January 29, 2004, Meeting of COMDA
Agenda
Agenda Item Information
Minutes
Agenda
Notice of PUBLIC
MEETING -
Notice is hereby given that a public meeting
of the Committee on Dental Auxiliaries will
be held as follows
January
29, 2004 - 9:00 a.m.
Sacramento
Marriott Rancho Cordova, 11211 Point East Drive,
Rancho Cordova - 916-638-1100
Agenda
1.
Call to Order/Roll Call/Establishment of Quorum
2. Approval of November 6, 2003, Meeting Minutes
3. Report of the Chair
4. Report of the Executive Officer
5. Legislation of Interest to COMDA
a. AB539 – 3rd and 4th year
dental students applying for RDH licensure
RDA Program
6. Review of RDA Educational Programs and Courses/Recommendations to Board
7. Proposed New Regulation 1070.3 – Approval of Pit and Fissure Sealant
Courses
8. Proposed Changes to Regulation 1081.1 – RDA Practical Examination
Requirements
9. Proposed Changes to Business and Professions Code Section 1645.1 – Required
Coronal Polishing and Radiation Safety Courses for RDAs
10. Proposed Changes to Regulations 1014 and 1014.1 – Approval of Radiation
Safety Programs
11. Teaching Methodology Course for RDA Educational Program Faculty
RDHAP Program
12. Consideration of RDHAP Educational Program Application of UOP
All Programs
13. Agenda Items for Future Meetings
14. Establishment of Future Meeting Dates
15. Public Comment
16. Adjournment
The Committee may take
action on any item listed on the agenda unless
listed as information only. All times are approximate
and subject to change. Public comments will be
taken on agenda items at the time the specific
item is raised. Items may be taken out of order
to accommodate speakers and to maintain a quorum.
The meeting may be cancelled without notice. For
meeting verification, call (916) 263-2595 or access
the Committee’s website at www. comda. ca.gov.
The meeting is accessible to the physically disabled.
A person who needs disability-related accommodations
or modifications in order to participate in the
meeting shall make a request to the Committee by
contacting Karen Wyant at (916) 263-2300 or sending
a written request to the person at the Committee
on Dental Auxiliaries, 1428 Howe Avenue, Suite
58, Sacramento, CA 95825, one week prior to the
day of the meeting. Contact: Karen Wyant, (916)
263-2595 or email Karen_Wyant@dca.ca.gov.
AGENDA
ITEM INFORMATION
5.
Legislation of Interest to COMDA
a. AB539 – 3rd and
4th year dental students applying
for RDH licensure
AB539 would allow 3rd and
4th year California dental school students
in good standing to apply for a Registered Dental
Hygienist license, which would require completion
of the National written examination and the State
clinical examination. It was amended before leaving
the Assembly to provide that a successful applicant
may only practice in a dental practice that serves
patients who are insured under Denti-Cal, the Healthy
Families Program, or other governmental programs,
or a dental practice that has a sliding scale fee
system based on income.
However, the language
is unclear as to whether the practice, for example,
need only serve one person in one of the designated
classes per year, or a majority of time, or exclusively.
In the Senate, the bill was amended to require that the examination fee for
such applicants not exceed the actual cost of the examination.
The bill was placed
on the inactive file by the author this year, and
may be restored to active status as a two-year
bill when the Legislature reconvenes in January.
The status of the bill will be reported at the
meeting.
As requested by members
at the November COMDA meeting, attached is information
provided by both the California Dental Association
(CDA) and the California Dental Hygienists Association
(CDHA) regarding the comparison between dental
hygiene education received by 3rd and
4th year dental students and that received
by dental hygiene program graduates.
6.
Review of RDA Educational Programs and Courses
Staff and consultants
have reviewed the curriculum and conducted an on-site
evaluation of the following proposed full RDA educational
program, and it is recommended that COMDA recommend
provisional approval to the Board. COMDA staff
and consultants then perform another on-site inspection
of the program at a later date to assure that it
is operating appropriately, and then make a recommendation
as to whether the program should be granted full
approval.
a. Silicon Valley College,
Fremont
Any other programs or
courses that are ready for consideration by the
meeting date will be presented at the meeting.
