) The applicant’s printed name and dated signature.

Source. #14398, eff 12-2-25, EXPIRES: 12-2-35

Den 401.05 Renewal of Licensure. Applications shall be reviewed as required by Plc 308.09 and Plc 308.11.

Source. #14398, eff 12-2-25, EXPIRES: 12-2-35

Den 401.06 Inactive Status.

(a) A dentist or dental hygienist licensed under this chapter who does not actively engage in such practice in New Hampshire within 2 years of their previous biennial registration shall have their license transferred to an inactive list and shall be required to register biennially and pay the inactive registration fee as long as the licensee remains inactive.

(b) Any dentist or dental hygienist with an inactive license who wants to become active again, shall submit a request to the OPLC that includes the following:

(1) A written request to have the status of their license changed from inactive to active;

(2) Proof of having completed 20 hours of continuing education for a dental hygienist required by Den 406.03(a) or 40 hours of continuing education for a dentist as required by Den 406.03(b);

(3) Payment of the fees required by Plc 1001.08(a) and Plc 1002.11; and

(4) If the licensee on inactive status has been practicing in another state, a letter of good standing from that state.

(c) A person's right to maintain a license with active status shall not be affected by any absence from active practice in New Hampshire while serving on active duty in the armed forces of the United States.

Source. #14398, eff 12-2-25, EXPIRES: 12-2-35

Den 401.07 Audit Procedure. Licensees shall be audited for compliance with continuing competency requirements as required by Plc 308.04(d).

Source. #14398, eff 12-2-25, EXPIRES: 12-2-35

PART Den 402 PERMIT RENEWAL AND INSPECTION

Den 402.01 Renewal of Permits for Facility or Facility Hosting to Administer General Anesthesia, Deep Sedation and Moderate Sedation, Moderate Sedation Only, or Moderate Sedation with Pediatric Qualification.

(a) Permit renewals shall be processed in accordance with Plc 308.09 through Plc 308.12.

(b) Each 3^rd biennial renewal after the initial permit is issued the facility shall:

(1) Have the facility inspected as described in (c) and (d) below, to be arranged by the dentist holding the facility permit or the facility hosting permit for that facility; and

(2) Have the qualified dentist holding a permit to administer general anesthesia, deep sedation and moderate sedation, moderate sedation only, or moderate sedation with pediatric qualification complete a simulated emergency management evaluation as described in (e) below.

(c) The facility inspection and simulated emergency management evaluation shall be completed at the same time unless the qualified dentist holds only a general anesthesia, deep sedation and moderate sedation permit, a moderate sedation only permit, or a moderate sedation permit with pediatric qualification.

(d) Each facility shall be inspected in accordance with Den 304.10 to ensure compliance with Den 304.07 and Den 304.09.

(e) Each dentist applying for a renewal permit to administer general anesthesia, deep sedation and moderate sedation, moderate sedation only, or moderate sedation with a pediatric qualification shall:

(1) Complete and pass a simulated emergency management evaluation of their emergency procedures through scenario based drills with a qualified consultant contracted by the OPLC;

(2) Be evaluated upon completion of no less than 5 scenario based drills; and

(3) Pass a simulated emergency management evaluation assessing the following:

a. The dentist’s response to the scenario presented; and

b. The staff assignment(s) and role(s) during the simulated emergency management evaluation.

(f) If the dentist fails to schedule or fails to pass their facility inspection and simulated emergency management evaluation before midnight on the day their permit is due to expire, their permit shall not be renewed and the failure will constitute misconduct pursuant to RSA 317-A:17.

Source. #14398, eff 12-2-25, EXPIRES: 12-2-35

PART Den 403 HOSTING FACILITY ONGOING REQUIREMENTS

Den 403.01 Attestation.

(a) Each dentist holding a hosting facility permit shall have each qualified provider who intends to administer general anesthesia, deep sedation and moderate sedation at the hosting facility complete the attestation described in Den 403.01(e).

(b) The hosting facility shall, at least one week prior to allowing a qualified provider to administer general anesthesia, deep sedation and moderate sedation submit to the OPLC, the completed, signed, and dated attestation required by (a) above.

(d) The hosting facility shall, before the expiration of the attestation, have the qualified provider complete an updated attestation and submit the updated attestation to the OPLC.

(e) The qualified provider shall provide the following information on the “Attestation of Qualified Providers”, revised October 2025:

(1) The qualified provider’s full legal name, and the name of the hosting facility;

(2) New Hampshire license type and license number;

(3) Business name and mailing address;

(4) Business telephone number; and

(5) The permit holder’s dated signature attesting to the fact that the qualified provider has all items listed in Den 304.07 in the facility each time the qualified provider administers general anesthesia, deep sedation and moderate sedation.

(f) The qualified provider shall attest to the following information by signing and dating the attestation:

(1) The information provided is true, complete, and not misleading to the best of the applicant’s knowledge and belief;

(2) The applicant understands that providing false or misleading information constitutes grounds for denial, suspension, or revocation of a license; and

(3) The applicant understands that knowingly providing false material information constitutes a misdemeanor under RSA 641:3 relative to falsification in official matters.

(g) If the relationship between the hosting facility and the qualified provider is terminated the hosting facility shall notify the OPLC of that termination within 15 days of the termination.

Source. #14398, eff 12-2-25, EXPIRES: 12-2-35

PART Den 404 ASSISTANTS

Den 404.01 Assistants’ Duties.

(a) A dental assistant shall perform the following duties under general supervision, as defined in Den 101.15 and arranged by degree of supervision in Den 302.02:

(1) Process and sterilize instruments and perform infection control;

(2) Organize and arrange instruments on bracket tables;

(3) Seat patient, place protective materials or garments on the patient including the lubrication of such patient's lips;

(4) Reorganize instruments and equipment after the patient has departed the healthcare facility;

(5) Process dental radiographs;

(6) Function as a dental laboratory technician;

(7) Perform tests on saliva;

(8) Train or instruct groups or individual patients in techniques of oral hygiene and mouth care; and

(9) Take and record vital signs of a patient.

(b) A dental assistant shall perform the following duties under direct supervision, as defined in Den 101.13 and arranged by degree of supervision in Den 302.02:

(1) Retract a patient's cheek, tongue, or other oral tissues during a dental operation;

(2) Assist with the placement or removal of a rubber dam and accessories used for its placement and retention, as directed by an operating dentist during the course of a dental operation;

(3) Remove such debris as is normally created or accumulated during the course of treatment being rendered by a licensed dentist by the use of vacuum devices, compressed air, mouth washes, and water;

(4) Place cotton rolls and topical anesthesia prior to delivery of local anesthesia by a dentist or dental hygienist;

(5) Apply topical fluoride after prophylaxis by a licensed professional;

(6) Apply non-prescription desensitizing agents to the cementum and dentin;

(7) Select, seat, hold, and remove impression trays;

(8) Insert athletic mouthguards; and

(9) Intraoral scanning utilizing a digital dental technological device, or photographs.

(c) Before qualifying to perform the duties delineated in Den 404.01(a)(1) and Den 404.01(d)(1), any dental assistant, other than a certified dental assistant or graduate dental assistant, shall qualify in infection control in the dental office as stated in Den 302.06(b).

(d) A dental assistant shall perform the following duties pursuant to the definition of public health supervision as set forth in Den 302.02(d)(2) to assist a certified public health dental hygienist (CPHDH):

(1) Process and sterilize instruments and perform infection control;

(2) Organize and arrange instruments on bracket tables;

(3) Seat patient, place protective materials or garments on the patient, including the lubrication of such patient's lips;

(4) Reorganize instruments and equipment after the patient has departed the healthcare facility;

(5) Process dental radiographs;

(6) Train or instruct groups or individual patients in techniques of oral hygiene and mouth care;

(7) Retract a patient's cheek, tongue, or other oral tissues during a dental hygiene operation and remove such debris as is normally created or accumulated during the course of treatment being rendered by a CPHDH by the use of vacuum devices, compressed air, mouthwashes, and water; and

(8) Assist with the placement or removal of a rubber dam and accessories used for its placement and retention, as directed by an operating CPHDH during the course of a dental hygiene operation.

