Kentucky requires special registration for dental hygienists to administer local anesthesia, practice under general supervision, insert intravenous access lines, perform laser debridement, and practice as public health hygienist. Pursuant to state law, hygienists can only perform these duties if they have the appropriate experience and are formally registered with the Board. These requirements are in excess of those necessary to obtain a standard dental hygiene license.
Local Anesthesia
A licensed dental hygienist who desires to administer local anesthesia in Kentucky must receive formal training from a dental or dental hygiene school accredited by the Commission on Dental Accreditation (CODA) that meets the following requirements:
- A minimum of thirty-two hours covering anatomical considerations, basic injunction technique, basic placement technique, nitrous oxide administration, recordkeeping, armamentarium exercise, local anesthesia and nitrous oxide, techniques of maxillary anesthesia, techniques of mandibular injections, partner injections and partner administration of nitrous oxide, neurophysiology, pharmacology, pharmacology of vasoconstrictors, physical and psychological evaluation, and contraindications;
- A minimum of two hours of clinical education for nitrous oxide administration with successful completion of administration, monitoring, and removal of nitrous oxide on at least two patients;
- A minimum of twelve hours demonstrating mastery of local anesthesia applications and successful completion of at least three injections each of all maxillary and mandibular injection sites; and
- A passing score of at least 75% on a written examination administered after coursework and clinical training.
Pease note that a dental hygienist holding a local anesthesia registration from the Board who has not administered block anesthesia, infiltration anesthesia, or nitrous oxide analgesia for one year must complete a board approved refresher course prior to resuming practice of that specific technique.
General Supervision
Requirements for General Supervision Registration
- An individual licensed as a hygienist in Kentucky and not subject to disciplinary action who desires to practice under general supervision shall:
- Complete the General Supervision Registration Application;
- Meet the requirements of KRS 313.040(7)(a);
- Document through payroll records, employment records, or other proof that is independently verifiable the dates and hours of employment by a dentist in the practice of dental hygiene that demonstrate the required two (2) years and 3,000 hours of experience;
- Successfully complete a live three (3) hour course approved by the board in the identification and prevention of potential medical emergencies that shall include, at a minimum, the following topics:
- Medical history, including American Society of Anesthesiologists (ASA) classifications of physical status;
- Recognition of common medical emergency situations, symptoms, and possible outcomes;
- Office emergency protocols; and
- Prevention of emergency situations during dental treatments.
- An individual authorized to practice under these provisions shall receive a license from the board indicating registration to practice under general supervision.
- A dentist who employs a dental hygienist who has met the standards of this administrative regulation and who allows the dental hygienist to provide dental hygiene services pursuant to KRS 313.040(7) shall complete a written order prescribing the dental service or procedure to be done to a specific patient by the dental hygienist and shall retain the original order in the patient's dental record.
- The minimum requirements for the written order shall include:
- Medical history update;
- Radiographic records requested;
- Dental hygiene procedures requested;
- Name of the patient;
- Date of last oral examination;
- Date of the written order; and
- Signature of the dentist
- The oral examination of the patient by the supervising dentist shall have been completed within the seven (7) months preceding treatment by the dental hygienist practicing under general supervision.
- The supervising dentist shall evaluate and provide to the board written validation of an employed dental hygienist's skills necessary to perform dental hygiene services established in KRS 313.040(7) as part of the General Supervision Registration Application.
- The supervising dentist shall provide a written protocol addressing the medically compromised patients who may or may not be treated by the dental hygienist. The dental hygienist shall only treat patients who are in the ASA Patient Physical Status Classification of ASA I or ASA II as listed in Guidelines for Teaching Pain Control and Sedation to Dentists and Dental Students, 2007 Edition, American Dental Association.
- A licensed dental hygienist shall not practice under general supervision if the licensee does not hold a general supervision registration issued by the board.
A hygienist must submit a separate application and $50 fee for each dentist for whom she wishes to practice general supervision.
To maintain general supervision privileges, a registered dental hygienist shall successfully complete a live three hour refresher course approved by the board in the identification and prevention of potential medical emergencies.
Intravenous Access Lines
To start IV access lines under the supervision of a licensed dentist who holds a sedation or anesthesia permit, a dental hygienists must complete a course approved by the Board that addresses patient safety techniques, anatomy and physiology, and techniques for starting and maintaining IV lines.
Application for Intravenous Access Line Administration
Public Health
- An individual licensed as a hygienist in Kentucky and not subject to disciplinary action who desires to practice as a public health registered dental hygienist shall:
- Submit a completed Public Health Registered Dental Hygienist Application;
- Meet the requirements established in KRS 313.040(8);
- Document through payroll records, employment records, or other proof that is independently verifiable, the dates and hours of employment by a dentist in the practice of dental hygiene that demonstrate the required two (2) years and 3,000 hours of experience; and
- During each renewal cycle, successfully complete a live three (3) hour course that has been approved by the board on the identification and prevention of potential medical emergencies that shall include, at a minimum, the following topics:
- Medical history, including American Society of Anesthesiologists (ASA) classifications of physical status;
- Recognition of common medical emergency situations, symptoms, and possible outcomes;
- Office emergency protocols; and
- Prevention of emergency situations during dental treatments.
An individual authorized to practice pursuant to subsection (1) of this section shall receive a certificate from the board indicating registration to practice as a public health registered dental hygienist. - A public health registered dental hygienist desiring to maintain certification as a public health registered dental hygienist shall be required to complete at least five (5) hours of continuing education in the area of public health or public dental health during each renewal cycle.
- Pursuant to KRS 313.040(8)(c), a public health registered dental hygienist may practice in a government-created public health program at the following sites:
- Local health departments;
- Public or private educational institutions that provide Head Start, preschool, elementary and secondary instruction to school aged children under the jurisdiction of the State Board of Education, and that have an affiliation agreement with the health department of jurisdiction;
- Mobile and portable dental health programs under contract with a governing board of health; and
- Public or private institutions under the jurisdiction of a federal, state, or local agency.
- A public health registered dental hygienist shall perform dental hygiene services only under the supervision of the governing board of health, as required by KRS 313.040(3)(b), as established in KRS 313.040(8), and as identified by the Department for Public Health Practice Reference.
- These services shall be limited to preventative services.
- The public health registered dental hygienist shall only treat a patient who is in the ASA Patient Physical Status Classification of ASA I or ASA II as established in the current edition of Guidelines for Teaching Pain Control and Sedation to Dentists and Dental Students, American Dental Association.
- The informed consent shall be required prior to preventative services and shall include:
- The name of the public health entity, including the name of the dentist, that assumes responsibility and control;
- An inquiry as to the current dentist; and
- A statement that services are provided by a dental hygienist without the direct supervision of a dentist.
- This administrative regulation shall not preclude a Kentucky-licensed dentist from directly participating in a public health program referenced in subsection 4(a), (b), (c), or (d) of this subsection.
The Kentucky Board of Dentistry requires a hygienist applying to be certified in laser debridement must show successful completion of a course that meets or exceeds the Academy of Laser Dentistry’s Category II Standard Proficiency level certification course as described in the Curriculum Guidelines and Standards for Dental Laser Education.
The Category II Standard Proficiency course, in brief includes a minimum of 12 hours of specific educational activity, which should include hands on training on the specific device the practitioner intends to use and a measured outcome learning verification exercise.
The course completion certificate issued by the course provider must include the type of laser/lasers and wavelengths on which the participant was trained.
Application for Laser Debridement Registration