7.
Proposed New Regulation 1070.3 – Approval
of Pit and Fissure Sealant Courses
In July, the Board voted
to amend regulation section 1086 to allow RDAs
to apply pit and fissure sealants if they have
completed a Board-approved course.
At COMDA’s November
meeting, a regulation was proposed to define the
requirements that such courses must meet to obtain
approval from the Board. It was decided to establish
a subcommittee to review and finalize the proposal.
After the meeting, it was determined that it would
be more timely and save money if comments were
collected informally and compiled for COMDA to
consider at its next meeting.
Vice Chair Drury-Klein
was designated by the Chair to coordinate this
effort. Attached is the original proposal, with
strike-out and underline indicating consensus changes
collected from the comments submitted. Also attached
are comments received from only single individuals,
which are not reflected in the revised proposal.
The format generally
follows the regulations that govern full RDA educational
programs, which were recently substantially amended.
____________
Proposed
New Regulation 1070.3: Approval of Pit and Fissure
Sealant Courses
1070.3 Approval of
Pit and Fissure Sealant Courses.
The following minimum
criteria shall be met for a course in the application
of pit and fissure sealants to secure and maintain
approval by the Board.
(a)
Educational Setting. The course shall
be established at the post-secondary
educational level.
(b) Prerequisites. Each student must possess the necessary requirements
for application for RDA licensure or currently possess an RDA license. Each student
must have already completed a Board-approved course in coronal polishing.
(c) Administration/Faculty. Adequate provision for the supervision
and operation of the course shall be made.
(1) The course director and each faculty
member shall possess a valid, active, and current RDAEF, RDH, RDHEF, RDHAP, or
dentist license issued by the Board, or an RDA license issued by the Board if
the person has completed Board-approved courses in coronal polishing and the
application of pit and fissure sealants. All faculty
shall have been licensed for a minimum of two years. All faculty shall
have the educational, background,
and occupational experience and/or teaching expertise necessary to teach, place,
and evaluate the application of pit and fissure sealants. All
faculty responsible for clinical evaluation shall have completed a two hour methodology
course in clinical evaluation.
(2) The course director must have the education, background,
and occupational experience necessary
to understand and fulfill the course
goals. He/she shall actively participate
in and be responsible for the day-to-day
administration of the course including
the following:
(A) Providing
daily guidance of didactic, laboratory and clinical assignments.
(B) Maintaining
for a period of not less than 5 years:
(1)
Copies of curricula, course outlines, objectives, and grading criteria.
(2)
Copies of faculty credentials, licenses, and certifications.
(3)
Individual student records, including those necessary to establish satisfactory
completion of the course.
(C) Informing
the Board of any changes to the course content, physical facilities, and/or faculty,
within 10 days of such changes.
(d) Length of Course. The program shall be of sufficient duration
for the student to develop minimum competence in the application of pit and fissure
sealants, but shall in no event be less than 16 clock hours, including at least
4 hours of didactic training, at least 4 hours of laboratory training, and at
least 8 hours of clinical training.
(e) Evidence of Completion. A certificate or other evidence of completion
shall be issued to each student who successfully completes the course.
(f) Facilities and Resources. Facilities and class scheduling shall
provide each student with sufficient opportunity, with instructor supervision,
to develop minimum competency in applying pit and fissure sealants. Such facilities
shall include safe, adequate and educationally conducive:
(1) Lecture classrooms. Classroom size and equipment
shall accommodate the number of students enrolled.
(2) Operatories. Operatories shall be sufficient
in number to allow a ratio of at least one operatory for every five students
at any one time.
(A) Each operatory shall
replicate a modern dental office containing functional equipment including: a
power-operated chair for treating patients in a supine position; operator and
assistant stools; air-water syringe; adjustable light; oral evacuation equipment;
work surface; hand-washing sink; curing light, and all other armamentarium required
to instruct in the application of pit and fissure sealants.
(B) Each operatory must
be of sufficient size to accommodate a practitioner, a student, an instructor,
and a patient at one time.