Source. #287.2, eff 1-17-74; ss by #2981, eff 2-28-85; amd by #4298, eff 7-28-87; ss by #5110, eff 4-4-91, EXPIRED: 4-4-97

New. #6909, eff 12-9-98; amd by #7970, eff 10-10-03; amd by #8584, eff 3-16-06; ss by #8838, eff 3-9-07; amd by #8963, eff 8-16-07; ss by #10794, eff 3-7-15; ss by #10991, eff 12-9-15; ss by #12428, eff 12-6-17; ss by #14398, eff 12-2-25, EXPIRES: 12-2-35 (formerly Den 401.01)

Den 404.02 Certified Dental Assistants’ and Graduate Dental Assistants’ Duties. Certified dental assistants as defined in Den 101.07 and graduate dental assistants as defined in Den 101.16 may, in addition to the duties of assistants, perform the following duties under direct supervision as defined in Den 101.13 and arranged by degree of supervision in Den 302.02:

(a) Take dental and medical histories;

(b) Place and remove rubber dams;

(d) Apply topical fluoride after prophylaxis by a licensed professional;

(e) Apply non-prescription topical anesthesia;

(f) Apply non-prescription desensitizing agents to the cementum and dentin;

(g) Take and record vital signs;

(h) Select, seat, hold, and remove impression trays;

(i) Insert athletic mouthguards;

(j) Perform pulpal vitality testing procedures;

(k) Remove sutures and dressings;

(l) After at least 400 hours of work experience in clinical dental assisting:

(1) Make final impressions;

(2) Place periodontal dressings;

(3) Place amalgam prior to condensing by a dentist;

(4) Place cavity liners and bases;

(5) Place and remove gingival retraction cord;

(6) Place and remove temporary restorations, not to include temporary crowns and bridges unless qualified pursuant to Den 302.06, and not to include the use of intraoral rotary instruments;

(7) Cement bands and bond brackets, not to include the use of rotary instruments to remove excess cement or bonding material;

(8) Make bite registrations when maximum intercuspation can be achieved; and

(9) Place and remove dry socket medications; and

(m) Intraoral scanning utilizing a digital dental technological device, or photographs.

Source. #287.2, eff 1-17-74; ss by #2981, eff 2-28-85; ss by #4298, eff 7-28-87; ss by #5110, eff 4-4-91, EXPIRED: 4-4-97

New. #6909, eff 12-9-98; amd by #8100, eff 6-11-04; amd by #8584, eff 3-16-06; ss by #8838, eff 3-9-07; amd by #9256, eff 9-10-08; amd by #9408-B, eff 3-10-09; amd by #9778, eff 9-3-10; ss by #10689, eff 10-7-14; ss by #12428, eff 12-6-17; ss by #14398, eff 12-2-25, EXPIRES: 12-2-35 (formerly Den 401.02)

Den 404.03 Qualified Dental Assistants’ Duties. Any dental assistant, who has qualified pursuant to Den 302.06, shall perform the following duties under direct supervision as defined in Den 101.13:

(a) Dental radiography;

(b) Pit and fissure sealants;

(d) Fabrication of provisional crown and bridge restorations;

(e) Coronal polishing;

(f) Preliminary oral inspection;

(g) Monitor nitrous oxide administration; and

(h) In-office tooth whitening.

Source. #287.2, eff 1-17-74; ss by #2981, eff 2-28-85; ss by #4105, eff 8-1-86; ss by #5110, eff 4-4-91, EXPIRED: 4-4-97

New. #6909, eff 12-9-98; amd by #7818, eff 1-9-03; amd by #8100, eff 6-11-04; ss by #8838, eff 3-9-07; ss by #9973, eff 8-9-11; ss by #13021, eff 4-9-20; ss by #14398, eff 12-2-25, EXPIRES: 12-2-35 (formerly Den 401.03)

PART Den 405 HYGIENISTS

Den 405.01 Hygienists' Duties: A dental hygienist shall perform the following duties:

(a) Under general supervision, as defined in Den 101.15:

(1) Perform all the duties a dental assistant might perform under Den 404.01 and all the duties a certified dental assistant and graduate dental assistant might perform under Den 404.02;

(2) Perform complete oral prophylaxis as appropriate, including the removal of subgingival biofilm, its by-products, and biofilm retentive calculus deposits by debridement, scaling, and root planing;

(3) Collect and assess medical and dental histories, including documentation of existing and relevant systemic conditions;

(4) Perform extraoral or intraoral assessment, including oral cancer screening, and document all findings;

(5) Assess the hard tissue and document all findings of existing conditions and deviations from normal;

(6) Assess periodontal structures and conditions and document all findings;

(7) Assess occlusion and document all findings;

(8) Make a complete and accurate recording of all assessment findings regarding dental hygiene services relevant to patient care;

(9) Perform dental radiography;

(10) Perform comprehensive collection of patient data to identify the physical and oral health status;

(11) Assess and analyze data collected and determine the patient’s dental hygiene treatment needs that a dental hygienist is qualified and licensed to treat;

(12) Establish a dental hygiene care plan that reflects the realistic goals and treatment strategies to facilitate optimal oral health;

(13) Implement a dental hygiene care plan and evaluate dental hygiene treatment for effectiveness;

(14) Place prescribed periodontal antimicrobial agents;

(15) Apply topical preventive and anesthetic agents, including silver diamine fluoride; and

(16) The administration, prescription, and dispensing of a fluoride supplement, topically applied fluoride, and chlorhexidine gluconate oral rinse;

(b) Under general supervision as defined in Den 101.15, in-office tooth whitening;

(1) Remove excess restorative material extending beyond the margins of the preparation, to include the use of a low speed hand piece, if necessary;

(2) Place retraction cord;

(3) Place and remove periodontal dressings;

(4) Place temporary restorations, not to include temporary crowns and bridges, unless qualified pursuant to Den 302.05;

(5) Make cytological smears;

(6) Perform brush biopsies;

(7) Make final impressions;

(8) Place amalgam prior to condensing by a dentist;

(9) Place cavity liners and bases;

(10) Remove temporary restorations, not to include the use of rotary instruments;

(11) Cement bands and bond brackets;

(12) Perform orthodontic duties, if qualified pursuant to Den 302.05;

(13) Fabricate provisional crown and bridge restorations, if qualified pursuant to Den 302.05;

(14) Administer local anesthesia, if qualified pursuant to Den 302.05;

(15) Monitor nitrous oxide inhalation administration, if qualified pursuant to Den 302.05; and

(16) Administer nitrous oxide if qualified pursuant to Den 302.05; and

(d) Under public health supervision as defined in Den 101.28:

(1) Collect and assess medical and dental histories, including preliminary inspection of the oral cavity and surrounding structures, and periodontal probing and charting;

(2) Perform complete oral prophylaxis as appropriate, including the removal of calciferous deposits and the removal of subgingival accretions and stains by scaling and root planing;

(3) Administer, prescribe, and dispense fluoride supplement, topically applied fluoride, and chlorhexidine gluconate oral rinse;

(4) Instruct in oral hygiene techniques;

(5) Administer fluoride rinse programs as follows:

a. Obtain consent from a legally responsible adult;

b. Train personnel in storage, dosage, safety, administration, and rinsing procedures; and

c. Have a legally authorized physician, dentist, advanced practice registered nurse, or physician assistant pursuant to RSA 318:42, II dilute concentrated fluoride solutions prior to dispensing;

(6) Place sealants when authorized by a dentist with an active license provided that:

a. Written informed consent shall be obtained from the patient’s legal guardian; and

b. The supervising dentist and the hygienist shall be responsible for the sealants being indicated and correctly placed; and

(7) Make impressions, fabricate, and deliver athletic mouthguards.

Source. #287.2, eff 1-17-74; ss by #2981, eff 2-28-85; ss by #4298, eff 7-28-87; ss by #5110, eff 4-4-91; amd by #5722, eff 10-15-93; ss by #6909, eff 12-9-98; amd by #7778, eff 10-10-02; amd by #7929, eff 8-6-03; amd by #7970, eff 10-10-03; amd by #8100, eff 6-11-04; amd by #8260, eff 1-19-05; amd by #8584, eff 3-16-06; ss by #8838, eff 3-9-07; amd by #9256, eff 9-10-08; amd by #9408-B, eff 3-10-09; amd by #9633, eff 1-7-10; amd by #9778, eff 9-3-10; amd by #9973, eff 8-9-11; amd by #10437, eff 10-8-13; ss by #10824, eff 5-6-15; ss by #10991, eff 12-9-15; ss by #12428, eff 12-6-17; ss by #13021, eff 4-9-20; ss by #14398, eff 12-2-25, EXPIRES: 12-2-35 (formerly Den 402.01)

Den 405.02 Public Health Supervision Status.