(3) Laboratories. The location and number of general
use equipment shall assure that each student has the access necessary to develop
minimum competency in the application of pit and fissure sealants. Protective
eyewear is required for each piece of equipment.
(4) Infection Control. The program shall establish
written clinical and laboratory protocols to ensure adequate asepsis, infection
and hazard control, and disposal of hazardous wastes, which shall comply with
the board's regulations and other Federal, State, and local requirements. The
program shall provide such protocols to all students, faculty, and appropriate
staff to assure compliance with such protocols. Adequate space shall be provided
for preparing and sterilizing all armamentarium.
(5) Emergency Materials/Basic Life Support.
(A) A written policy
on managing emergency situations must be made available to all students, faculty,
and staff.
(B) All students,
faculty, and staff involved in the direct provision of patient care must be certified
in basic life support procedures, including cardiopulmonary resuscitation. Re-certification
intervals may not exceed two years. The program must document, monitor, and ensure
compliance by such students, faculty, and staff.
(g) Program Content.
(1) Sufficient time shall be available for
all students to obtain laboratory and clinical experience to achieve minimum
competence in the various protocols used in the application of pit and fissure
sealants.
(2) A detailed course outline shall be provided
to the board which clearly states curriculum subject matter and specific instruction
hours in the individual areas of didactic, laboratory, and clinical instruction.
(3) General program objectives and specific
instructional unit objectives shall be stated in writing, and shall include theoretical
aspects of each subject as well as practical application. The theoretical aspects
of the program shall provide the content necessary for students to make judgments
regarding the application of pit and fissure sealants. The course shall assure
that students who successfully complete the course can apply pit and fissure
sealants with minimum competence.
(4) Objective evaluation criteria shall
be used for measuring student progress toward attainment of specific course objectives.
Students shall be provided with specific unit objectives and the evaluation criteria
that will be used for all aspects of the curriculum including written and practical
examinations. The program shall establish a standard of performance that states
the minimum number of satisfactory performances that are required for each procedure.
(5) Areas of instruction shall include at
least the following as they relate to pit and fissure sealants:
(A) Dental Science
- Oral Anatomy, Histology, Physiology, Oral Pathology,
Normal/Abnormal Anatomical and Physiological
Tooth Descriptions
(B) Morphology and Microbiology
(C) Dental Materials and Pharmacology
(D)Sealant Basics
i. Legal requirements
ii. Description and goals of sealants
iii. Indications and contraindications
iv. Role in preventive programs
(E) Sealant Materials
i. Etchant and/or
etchant/bond combination material composition,
process, storage and handling
ii. Sealant material composition, polymerization type, process, storage
and handling
iii. Armamentaria for etching and sealant application
iv. Problem solving for etchant and sealant material placement/manipulation
(F)
Sealant Criteria
i. Areas of application
ii. Patient selection factors
iii. Other indication factors
(G) Preparation Factors
i. Moisture control
protocol
ii. Tooth/teeth preparation procedures prior to etching or etchant/bond
(H) Acid Etching or
Etchant/Bond Combination
i. Material preparation
ii. Application areas
iii. Application time factors
iv. Armamentaria
v. Procedure
vi. Etchant or etchant/bond evaluation criteria
(I) Sealant Application
i. Application
areas
ii. Application time factors
iii. Armamentaria
iv. Procedure for chemical cure and light cure techniques
v. Sealant evaluation criteria
vi. Sealant adjustment techniques
(J) Infection control
protocol
(K) Clinical re-call
re-evaluation protocols
(6)
There shall be no more than 14 students per instructor
during laboratory instruction. Laboratory instruction
may be conducted on a typodont, a simulated model,
and/or mounted extracted
teeth. Sufficient time shall be available for all
students to obtain laboratory experience to achieve
minimum competence in pit and fissure sealant application
prior to the performance of procedures on patients.
(7) Clinical instruction shall be of sufficient
duration to allow the procedures to be performed to clinical proficiency. There
shall be no more than 6 students per instructor during clinical instruction.
Clinical instruction shall include clinical experience on four patients with two of the four patients used for the clinical
examination. Each clinical patient must have a minimum of four
(4) virgin, non-restored, natural teeth, sufficiently erupted so that a dry field
can be maintained, for application of the etching, or etchant/bond combination,
and sealant materials. Such clinical instruction shall include teeth in all four
quadrants among the four patients. for
each patient.
(h) Externship Instruction.
(1) If an extramural clinical facility is
utilized, students shall, as part of an organized program of instruction, be
provided with planned, supervised clinical instruction in the application of
pit and fissure sealants.
(2) The program director/coordinator or
a dental faculty member shall be responsible for selecting extern clinical sites
and evaluating student competence in performing procedures both before and after
the clinical assignment.
(3) Objective evaluation criteria shall
be used by the program faculty and clinic personnel.
(4) Dentists who intend to provide extramural
clinical practices shall be oriented by the program director/coordinator or a
dental faculty member prior to the student assignment. Orientation shall include
the objectives of the course, the preparation the student has had for the clinical
assignment, and a review of procedures and criteria to be used by the dentist
in evaluating the student during the assignment.
(5) There shall be a written contract of
affiliation with each extramural clinical facility utilized by the program. Such
contract shall describe the settings in which the clinical training will be received,
affirm that the clinical facility has the necessary equipment and armamentarium
appropriate for the procedures to be performed, and affirm that such equipment
and armamentarium are in safe operating condition.
(i)
Evaluation and Examination.
(1) Upon completion of the course, each
student must be able to:
(A) Identify the
major characteristics of oral anatomy, histology,
physiology, oral pathology, normal/abnormal
anatomical and physiological tooth descriptions,
morphology and microbiology as they relate
to pit and fissure application.
(B)
Explain the procedure to patients.
(C)
Recognize decalcification, caries and fracture
lines.
(D)
Identify the indications and contraindications
for sealants.
(E)
Identify the characteristics of self curing and
light cured sealant material.
(F) Define the appropriate
patient selection factors and indication factors
for sealant application.
(G)
Utilize proper armamentaria in an organized sequence.
(H) Maintain appropriate
moisture control protocol before and during
application of etchant and sealant material.
(I) Demonstrate
the proper technique for teeth preparation
prior to etching.
(J)
Select and dispense the proper amount of etchant
and sealant material.
(K)
Demonstrate the proper techniques for application
of the etchant and sealant material.
(L)
Implement problem solving techniques associated
with pit and fissure sealants.
(M)
Evaluate the etchant and sealant placement techniques
according to appropriate criteria.
(N)
Check the occlusion and proximal contact for appropriate
placement techniques.
(O)
Adjust occlusion and proximal contact of sealant
when indicated.
(P)
Maintain aseptic techniques including disposal
of contaminated material.
(2) Each student shall pass a written
examination which reflects the entire curriculum content.
(3)
Each student shall pass a clinical examination in which the student successfully
completes the application of pit and fissure sealants on two of the four clinical
patients required for clinical instruction. The examination shall include teeth
in all four quadrants.
Note: Authority cited: Section 1614, Business
and Professions Code. Reference: Section 1754, Business and Professions Code.
8.
Proposed Changes to Regulation 1081.1 – RDA
Practical Examination Requirements
In July, the Board voted
to amend regulation section 1086 to allow RDAs
to perform a number of new duties. While the regulation
is currently on hold pursuant to the Governor’s
Executive Order S2-03, the regulation defining
what procedures should be included on the RDA practical
examination may need to be changed.
Attached is a list of
the proposed new duties, followed by a copy of
the current regulation. COMDA may wish to discuss
which duties, if any, should be added to the list
of testable duties contained in Regulation section
1081.1, so that a proposal can be finalized at
COMDA’s March meeting, and presented to the
Board at that time.
The current regulation
lists many duties that MAY be tested; COMDA’s
RDA Examination Subcommittee then chooses two procedures
to actually be tested. One alternative that COMDA
may want to consider would be to add all, or nearly
all, of the new procedures to the list of duties
that can potentially be tested, then ask for feedback
from the RDA Examination Subcommittee on the feasibility
and/or desirability of testing each procedure.