(a) In order to obtain public health supervision status, a dental hygienist shall complete a “Dental Hygienist Application for Public Health Supervision Status,” revised October 2025, which requires the following:

(1) Applicant’s full legal name and New Hampshire license number;

(2) Applicant’s current business and residential addresses, telephone numbers, and primary email address either business or personal;

(3) The name of the public health supervision program where the applicant is employed;

(4) The applicant’s answer in the affirmative that they agree to limit any duties to those outlined in Den 405;

(5) The applicant’s answer in the affirmative that they agree to follow appropriate infection control guidelines as recommended by the Center for Disease Control and Prevention; and

(6) The applicant’s answer in the affirmative that they agree to advise participants in the program that the services provided do not replace regular examination by a dentist.

(b) The hygienist or supervising dentist shall send a summary of program results to the board at the one-year anniversary of the program's inception and each and every year after or, if the program lasts less than a year, at the end of the program.

(c) The form shall include the printed names and signatures of the applicant and supervising dentist, along with the date.

Source. #10991, eff 12-9-15; ss by #14398, eff 12-2-25, EXPIRES: 12-2-35 (formerly Den 402.02)

Den 405.03 Public Health Supervision Program.

(a) Each applicant for approval of a program under public health supervision shall provide the following on the “Application for Dental Program Approval Under Public Health Supervision” form, revised October 2025:

(1) Supervising dentist’s name and license number;

(2) Supervising dentist's primary business address, business telephone number, and primary email address either business or personal;

(3) Name of the program;

(4) Agency sponsoring the program;

(5) Date(s) of activity, as well as sites and population served;

(6) A description of the dental hygiene services to be provided; and

(7) The names and license numbers of hygienists working in the program.

(b) The form shall be signed and dated by the hygienist and the supervising dentist of the program.

(c) The hygienist or supervising dentist shall send a summary of program results to the board at the one-year anniversary of the program's inception and each and every year after or, if the program lasts less than a year, at the end of the program.

(d) The hygienist or supervising dentist shall notify the OPLC within 30 days of any changes in the information provided on the “Application for Dental Program Approval Under Public Health Supervision” that occur.

Source. #10991, eff 12-9-15; ss by #14398, eff 12-2-25, EXPIRES: 12-2-35 (formerly Den 402.03)

PART Den 406 CONTINUING EDUCATION

Den 406.01 Purpose. The purpose of this section is to establish the minimum continuing education requirements as provided by RSA 317-A:12, XI.

Source. #5332, eff 4-1-92 (from Den 304.02), EXPIRED: 4-1-98

New. #6909, eff 12-9-98, EXPIRED: 12-9-06

New. #8838, eff 3-9-07; ss by #10794, eff 3-7-15; ss by #14398, eff 12-2-25, EXPIRES: 12-2-35 (formerly Den 403.01)

Den 406.02 Definitions of Terms. The following definitions of terms shall apply to this part:

(a) “Certificate of CEU credit” means a document issued to a particular licensee by a provider certifying that the licensee has satisfactorily completed a program of continuing education;

(b) “Clinical dental care or dental hygiene care subjects” means those areas of study that deal with the performance of dental or dental hygiene services for patients;

(c) “Continuing education” means dental education designed to maintain professional competence in the practice of dental hygiene or dentistry, improve professional skills, and preserve dental standards for the purpose of protecting the public health and welfare;

(d) “Continuing education unit (CEU)” means one hour of attendance at lectures, seminars, and meetings, or 20 minutes as a presenter of an original paper, essay, or formal lecture to a group of professionals, not including certification in a specialty; and

(e) “Non-clinical subjects” means those areas of study related to personal development or practice management as related to dentistry or dental hygiene.

Source. #5332, eff 4-1-92 (from Den 304.02), EXPIRED: 4-1-98

New. #6909, eff 12-9-98, EXPIRED: 12-9-06

New. #8838, eff 3-9-07; ss by #10794, eff 3-7-15; ss by #12428, eff 12-6-17; ss by #14398, eff 12-2-25, EXPIRES: 12-2-35 (formerly Den 403.02)

Den 406.03 Continuing Education Requirement.

(a) Dental hygienists with an active New Hampshire license shall complete a minimum of 20 CEUs of continuing education per biennium. Of the 20 CEU’s the dental hygienist shall have:

(1) At least 15 CEUs earned in clinical dental care subjects;

(2) Successfully completed a BLS-HCP course that includes a hands-on component as required by Den 406.06(c);

(3) At least 2 CEUs earned in infection control in a course which includes the Center for Disease Control’s “Infection Prevention and Control’s Guidelines and Recommendations” in its syllabus;

(4) At least 2 CEUs earned in Medical Emergency Training; and

(5) At least 10 CEU’s in restorative dentistry in addition to the 20 CEU’s required by (a) above if the hygienist has completed the EFDA course.

(b) Dentists with an active New Hampshire license shall complete a minimum of 40 CEUs of continuing education per biennium. Of the 40 CEU’s the dentist shall have:

(1) At least 30 CEUs earned in clinical dental care subjects;

(2) Successfully completed a BLS-HCP course that includes a hands-on component as required by Den 406.06(c);

(3) At least 2 CEUs earned in infection control in a course which includes Center for Disease Control’s “Infection Prevention and Control’s Guidelines and Recommendations” in its syllabus; and

(4) At least 2 CEUs earned in Medical Emergency Training.

(c) Licensees required to register with the prescription drug monitoring program and who possess a valid drug enforcement administration number shall provide evidence of having completed the following as part of their biennial renewal as required by Plc 318-B:41, VI:

(1) Three CEUs in the area of pain management, addiction disorder, or a combination of both pain management and addiction disorder; or

(2) An online examination in the area of pain management, addiction disorder, or a combination of pain management and addiction disorders.

(d) One CEU shall be given for each hour of attendance at lectures, seminars, and meetings, or 20 minutes as a presenter of an original paper, essay, or formal lecture to a group of professionals, not including certification in a specialty. Successful completion of an entire course or segment of a course shall be required to receive continuing education credit for that course.

(e) Each licensee shall retain all certificates or documents as evidence of participation in a continuing education program or course for a period of 3 years from the date of the program course. It shall be the responsibility of each course participant to ensure that verification of course participation is attained. Upon request of the board, such documentation shall be made available to the board or its representative for random audit or verification purposes.

(f) Excess CEUs earned in one renewal period shall not be carried forward into the next renewal period for the purpose of fulfilling continuing education requirement for licensure renewal.

(g) Up to 3 CEUs shall be given for courses taken when initially obtaining a specialty.

(h) Those dental hygienists and dentists that have obtained their first license after graduation from an accredited college or university shall be exempt from the continuing education requirement for the first biennial renewal after their initial license was granted.

Source. #5332, eff 4-1-92 (from Den 304.02); amd by #6186, eff 2-17-96; paragraphs (a)-(c), (g) & (h) EXPIRED: 4-1-98; ss by #6909, eff 12-9-98; amd by #7364, eff 9-19-00; amd by #8694, eff 7-27-06; ss by #8838, eff 3-9-07; amd by #10328-B, eff 5-7-13; ss by #10689, eff 10-7-14; ss by #10991, eff 12-9-15; ss by #12428, eff 12-6-17; ss by #13021, eff 4-9-20; ss by #14398, eff 12-2-25, EXPIRES: 12-2-35 (formerly Den 403.03)

Den 406.04 Waivers of Continuing Education Requirements. A licensee seeking a waiver because of severe illness, incapacity, or other hardship of any requirement of this part shall submit a written petition to the board outlining the reasons the licensee was unable to satisfy the biennial continuing education requirement. Waivers shall be granted if the board finds that severe illness, incapacity, or other hardship prevented the licensee from satisfying the biennial continuing education requirement pursuant to Den 201.02.