RDA Examination Requirements
New duties contained in proposed
changes to Regulation 1086:
1. Size, fit, adjust, pre-position,
cure in dentist-approved position of, and remove
orthodontic bands and brackets (currently allowed
to size bands, remove bands, and place and ligate
arch wires).
2. Take facebow transfers and bite
registrations (bite registrations currently must
be for diagnostic study models only)
3. Take impressions for space maintaining
appliances, orthodontic appliances, and occlusal
guards.
1081.1. RDA Practical Examination-Requirements.
(a) In addition to the written examination, each applicant for licensure as
an RDA shall also take a practical examination consisting of any or all
of the procedures listed below. The specific procedures will be assigned
by an RDA examination committee appointed by the board. The procedures
shall be performed on a full articulated maxillary and mandibular typodont
secured with a bench clamp and shall be graded by examiners appointed by
the board for that purpose. Each applicant shall furnish the required materials
necessary to complete all of the following procedures.
(1) Placement of a rubber dam;
(2) Placement of a matrix band for amalgam preparation;
(3) Placement of a base into a prepared tooth
(For purposes of the examination, "prepared
tooth" means a tooth from which material has been removed so as to
simulate the surgical excision of dental caries);
(4) Placement of a liner into a prepared tooth;
(5) Placement of orthodontic separators;
(6) Placement of a periodontal dressing;
(7) Placement of a temporary sedative dressing into a prepared tooth.
(8) Sizing and placement of a temporary crown.
(9) Temporary cementation of a temporary crown.
(10) Removal of excess cement from supragingival surfaces with a hand instrument
or floss.
Note Authority cited: Section
1614, Business and Professions Code. Reference:
Sections 1614 and 1753, Business and Professions Code.
9.
Proposed Changes to Business and Professions
Code Section 1645.1 – Required Coronal
Polishing and Radiation Safety Courses for
RDAs
During a previous review
by the Joint Legislative Sunset Review Committee
(JLSRC), COMDA and the Board recommended that all
RDAs, who had not already done so, should be required
to complete Board-approved courses in radiation
safety and coronal polishing.
The JLSRC agreed and
sponsored successful legislation placing such a
requirement in statute (section 1645.1). The law
provides that on and after January 1, 2005, all
RDA licensees who have not complied will be automatically
suspended until certification of completion is
received.
Two
issues have resulted:
1. COMDA is still in
the process of mailing notices to all affected
licenses (about 27,000), and considerable staff
resources have had to be devoted to answering inquiries
regarding the new requirement, processing certificates,
and searching the Board x-ray records that existed
prior to 1985. At the meeting, staff will provide
COMDA with the number of RDAs who have still not
completed the requirements.
If the number is large,
COMDA may want to consider seeking an amendment
to the law extending the date by one year, so that
affected RDAs have sufficient time to comply, and
to assure that the workload is extended another
year for a very limited COMDA staff.
2.
The revised law did not make an exception for RDAs
who have placed their licenses on inactive statue.
An RDA can place his or her license on inactive
status at any time, which means the licensee has
to pay the renewal fee every two years, but does
not have to complete any CE requirements until
he or she requests that the license be reactivated.
Staff has received many
complaints from inactive licensees about the new
radiation safety and coronal polishing requirement.
COMDA may want to consider seeking an amendment
to require that proof of completion of the two
courses be submitted by inactive licensees only
when and if they seek to re-activate their licenses.
10. Proposed Changes to Regulations 1014 and 1014.1 – Approval
of Radiation Safety Programs
Regulation sections
1014 and 1014.1 define the requirements that providers
must meet to obtain and maintain Board approval
to offer radiation safety programs.
Attached are proposed
amendments that will be presented by Vice Chair
Drury-Klein.
1014. Approval of
Radiation Safety Courses.
(a) A radiation safety course is one which has as its primary purpose
providing theory and clinical application in radiographic techniques. A single
standard of care shall be maintained and the board shall approve only those courses
which continuously maintain a high quality standard of instruction.
(b) A radiation safety course applying for approval shall submit
to the board an application and other required documents and information on forms
prescribed by the board. The board may approve or deny approval of any such course.