Source. #5332, eff 4-1-92 (from Den 304.02), EXPIRED: 4-1-98

New. #6909, eff 12-9-98, EXPIRED: 12-9-06

New. #8838, eff 3-9-07; amd by #9256, eff 9-10-08; EXPIRED: 3-9-15 (para. (b)); ss by #10991, eff 12-9-15; ss by #14398, eff 12-2-25, EXPIRES: 12-2-35 (formerly Den 403.05)

Den 406.05 Criteria of Acceptance of Continuing Education and Documentation of Completion.

(a) The board shall not pre-approve courses.

(b) Each licensee shall select courses dealing with matters directly related to the practice of dentistry or dental hygiene.

(c) The licensee shall maintain records provided by the program sponsor for a period no less than 3 years from the date the course was completed.

(d) Documentation of completion of continuing education shall contain the following:

(1) Name of the licensee;

(2) Full name of the course;

(3) Date of the course;

(4) Location where the course was given;

(5) Duration of the course in days and hours;

(6) Name and mailing address of the provider; and

(7) Number of CEUs.

(e) Certificates or printouts from the following shall be acceptable:

(1) Academy of General Dentistry;

(2) NH Dental Society, American Dental Association, and their recognized specialty organizations; or

(3) American Dental Hygienists’ Association, NH Dental Hygienists’ Association, or their sponsoring organization.

Source. #5332, eff 4-1-92 (from Den 304.02), EXPIRED: 4-1-98

New. #6909, eff 12-9-98, EXPIRED: 12-9-06

New. #8838, eff 3-9-07; amd by #9973, eff 8-9-11; EXPIRED: 3-9-15 (paras. (b)-(d)); ss by #11053, eff 3-10-16; ss by #14398, eff 12-2-25, EXPIRES: 12-2-35 (formerly Den 403.06)

Den 406.06 Categories of Credit.

(a) A licensee shall be entitled to obtain up to 100% of the required continuing education units CEUs in any or all of the following categories:

(1) Education and scientific courses sponsored or approved by the following:

a. American Dental Association, component societies, and constituent societies;

b. Academy of General Dentistry;

c. American Dental Hygienists’ Association, component societies, and constituent societies;

d. State or local dental or dental hygiene professional associations or societies;

e. Dental schools, medical schools, and dental hygiene schools;

f. Hospital sponsored courses and conferences;

g. Governmental health agencies and health institutions; and

h. Postgraduate dental schools or postgraduate dental hygiene schools; and

(2) Courses required to maintain certification in any nationally recognized professional specialty board.

(b) A licensee shall receive credit for 100% of required CEUs for passing the written portion of the American Board of Dental Examiners (ADEX), or other similar U.S. regional or state board clinical examination or manikin examination for dentists or dental hygienists.

(c) A licensee shall receive credit for 3 CEUs per biennium for successful completion of BLS-HCP course(s) given by an American Heart Association, American Red Cross, National Safety Council, American Safety and Health Institute, American College of Emergency Physicians, or Military Training Network qualified instructor, or sponsored or approved by organizations referenced in Den 406.06(a)(1). BLS-HCP shall be considered a clinical care subject. All BLS-HCP, ACLS, and PALS courses shall include a hands-on component.

(d) A licensee shall receive credit for up to 75% of the required CEUs by participating in audio-visual or online programs or live webinars.

(e) A licensee shall receive credit for up to 10% of the required CEUs by attending regional or national meetings of the American Dental Association and its components, the Academy of General Dentistry, the American Dental Hygienists’ Association, and their recognized specialty organizations.

Source. #5332, eff 4-1-92 (from Den 304.02), EXPIRED: 4-1-98

New. #6909, eff 12-9-98; amd by #7270, eff 5-12-00; amd by #7661, eff 3-13-02; amd by #7929, eff 8-6-03; amd by #8100, eff 6-11-04; amd by #8260, eff 1-19-05; amd by #8584, eff 3-16-06; ss by #8838, eff 3-9-07; amd by #8963, eff 8-16-07; amd by #9256, eff 9-10-08; amd by #9408-B, eff 3-10-09; amd by #9973, eff 8-9-11; amd by #10328-B, eff 5-7-13; ss by #10689, eff 10-7-14; ss by #12428, eff 12-6-17; ss by #13021, eff 4-9-20; amd by #13341, EMERGENCY RULE, eff 2-8-22; ss by #13366, eff 4-19-22 (see Revision Note at chapter heading for Den 400); ss by #14398, eff 12-2-25, EXPIRES: 12-2-35 (formerly Den 403.07)

PART Den 407 REVOCATION, SUSPENSION AND OTHER SANCTIONS, INCLUDING NON-DISCIPLINARY SUBSTANCE ABUSE RECOVERY PROGRAM

Den 407.01 Misconduct. Misconduct shall be:

(a) Addiction to mind-altering drugs or intoxicants;

(b) Commission of any felony or misdemeanor involving dishonesty, untrustworthiness, or unprofessional conduct;

(d) The practice of fraud or untruthfulness in obtaining educational credentials, examination scores, or professional licensure in this or any other jurisdiction;

(e) Affliction with a physical or mental impairment or disease which is dangerous to the public health or which precludes the practice of dentistry or dental hygiene at ordinary levels of proficiency;

(f) Ignorance, incompetence, or a pattern of behavior inconsistent with the basic knowledge and skills expected of persons licensed to practice dentistry or dental hygiene;

(g) Gross or repeated negligence in practicing dentistry or dental hygiene;

(h) Intentionally injuring a patient or engaging in any other unprofessional or dishonest conduct in practicing dentistry or dental hygiene;

(i) Failure to follow the current guidelines of:

(1) The American Dental Association, as adopted by the board, as published in:

a. The “Dental Radiographic Examinations: Recommendations for Patient Selection and Limiting Radiation Exposure”, required by Den 501.01(p); or

b. “Recommendations in Radiographic Practices: an update” Journal of the American Dental Association, January 1989; and

(2) The Centers for Disease Control and Prevention as published in Infection Control Recommendations;

(j) Advertising the licensee's dental practice by using any newspaper, broadcast, cable transmission, telephone, sign, poster, or other advertising message which:

(1) Deceives or is intended to deceive the public concerning dental services, techniques, the qualifications of a licensee, or the prices to be charged;

(2) Claims or suggests that the licensee enjoys professional superiority or performs services in a manner superior to other persons licensed by this chapter or that the licensee performs services or any particular service in a painless manner; or

(3) Announces the use of any drug or medicine of an unknown formula or any system or anesthetic that is unnamed, misnamed, misrepresented, or not in reality used;

(k) Employing or permitting an unlicensed person to practice in the licensee's office;

(l) Knowingly or willfully violating any provision of the board’s administrative rules, RSA 317-A, order of the dental board, any federal, state, or local controlled drug law or other federal, state, or local laws or regulations pertaining to:

(1) The practice of dentistry, and the Principles of Ethics and Code of Professional Conduct of the American Dental Association, as required by Den 501; or

(2) The practice of dental hygiene, and the Code of Ethics of the American Dental Hygienists' Association, as required by Den 501;

(m) Having more than one patient undergoing moderate sedation, deep sedation, or general anesthesia on an outpatient basis at any given time unless each patient is being continuously monitored on a one-to-one ratio while sedated by either the dentist or another licensed health professional authorized by law to administer moderate sedation, deep sedation, or general anesthesia;

(n) Failing to have patients recovering from moderate sedation, deep sedation, or general anesthesia closely monitored by licensed health professionals experienced in the care and resuscitation of patients recovering from moderate sedation, deep sedation, or general anesthesia. If one licensed professional is responsible for the recovery care of more than one patient at a time, all of the patients shall be physically in the same room to allow continuous visual contact with all patients and the patient to recovery staff ratio should not exceed 3 to one;

(o) Failing to have patients continuously monitored with a pulse oximeter or arterial blood gas monitoring machine while undergoing or recovering from moderate sedation, deep sedation, or general anesthesia;

(p) Failing to perform an adequate history and physical as defined in rules under RSA 317-A:12, XII-a(i) or to obtain the written informed consent of a patient prior to the administering general anesthesia, deep sedation, or moderate sedation. In the case of a minor, the consent shall be obtained from the child's parent or guardian;

(q) Failing to report an adverse event or implement a corrective action plan as required by RSA 317-A:20-a; or

(r) Violation of:

(1) Any provision of RSA 317-A;

(2) Any rule adopted by the board; or

(3) Any state or federal law reasonably related to the licensee's authority to practice or the licensee's ability to practice safely; and

(s) In the licensees role as a dentist or dental hygienist, unprofessional conduct shall include, but not be limited to:

(1) Yelling, swearing, or using profanity;

(2) Throwing items at or in the direction of any person;

(3) Verbally threatening; and

(4) Grabbing, pulling, or pushing any person.

Source. #13956, eff 7-5-24, EXPIRES: 7-5-34; renumbered by #14398 (formerly Den 404.01)

Den 407.02 Sanctions.

(a) Pursuant to RSA 310:12, I(e), disciplinary measures available to the board to sanction misconduct shall be:

(1) Revocation or suspension of a licensure;

(2) Limitation or restriction of a license;

(3) Requiring the licensee to submit to the care, counseling, or treatment of a physician, counseling service, health care facility, professional assistance program, or any comparable person or facility, approved by the board;

(4) Requiring the licensee to participate in educational programs relevant to the practice of dentistry in substantive areas in which the licensee has been found professionally deficient;

(5) Requiring the licensee to practice under the direction of a dentist in a public institution, public, or private health care program, or private practice for a period of time specified in Den rules adopted pursuant to RSA 541-A;

(6) Assessing administrative fines in amounts established in Den 404.05 below which shall not exceed $2,000 per offense or, in the case of continuing offenses, $250 for each day the violation continues; or

(7) Reprimand.

Source. #13956, eff 7-5-24, EXPIRES: 7-5-34; renumbered by #14398 (formerly Den 404.02)

Den 407.03 Procedure for Imposition of Sanctions. Other than immediate license suspension authorized by RSA 541-A:30, III, the board shall impose disciplinary sanctions only:

(a) After prior notice to the licensee and opportunity for the licensee to be heard; or

(b) By agreement in a settlement between the board and the licensee.

Source. #13956, eff 7-5-24, EXPIRES: 7-5-34; renumbered by #14398 (formerly Den 404.03)

Den 407.04 Determinations Required for Sanctions. Sanctions by the board shall be determined as follows:

(a) The board shall select appropriate sanction(s) from the list in Den 404.02, choosing the sanction or combination of sanctions most likely to:

(1) Protect public health and safety;

(2) Prevent future misconduct by the licensee;

(3) Take into account any acknowledgement of fault by the licensee and any cooperation by the licensee with the board’s investigation of misconduct;

(4) Correct any attitudinal, educational, or other deficiencies which led to the licensee’s misconduct;

(5) Encourage the responsible practice of mental health; and

(6) Demonstrate to the licensee and the public the board’s intention to ensure that its licensees practice in accordance with applicable law and the public welfare.

(b) In determining which sanction or combination of sanctions to impose, the board shall:

(1) First determine the nature of the act or omission constituting the misconduct done by the licensee;

(2) Next determine whether the misconduct has one or more of the characteristics listed in (c) below; and

(3) Apply the standard’s outlined in Den 404.04(a).

(1) The misconduct actually caused physical or mental harm to the client or another person;

(2) The misconduct had the potential to cause physical or mental harm to the client or another person;

(3) The misconduct repeated earlier misconduct done by the licensee, as determined by:

a. An earlier hearing;

b. An earlier settlement agreement predicated on the same misconduct by the licensee; or

c. An admission by the licensee;

(4) The misconduct was not the first misconduct by the licensee, as determined by:

a. An earlier hearing;

b. An earlier settlement agreement predicated on the same misconduct by the licensee; or

c. An admission by the licensee; and

d. The misconduct was intentional rather than the result of negligence or inadvertence.

Source. #13956, eff 7-5-24, EXPIRES: 7-5-34; renumbered by #14398 (formerly Den 404.04)

Den 407.05 Imposition of Fines.

(a) Fines, penalties, and monetary sanctions shall be assessed by the board upon a finding of licensee misconduct in accordance with the considerations of RSA 310:12, Den 501, and Den 502.

(b) Fines, if imposed, shall not exceed the following amounts:

(1) When no violation of the same type has occurred within the 5 years preceding the board’s notice to the respondent, the fine assessed shall not exceed $500.00 per offense;

(2) When a single disciplinary infraction of the same type has occurred within the 5 years preceding the board’s notice to the licensee, the fine assessed shall not exceed $1000.00 per offence; and

(3) When more than one disciplinary infraction of the same type has occurred within the 5 years preceding the board’s notice to the licensee, the fine assessed shall not exceed $2000.00 per offense.

(c) Each day the violation continues, a separate fine up to $250.00 per day shall be assessed which shall not exceed $2000.00.

Source. #13956, eff 7-5-24, EXPIRES: 7-5-34; renumbered by #14398 (formerly Den 404.05)

Den 407.06 Monetary Sanctions: Expenses Relating to Discipline Enforcement.

(a) Expenses incurred by the board in the conduct of a hearing and enforcement of discipline shall be assessed, in whole or in part, against a licensee who is disciplined following the hearing provided the board sets forth its reasons based upon the following criteria:

(1) The severity of the conduct resulting in the discipline imposed;

(2) The extent to which the evidence was in dispute;

(3) The nature and extent of the investigation and hearing;

(4) Whether the licensee was given the opportunity to enter into a reasonable settlement agreement before the hearing;

(5) The contribution that repayment of expenses makes toward rehabilitation;

(6) Whether the payment of all or a portion of a monetary fine was suspended; and

(7) The likelihood that assessment of expenses will deter the licensee or others from engaging in similar conduct.

(b) Following any assessment, the board shall send a written statement of the nature and amount of each such expense to the disciplined licensee, together with a formal demand for payment.

Source. #13956, eff 7-5-24; EXPIRES: 7-5-34; renumbered by #14398 (formerly Den 404.06)

CHAPTER Den 500 ETHICAL AND PROFESSIONAL DUTIES

PART Den 501 ETHICAL DUTIES

Den 501.01 Ethical Duties.

(a) In addition to those obligations of dentists under the American Dental Association Principles of Ethics and Code of Professional Conduct revised March 2023, as specified in Appendix II, and the obligations of dental hygienists under the Code of Ethics of the American Dental Hygienists’ Association adopted June 2024, as specified in Appendix II, pursuant to RSA 317-A:17, II(j), the provisions of this section shall apply.

(b) Dentists shall protect the health of their patients by only assigning to hygienists and assistants those duties specified in Den 400 that the hygienist and assistants are trained to perform correctly.

(c) Dentists shall be further obliged to prescribe and supervise the patient care provided by all dental hygienists and dental assistants working under their direction.

(d) A dentist shall neither aid nor encourage a dentist, a dental hygienist, or a dental assistant in their employ to make use of lists of patients from an office of former employment, nor shall a dentist, a dental hygienist, or a dental assistant use such lists or information gathered therefrom unless prior written consent allowing use of the lists has been obtained from the previous employer.

(e) Upon request of a patient, dentists shall provide a copy of the patient’s records within 20 days for a nominal fee not to exceed $15 for up to 30 pages and $0.50 per page thereafter, pursuant to RSA 332-I:1, I. Radiographs and models shall be provided at a reasonable cost. This obligation shall exist whether or not the patient’s account is paid in full or whether the patient has paid for their records.

(f) A dentist shall inform the board in writing within 15 working days of patient mortality associated with dental treatment. The mortality report shall meet the requirements of Den 304.07(b).

(g) Dentists who are about to close a dental practice in New Hampshire shall inform their patients of record of the impending closure to allow 3 months, when possible, for patients to obtain copies of their records or have their records sent to another dentist. Such dentist shall notify the board in writing of their intent to close a dental practice and shall provide the board with the name, address, and telephone number of the licensee to whom the dentist’s patient records will be transferred.

(h) Pursuant to RSA 317-A:27-a, dentists shall have an ongoing obligation, for at least 7 years, to afford their prior patients access to those records not previously provided to the patient or new dentist.

(i) Dentists and dental hygienists shall have an ongoing obligation to repay loans provided to them for their dental education.

(j) Dentists and dental hygienists shall inform the board within 30 days in writing of any sanction pursuant to Den 301.01(a)(10), Den 301.02(a)(10), Den 301.03(a)(10), and Den 301.04(a)(12) imposed by any jurisdiction.

(k) When discontinuing a course of treatment, dentists shall be available to provide emergency care for up to 30 days or until the patient obtains the services of another dentist, whichever occurs first.