Approval may be granted after an on-site evaluation of all components of the
course has been performed and the report of such evaluation indicates that the
course meets the board's requirements. The board may, in lieu of conducting its
own investigation, accept the findings of any commission or accreditation agency
approved by the board and adopt those findings as its own.
(c) The board may withdraw its approval of a course at any time,
after giving the course provider written notice setting forth its reason for
withdrawal and after affording a reasonable opportunity to respond. Approval
may be withdrawn for failure to comply with the board's standards or for fraud,
misrepresentation or violation of any applicable federal or state laws relating
to the operation of radiographic equipment.
(d) The processing times for radiation safety course approval are
set forth in Section 1061.
Note Authority
cited: Sections 1614 and 1656, Business and Professions
Code. Reference: Section 1656 Business and Professions
Code; and Section 15376, Government Code.
1014.1. Requirements for Radiation
Safety Courses.
A radiation safety course shall comply
with the requirements set forth below
in order to secure and maintain approval
by the board. The course of instruction
in radiation safety and radiography techniques
offered by a school or program approved
by the board for instruction in dentistry,
dental hygiene or dental assisting shall
be deemed to be an approved radiation
safety course if the school or program
has submitted evidence satisfactory to
the board that it meets all the requirements
set forth below.
(a) Educational Level. The course shall be established at the postsecondary
educational level or a level deemed equivalent thereto by the board.
(b) Program Director. The program director, who may also be an instructor,
shall actively participate in and be responsible for at least all of the following:
(1) Providing daily guidance of didactic,
laboratory and clinical assignments;
(2) Maintaining all necessary records, including
but not limited to the following:
(A) Copies of current
curriculum, course outline and objectives;
(B) Faculty credentials;
(C) Individual student
records to include pre-clinical and clinical
evaluations, examinations and copies of all successfully completed radiographic
series used toward course completion. Records are to be maintained for at least
five years from the date of course completion.
(3) Issuing certificates to each student
who has successfully completed the course and maintaining a record of each certificate
for at least five years from the date of its issuance;
(4) Transmitting to the board on a form
prescribed by the board the name, address social
security number and, where applicable,
license number of each student who has successfully completed the course;
(5) Informing the board of any significant
revisions to the curriculum or course outlines.
(c) Faculty. The faculty shall be adequate in number, qualifications
and composition and shall be suitably qualified through academic preparation,
professional expertise, and/or appropriate training, as provided herein. Each
faculty member shall possess the following qualifications:
(1) Hold a valid special permit or valid
license as a dentist, registered dental hygienist or registered dental assistant
issued by the board;
(2) Have background in and current knowledge
of dental radiography techniques;
(3) Shall have either passed the radiation
safety examination administered by the board or equivalent licensing examination
as a dentist, registered dental assistant,or dental hygienist or, on or after January 1, 1985,
shall have successfully completed a board approved radiation safety course.
(d) Facilities. There shall be a sufficient number of safe, adequate,
and educationally conducive lecture classrooms, radiography operatories, darkrooms,
and viewing spaces for mounting, viewing and evaluating radiographs. Adequate
sterilizing facilities shall be provided and
all disinfection and sterilization procedures shall be followed according to
the Board’s Infection Control Regulations.
(1) A radiographic operatory shall be deemed
adequate if it fully complies with the California Radiation Control Regulations
(Title 17, Cal. Code Regs., commencing with section 30100), is properly equipped
with supplies and equipment for practical work and includes for every seven students
at least one functioning radiography machine which is adequately filtered and
collimated in compliance with Department of Health Services regulations and which
is equipped with the appropriate position-indicating devices for each technique
being taught.
(2) The darkroom shall be deemed adequate
if it is of sufficient size, based upon the number of students, to accommodate
students' needs in learning various processing procedures and is properly equipped with
supplies and equipment for practical work using
either manual or automatic equipment.
(3) X-ray areas shall provide protection
to patients, students, faculty and observers in full compliance with applicable
statutes and regulations.