(l) A consultant shall not be required to have a New Hampshire dental license to provide a consultation or expert opinion to a New Hampshire dentist regarding a patient, if the consultant has no contact with the patient.

(m) When dental records are being discarded, dentists shall destroy them by some method that maintains confidentiality.

(n) Either directly or through a third-party creditor, dentists shall not make patients financially responsible for the entire cost of a treatment plan before the patient gives informed consent to the treatment plan, including all financial responsibilities clearly explained.

(o) Licensees shall submit only truthful and correct information in any application or other documents filed with or statement made to the board or the OPLC.

(p) Pursuant to RSA 317-A:17, II(g), licensees shall adhere to the American Dental Association’s guidelines for ”Infection Control and Sterilization” revised 10/2022 and “X-Rays/Radiographs” revised 3/2024 and available as noted in Appendix II.

Source. #287.2, eff 1-17-74; ss by #2981, eff 2-28-85; ss by #5110, eff 4-4-91, EXPIRED: 4-4-97

New. #6540, eff 7-18-97; ss by #6909, eff 12-9-98; amd by #7364, eff 9-19-00; amd by #7778, eff 10-10-02; amd by #7929, eff 8-6-03; amd by #7970, eff 10-10-03; amd by #8260, eff 1-19-05; amd by #8584, eff 3-16-06; amd by #8694, eff 7-27-06; ss by #8838, eff 3-9-07; amd by #8963, eff 8-16-07; amd by #9256, eff 9-10-08; amd by #9408-B, eff 3-10-09; amd by #9633, eff 1-7-10; amd by #9778, eff 9-3-10; amd by #9973, eff 8-9-11; amd by #10068, eff 1-10-12; amd by #10328-B, eff 5-7-13; amd by #10437, eff 10-8-13; ss by #10689, eff 10-17-14; ss by #10824, eff 5-6-15; ss by #10991, eff 12-9-15; ss by #12428, eff 12-6-17; amd by #12549, eff 6-15-18; ss by #14167, eff 3-7-25

PART Den 502 PROFESSIONAL DUTIES

Den 502.01 Controlled Substance Misconduct.

(a) Dentists shall, pursuant to RSA 317-A:17, II(j), be under a professional duty to comply with the requirements of the Controlled Drug Prescription Health and Safety Program (PDMP), RSA 126-A:91, and all administrative rules of the board of pharmacy adopted thereunder.

(b) As established by RSA 126-A:92, I, the following actions shall result in a disciplinary proceeding and the imposition of sanctions by the board in accordance with its rules:

(1) Prescribing or dispensing of controlled substances in schedules II-IV after June 30, 2015 without having registered with the program;

(2) The knowing disclosure of program information by a person authorized to receive it in a manner that violates RSA 126-A:92, I or administrative rules of the department of health and human services;

(3) The use of program information by a person authorized to receive it for a purpose that violates RSA 126-A:92, I or administrative rules of the department of health and human services; and

(4) Permitting the use or disclosure of program information under control of the dentist by a person not authorized to receive it in violation of RSA 126-A:92, I or administrative rules of the department of health and human services.

Source. #10824, eff 5-6-15; amd in para (c) by #11013, EMERGENCY RULE, eff 1-5-16, EXPIRES: 7-3-16; amd in para. (c) by #11129, REPEAL OF EMERGENCY RULE, eff 6-29-16; ss by #14167, eff 3-7-25

PART Den 503 OPIOID PRESCRIBING

Den 503.01 Applicability. This part shall apply to the prescribing of opioids for the management or treatment of non-cancer and non-terminal pain, and shall not apply to the supervised administration of opioids in a health care setting.

Source. #11130, eff 6-29-16; ss by #12061, eff 1-1-17

Den 503.02 Definitions. Except where the context makes another meaning manifest, the following words shall have the meanings indicated when used in this part:

(a) “Acute pain” means the normal, predicted physiological response to a noxious chemical, thermal, or mechanical stimulus and typically is associated with invasive procedures, trauma, and disease. It can be time-limited, often less than 30 days in duration;

(b) “Chronic pain” means a state in which non-cancer pain persists beyond the usual course of an acute disease or healing of an injury, or that might or might not be associated with an acute or chronic pathologic process that causes continuous or intermittent pain over months or years. It also includes intermittent episodic pain that might require periodic treatment. For the purposes of these rules, chronic pain does not include pain from cancer or terminal disease;

(c) “Clinical coverage” means specified and prearranged coverage that is available 24 hours a day, 7 days a week, to assist in the management of patients with chronic pain;

(d) “Medication-assisted treatment” means any treatment of opioid addiction that includes a medication, such as methadone, buprenorphine, or naltrexone, that is approved by the FDA for opioid detoxification or maintenance treatment;

(e) “Morphine equivalent dose (MED)” means a conversion of various opioids to a morphine equivalent dose by the use of board-approved conversion tables;

(f) “Risk assessment” means a process for predicting a patient’s likelihood of misusing or abusing opioids in order to develop and document a level of monitoring for that patient; and

(g) “Treatment agreement” means a written agreement that outlines the joint responsibilities of dentist and patient.

Source. #11130, eff 6-29-16; ss by #12061, eff 1-1-17; ss by #14167, eff 3-7-25 (formerly Den 503.03)

Den 503.03 Acute Pain. If opioids are indicated and clinically appropriate for prescription for acute pain, prescribing licensees shall:

(a) Conduct and document an examination of the oral cavity and associated structures and a medical history;

(b) Consider the patient’s risk for opioid misuse, abuse, or diversion and prescribe for the lowest effective dose for less than 30 days;

(d) Ensure that the patient has been provided information that contains the following:

(1) Risk of side effects, including addiction and overdose resulting in death;

(2) Risks of keeping unused medication;

(3) Options for safely securing and disposing of unused medication; and

(4) Danger in operating motor vehicle or heavy machinery;

(e) Comply with all federal and state controlled substances laws, rules, and regulations;

(f) Complete a board-approved risk assessment tool, such as the evidence based screening tool Screener and Opioid Assessment for Patients with Pain (SOAPP);

(g) Document the consideration of non-pharmacological modalities and non-opioid therapy, and an appropriate pain treatment plan which includes the type of drug, the dosage, and the duration of the prescription;

(h) Utilize a written informed consent that explains the following risks associated with opioids:

(1) Addiction;

(2) Overdose and death;

(3) Physical dependence;

(4) Physical side effects;

(5) Hyperalgesia;

(6) Tolerance; and

(7) Crime victimization;

(i) In an emergency department, urgent care setting, or walk-in clinic:

(1) Not prescribe more than the minimum amount of opioids dentally necessary to treat the patient’s dental condition. In most cases, an opioid prescription of 3 or fewer days is sufficient, but a licensee shall not prescribe for more than 7 days; and

(2) If prescribing an opioid for acute pain that exceeds a board-approved limit, document the dental condition and appropriate clinical rationale in the patient’s medical record; and

(j) Not be obligated to prescribe opioids for more than 30 days, but if opioids are indicated and appropriate for persistent, unresolved acute pain that extends beyond a period of 30 days, the licensee shall work in concert with the patient’s primary care physician or a licensed pain management program, and shall continue to adhere to the terms of Den 503.05 for establishing a pain management program.

Source. #11130, eff 6-29-16; ss by #12061, eff 1-1-17 (from Den 503.03); renumbered by #12167, eff 3-7-25 (formerly Den 503.04)

Den 503.04 Chronic Pain. If opioids are indicated and clinically appropriate for prescription for chronic pain, prescribing licensees shall:

(a) Conduct and document an examination of the oral cavity and associated structures and a medical history;

(b) Conduct and document a risk assessment, including, but not limited to, the use of an evidence-based screening tool such as the Screener and Opioid Assessment for Patients with Pain (SOAPP);

(d) Prescribe for the lowest effective dose for a limited duration;

(e) Comply with all federal and state controlled substances laws, rules, and regulations;

(f) Utilize a written informed consent that explains the following risks associated with opioids:

(1) Addiction;

(2) Overdose and death;

(3) Physical dependence;

(4) Physical side effects;

(5) Hyperalgesia;

(6) Tolerance; and

(7) Crime victimization;

(g) Create and discuss a treatment plan with the patient. This shall include, but not be limited to the goals of treatment, in terms of pain management, restoration of function, safety, time course for treatment, and consideration of non-pharmacological modalities and non-opioid therapy. Informed consent documents and treatment agreements may be part of one document for the sake of convenience;

(h) Utilize a written treatment agreement that is included in the medical record, and specifies conduct that triggers the discontinuation or tapering of opioids;

(i) The agreement shall also address, at a minimum, the following:

(1) The requirement of safe medication use and storage;

(2) The requirement of obtaining opioids from only one prescriber or practice;

(3) The consent to periodic and random drug testing; and

(4) The prescriber’s responsibility to be available or to have clinical coverage available;

(j) Document the consideration of a consultation with an appropriate specialist in the following circumstances:

(1) When the patient receives a 100 mg morphine equivalent dose daily for longer than 90 days;

(2) When a patient is at high risk for abuse or addiction; or

(3) When a patient has a co-morbid psychiatric disorder;

(k) Reevaluate treatment plans and use of opioids at least twice a year;

(l) Require random and periodic urine drug testing at least annually for all patients using opioids for longer than 90 days. Unanticipated findings shall be addressed in a manner that supports the health of the patient;

(m) Have clinical coverage available for 24 hours per day, 7 days per week, to assist in the management of patients; and

(n) The prescribing licensee may forego the requirements for a written treatment agreement and for periodic drug testing for patients:

(1) Who are residents in a long-term, non-rehabilitative nursing home facility where medications are administered by licensed staff; or

(2) Who are being treated for episodic intermittent pain and receiving no more than 50 dose units of opioids in a 3 month period.

Source. #11130, eff 6-29-16; ss by #12061, eff 1-1-17 (from Den 503.04); renumbered by #12167, eff 3-7-25 (formerly Den 503.05)

Den 503.05 Prescription Drug Monitoring Program.

(a) Prescribing licensees required to register with the program under RSA 318-B:31-40, or their delegate, shall query the prescription drug monitoring program to obtain a history of schedule II-IV controlled substances dispensed to a patient, prior to prescribing an initial schedule II, III, and IV opioids for the management or treatment of this patient’s pain and then periodically and at least twice per year, except when:

(1) Controlled medications are to be administered to patients in a health care setting;

(2) The program is inaccessible or not functioning properly, due to an internal or external electronic issue; or

(3) An emergency department is experiencing a higher than normal patient volume such that querying the program database would materially delay care.

(b) A licensee shall document the exceptions described in (a)(2) and (3) above in the patient’s medical record.

Source. #11130, eff 6-29-16; ss by #12061, eff 1-1-17; renumbered by #12167 (formerly Den 503.06)

Den 503.06 Medication Assisted Treatment. Prescribing licensees who prescribe medication assisted treatment shall adhere to the principles outlined in the American Society of Addiction Medicine’s National Practice Guideline For the Use of Medications in the Treatment of Addiction Involving Opioid Use (2015) found at http://www.asam.org/quality-practice/guidelines-and-consensus-documents/npg/complete-guideline as cited in Appendix II.

Source. #11130, eff 6-29-16; ss by #12061, eff 1-1-17; renumbered by #12167, eff 3-7-25 (formerly Den 503.07)

Den 503.07 Ongoing Requirements for the Use of General Anesthesia, Deep Sedation, and Moderate Sedation, Moderate Sedation Only, or Moderate Sedation with Pediatric Qualification. No dentist shall use general anesthesia, deep sedation, or moderate sedation on an outpatient basis for dental patients except pursuant to Den 304.

Source. #14167, eff 3-7-25

APPENDIX I

RULE	STATUTE
Den 101	RSA 541-A:7
Den 101.02	RSA 317-A:12, XIII and XIV
Den 101.03	RSA 317-A:12, XIII and XIV
Den 101.05	RSA 317-A:12, XIII
Den 101.06	RSA 541-A:7; 317-A:12, XII-b and XII-c
Den 101.11	RSA 317-A:12, XII
Den 101.10	RSA 317-A:12, XIII
Den 101.14	RSA 317-A:12, XIII and XIV
Den 101.15	RSA 317-A:7; 317-A:9; 317-A:12, IV
Den 101.16	RSA 317-A:12, XIII
Den 101.20	RSA 317-A:12, XIII; 317-A:21-e, IV
Den 101.24	RSA 317-A:12, XIII
Den 101.25	RSA 317-A:12, XIII and XIV
Den 101.34	RSA 317-A:12, XIII and XIV
Den 102.01(a) and (b)	RSA 317-A:2; RSA 317-A:3
Den 102.1(c)	RSA 310:6, III
Den 102.01(d) and (e)	RSA 317-A:4
Den 102.01(f)	RSA 317-A:12, III, VI, XI; RSA 317-A:21-g, III
Den 102.01(g)	RSA 317-A:2-a, II; RSA 317-A:2-b, II
Den 103	RSA 317-A:4, II; RSA 317-A:12, XIV

Den 201.01	RSA 317-A:12, IX, XIV
Den 201.02	RSA 541-A:16, I (b); RSA 317-A:12, XIV

Den 301.01 (Specific provisions implementing specific statutes are cited below)	RSA 317-A:12, I, and III; 317-A:8
Den 301.01	RSA 317-A:12, III; RSA 317-A:21, II
Den 301.01(i)	RSA 317-A:12, III and IV
Den 301.01(k)	RSA 317-A:12 III, and IV

Den 301.02 (Specific provisions implementing specific statutes are cited below)	RSA 317-A:12, I, and III; 317-A:8
Den 301.02	RSA 317-A:12, III; RSA 317-A:21, II
Den 301.02(h) (1)	RSA 317-A:12, III and IV
Den 301.02(o)	RSA 318-B:33, II
Den 301.05	RSA 317-A:8; 317-A:12, I
Den 301.06	RSA 317-A:12, VIII; RSA317-A:12, XIV; RSA 317-A:16
Den 301.07	RSA 317-A:12, I
Den 301.09	RSA 317-A:12, I and II; RSA 317-A:13, III; RSA 317-A:18, VI
Den 301.10	RSA 317-A:7-a, III; 317-A:12, III
Den 301.11	RSA 161-B:II, VI-a
Den 301.12	RSA 317-A:15-a;
Den 301.13	RSA 317-A:12, III
Den 302.01	RSA 317-A:12, III
Den 302.02	RSA 317-A:12, XIII
Den 302.03	RSA 317-A:12, III
Den 302.04	RSA 317-A:12, III
Den 302.05	RSA 317-A:12, III and XII-b
Den 302.06	RSA 317-A:12, III and XII-b
Den 302.07	RSA 317-A:12, III
Den 302.08	RSA 317-A:12, III
Den 303.01	RSA 317-A:9; 317-A:12, IV
Den 303.02	RSA 317-A:9; 317-A:12, IV; 317-A:21-a
Den 303.03	RSA 317-A:12, IV; RSA 317-A:12, XIV
Den 304.01	RSA 317-A:20, II; 317-A:12, XII-c (a)
Den 304.02	RSA 317-A:20, II; 317-A:12, XII-a (e) & (c)
Den 304.03	RSA 317-A:20, II; 317-A:12, XII-a (e) & (c)
Den 304.04	RSA 317-A:12, XII-a(f)
Den 304.05	RSA 317-A:12, XII-a (f) & (h)
Den 304.06	RSA 317-A:12, XII-a; RSA 317-A:20, II
Den 304.07	RSA 317-A:12, XII-a (f); RSA 317-A:12, XII-c
Den 304.08	RSA 317-A:12, XII-a (h)

Den 401.01	RSA 317-A:12, XIV; RSA 317-A:13
Den 401.02	RSA 317-A:12, III; RSA 317-A:12, XIV
Den 401.03	RSA 317-A:12, XIV; RSA 317-A:12-a
Den 401.04	RSA 317-A:12, XIV; RSA 317-A:12-a
Den 401.05	RSA 317-A:12, XIV
Den 401.06	RSA 317-A:16
Den 401.07	RSA 317-A:12, XI; RSA 317-A:12, XIV; RSA 317-A:20, II
Den 402.01	RSA 317-A:12, XII-a; RSA 317-A:12, XIV; RSA 317-A:20, II
Den 403.01	RSA 317-A:12, XII-a(c)
Den 404.01	RSA 317-A:12, XII-b
Den 404.02	RSA 317-A:12, XII-b
Den 404.03	RSA 317-A:12, XII-b
Den 405.01	RSA 317-A:21-c; RSA 317-A:12, XII-b
Den 405.02	RSA 317-A:12, XIV
Den 405.03	RSA 317-A:12, XIV
Den 406.01	RSA 317-A:12, XI
Den 406.02	RSA 317-A:12, XI
Den 406.03	RSA 317-A:12, XI
Den 406.04	RSA 317-A:12, XI
Den 406.05	RSA 317-A:12, XI
Den 406.06	RSA 317-A:12, XI
Den 407.01	RSA 317-A:17, II
Den 407.02	RSA 310:12, I(e)
Den 407.03	RSA 310:12, I(e)
Den 407.04	RSA 310:12, I(e)
Den 407.05	RSA 310:12, I(e)
Den 407.06	RSA 310:12, I(e)