(e) Didactic Instruction and Demonstration. Sufficient classroom
instruction shall be provided in at least the following subjects to provide the
educational foundation necessary for the laboratory and clinical phases of the
program:
(1) Radiation physics and biology
(2) Radiation protection and safety
(3) Film exposure and processing techniques using either manual or
automatic methods
(4) Film mounting and viewing
(5) Intraoral techniques and holding devices
(6) Use of cylindrical and rectangular collimation
(7) Supplemental techniques including the optional use of Computerized Digital
Radiography
(8) Infection control in Dental Radiographic
procedures.
Students may be given the opportunity to obtain credit by the use of challenge
examinations and other methods of evaluation.
(f) Laboratory Instruction. Sufficient hours of laboratory instruction
shall be provided to ensure that a student successfully completes on a manikin
at least the procedures set forth below. A procedure has been successfully completed
only if each film is of diagnostic quality as
defined by the American Association of Dental Schools' 1978 Position Paper on
Dental Radiography.
(1)
Two full mouth periapical surveys, consisting of at least 18 films each, 4
of which must be bitewings; no
more than one set may be completed using Computer Digital Radiographic equipment;
(2) Two bitewing surveys, consisting of
at least 4 films each;
(3) Developing and/or processing,
and mounting of exposed radiographs;
(4) Student and instructor written evaluation
of radiographs.
(g) Clinical Experience. The course of instruction shall include
sufficient clinical experience, as part of an organized program of instruction,
to obtain clinical competency in radiographic techniques. Clinical experience
shall include:
(1) Successful
completion of a minimum of four full mouth periapical surveys, consisting
of at least 18 films each, 4 of which must be bitewings. No
more than three sets may be completed using Computer
Digital Radiographic equipment. Such films
shall be of diagnostic quality as
defined by the American Association of Dental Schools' 1978 Position Paper on
Dental Radiography. All exposures made on human subjects shall
only be made for diagnostic purposes. All clinical instruction procedures
on human subjects shall be performed under the supervision prescription of
a licensed dentist in accordance with sections 25661(h) and 25672(b) of the Health
and Safety Code and
under the clinical supervision/instruction of a licensed dentist, registered
dental assistant, or registered dental hygienist.
(2) Developing and/or processing, and
mounting of exposed human subject radiographs;
(3) Student and instructor written evaluation
of radiographs.
There shall be a written
contract of affiliation with each clinical facility utilized by a course. Such
contract shall describe the settings in which the clinical training will be
received and shall provide that the clinical facility has the necessary equipment
and accessories appropriate for the procedures to be performed and that such
equipment and accessories are in safe operating condition.
(h) Certificates. A certificate shall be issued to each student
who successfully completes the course. A student shall be deemed to have successfully
completed the course if the student has met all the course requirements and has
obtained passing scores on both written and clinical examinations.
Note Authority cited: Sections 1614 and
1656, Business and Professions Code. Reference: Section 1656, Business and
Professions Code.
11. Teaching Methodology
Course for RDA Educational Program Faculty
May 30, 2003 changes
to the regulations governing the approval of RDA
educational program provide that:
1070.2 (c)….(2) Effective two
years after the effective date of this regulation,
each faculty member shall have received a certificate
of completion of an COMDA approved course in teaching
methodology of at least 60 hours at a post-secondary
institution prior to student instruction.
This
requirement will be effective on and after May
30, 2005.
COMDA needs to determine
how it wishes to implement this requirement. Following
are two alternatives:
1. Review and approve
each course on a case-by-case basis. There would
be no requirement that a separate regulation defining
the standards that each course must meet, as long
as COMDA does not establish any "standards" or "requirements" that
each program must meet for approval. Initially,
at least, this may be the best solution since (a)
courses may be presented in a variety of different
formats that would be difficult to govern by one
regulation, and (b) COMDA may not have enough expertise
initially to define the standards that each course
must meet.
2. Develop a regulation
that will define all of the standards and requirements
that each course must meet. The drawbacks to doing
so would be that (a) courses may be presented in
a variety of different formats that would be difficult
to govern by one regulation, and (b) COMDA may
not have enough expertise at this time to define
the standards that each course must meet.