Den 501.01	RSA 317-A:12, VI
Den 502.01	RSA 318-B:33
Den 503	RSA 317-A:12, VI, XIII; RSA 318-B:41, I(a)(2), II
Den 503.02	RSA 317-A:12, VI and XIII; RSA 318-B:41, I(a)(2) and II
Den 503.07	RSA 317-A:12, VI and XIII; RSA 318-B:41, I(a)(2) and II

APPENDIX II

Rule

Title

Obtain at:

Den 304.02 (b)(3)a.1.

and b.2.; (c)(3) b.2.;

and (m)(3)

ADA 2012 “Guidelines for the Use of Sedation and General Anesthesia by Dentists”

(Amended 2012)

American Dental Association

Obtain online www.ada.org/~/media/ADA/Advocacy/Files/ anesthesia_use_guidelines.ashx

Cost: none

Contact: (800) 621-8099

Jane Josek, ext. 2694

Den 304.02 (b)(3)b.1.; and (c)(3)b.1.

8^th edition of the “Office Anesthesia Evaluation Manual” of the American Association of Oral and Maxillofacial Surgeons, 2012

American Association of Oral and Maxillofacial Surgeons

Obtain online www.ada.org/~/media/ADA/Advocacy/Files/ anesthesia_use_guidelines.ashx

Cost: $95 (member)

$285 (non-member)

Contact: (800) 366-6725

Den 304.02 (c)(3)a.;

and (m)(2)

ADA 2012 “Guidelines for Teaching Pain Control and Sedation to Dentists and Dental Students”

(Amended 2012)

American Dental Association

Obtain online

www.ada.org/~/media/ADA/Member%20 Center/FIles/teaching_paincontrol_guidelines.ashx

Cost: none

Contact: (800) 621-8099

Jane Josek, ext. 2694

Den 304.04 (a)(3)a.;

and Den 304.06(a)(2)

ADA October 2016 “Guidelines for Teaching Pain Control and Sedation to Dentists and Dental Students”

(Amended Oct. 2016)

American Dental Association

Obtain online

www.ada.org/~/media/ADA/Member%20 Center/FIles/teaching_paincontrol_guidelines.ashx

Cost: none

Contact: (800) 621-8099

Jane Josek, ext. 2694

Den 304.06(a)(3)

ADA October 2016 “Guidelines for the Use of Sedation and General Anesthesia by Dentists”

American Dental Association

Obtain online www.ada.org/~/media/ADA/Advocacy/Files/ anesthesia_use_guidelines.ashx

Cost: none

Contact: (800) 621-8099

Jane Josek, ext. 2694

Den 304.02 (d)(1)

American Academy of Pediatric Dentistry 2006 “Guidelines for Monitoring and Management of Pediatric Patients During and After Sedation for Diagnostic and Therapeutic Procedures”

(Adopted 2006)

(Reaffirmed 2011 by American Academy of Pediatric Dentistry and American Academy of Pediatrics)

American Academy of Pediatric Dentistry

Obtain online

www.aapd.org/media/Policies_Guidelines/ G_Sedation.pdf

Cost: none

Contact: (312) 337-2169

Den 304.03 (b)(3)a.1. and b.2.; (c)(3) b.2.; and Den 304.04(a)(3)b., 2.

ADA 2016 “Guidelines for the Use of Sedation and General Anesthesia by Dentists”

American Dental Association

Obtain online www.ada.org/~/media/ADA/Advocacy/Files/ anesthesia_use_guidelines.ashx

Cost: none

Contact: (800) 621-8099

Jane Josek, ext. 2694

Den 304.03(b)(3)b.1; and Den 304.04(a)(3)b.1

8^th Edition of the “Office Anesthesia Evaluation Manual” of the American Association of Oral and Maxillofacial Surgeons, 2012

American Association of Oral and Maxillofacial Surgeons

Obtain online

https://www.aaomsstore.com/p-134-office-anesthesia-evaluation-manual-8th-edition.aspx

Cost: $95 (member)

$285 (non-member)

$190 (instutition)

Contact: (800) 366-6725

Den 304.04 (a)(3)a.;

and Den 304.06(a)(2)

ADA 2012 “Guidelines for Teaching Pain Control and Sedation to Dentists and Dental Students”

(Amended 2012)

American Dental Association

Obtain online

www.ada.org/~/media/ADA/Member%20 Center/FIles/teaching_paincontrol_guidelines.ashx

Cost: none

Contact: (800) 621-8099

Jane Josek, ext. 2694

Den 304.04(b)(1)

“Guidelines for Monitoring and Management of Pediatric Patients During and After Sedation for Diagnostic and Therapeutic Procedures”

(Eff. 2006)

American Academy of Pediatric Dentistry

Obtain online

http://www.aapd.org/media/Policies_Guidelines/

G_Sedation1.pdf

Cost: none

Den 304.06(a)(3)

“Guidelines for the Use of Sedation and General Anesthesia by Dentists”

(Eff. 2012)

American Dental Association

Obtain online

http://www.ada.org/en/~/media/ADA/

Education%20and%20Careers/

Files/ADA_Sedation_Use_Guidelines

Cost: none

Den 501.01 (a); Den 302.04 (b)

Principles of Ethics and Code of Professional Conduct

(Amended April 2012)

American Dental Association

Obtain online www.ada.org/194.aspx

Cost: none

Contact: (312) 440-2500

American Dental Association

211 East Chicago Ave.

Chicago, IL 60611-2678

Den 501.01 (a)

Code of Ethics of the American Dental Hygienists Association

(Adopted June 20, 2011

Amended June 18, 2012)

American Dental Hygienists’ Association

Obtain online www.adha.org

Click on tab About ADHA,

then click on Bylaws and Ethics

Cost: none

Any questions or information requests can be directed to membership. services@adha.net

or by calling (312) 440-890

Den 501.01(p) and Den 404.01(i)(1)a.

Dental Radiographic Examinations: Recommendations for Patient Sedation and Limiting Radiation Exposure

(Revised 2016)

American Dental Association

Obtain online at no cost at:

http://www.ada.org/~/media/ADA/Member%20Center/

FIles/Dental_Radiographic_Examinations_2012.ashx

Den 404.01(i)(1)a.

Recommendations in Radiographic Practices: an update, 1988 (JADA, Volume 118, January 1989)

American Dental Association Council on Dental Materials, Instruments, and Equipment

Obtained at no cost at:

https://www.sciencedirect.com/sdfe/pdf/download/eid/1-s2.0-S0002817789810281/first-page-pdf

Den 501.01 (a); Den 302.04 (b)

Principles of Ethics and Code of Professional Conduct

(Amended Nov. 2016)

American Dental Association

Obtain online www.ada.org/194.aspx

Cost: none

Contact: (312) 440-2500

American Dental Association

211 East Chicago Ave.

Chicago, IL 60611-2678

Den 501.01 (a)

Code of Ethics of the American Dental Hygienists Association

(Adopted June 20, 2011

Amended June 13, 2016)

American Dental Hygienists’ Association

Obtain online www.adha.org

Click on tab About ADHA, then click on Bylaws and Ethics

Cost: none

Any questions or information requests can be directed to membership. services@adha.net

or by calling (312) 440-890

Den 503.07

The American Society of Addiction Medicine’s “National Practice Guideline For the Use of Medications in the Treatment of Addiction Involving Opioid Use,” adopted on June 1, 2015.

No cost to download from:

http://www.asam.org/quality-practice/guidelines-and-consensus-documents/npg/complete-guideline