In addition, COMDA should
determine if a "course" must be one given
by one provider in a continuous format, or if multiple
courses, perhaps given by different providers,
would be sufficient.
12.
Consideration of RDHAP Educational Program
Application of UOP
The University of the
Pacific (UOP) has submitted an application for
approval of a proposed RDHAP educational program
(there is currently only one approved program – West
Los Angeles College). The application has been
reviewed by two COMDA educational consultants in
conjunction with a COMDA subcommittee composed
of Shanda Wallace and Darla Dale.
The Subcommittee will
make its recommendation at the meeting.
Following is the text
of the Board regulations governing the approval
of such programs.
1073.2 Approval of RDHAP
Educational Programs.
(a) The Board shall approve only those educational programs for registered
dental hygienists in alternative practice (RDHAPs) which continuously maintain
a high quality standard of instruction. The requirements contained in this
article are designed to that end and govern the approval of educational programs
for RDHAPs. Continuation of approval will be contingent upon compliance with
these requirements.
(b) An educational program for RDHAPs is one which has as its primary purpose
providing college level education including, but not limited to, dental hygiene
technique and theory, which shall include gerontology, medical emergencies,
business administration and practice management as they pertain to RDHAPs.
The program shall be given by a college or institution of higher education
that is accredited by a national agency recognized by the Council for Higher
Education Accreditation.
(c) Any program for RDHAPs shall apply for and receive approval prior to operation.
The Board may approve, provisionally approve, or deny approval of any such
program. Provisional approval shall not be granted for a period which exceeds
the length of the program and in no event for more than 30 days. When the Board
provisionally approves a program, it shall state the reasons therefor. Provisional
approval shall be limited to those programs which substantially comply with
all existing standards for full approval. A program given provisional approval
shall immediately notify each student of such status. The Board's maximum processing
time for an application for an RDHAP educational program shall not exceed ten
days to notify the applicant in writing that the application is complete and
accepted for consideration by the Board or, that the application is deficient
and what specific information is required. The Board's maximum time to approve,
provisionally approve, or deny approval of the RDHAP educational program shall
not exceed 90 days upon the filing of a completed application.
The Board may, in lieu of conducting its own investigation, accept the findings
of any national agency recognized by the Council for Higher Education Accreditation
and adopt those findings as its own. If the Board denies approval of a program,
the specific reasons therefor shall be provided by the Board in writing within
90 days after denial.
Note Authority cited: Section
1614, Business and Professions Code. Reference: Section
1768, Business and Professions Code.
History: Amendment of subsections (b) and (c) filed 5-22-2003; operative 6-21-2003.
1073.3. Requirements for
Approval of RDHAP Educational Programs.
(a) Requirements of Students: All students must possess a valid, active registered
dental hygienist license issued by the Board and hold a current CPR certification
in order to be eligible for admission to the program.
(b) Administration. Each program shall provide the resources necessary to accomplish
education of RDHAPs as specified in this section.
(c) Facilities and Equipment. Physical facilities and equipment shall be maintained
and replaced in a manner designed to provide students with an educationally
optimal environment.
(d) Curriculum Organization/Learning Resources.
(1) The organization of the curriculum for RDHAPs shall be flexible, creating
opportunities for adjustments to and research of advances in the practice of
registered dental hygiene in alternative practice. In addition each program
shall establish and maintain qualitative standards for proficiency and accomplishment.
(2) Students shall have access to dental/medical reference texts, current journals,
audiovisual materials and other relevant resources to ensure they achieve and
maintain the proficiency standards established by the program.
(e) Curriculum Content. Curriculum must include content designed to prepare
the student to assess, plan, implement, and evaluate dental hygiene services
as an independent practitioner as specified and in accordance with Business
and Professions Code Section 1770. The curriculum content shall include, at
least the following:
(1) Dental Hygiene Technique and Theory, including:
(A) Oral pathology;
(B) Pharmacology;
(C) Sociology, psychology, and treatment of special populations, including:
1. Geriatric
2. Medically compromised
3. Developmentally disabled
4. Pediatric
(D) Evaluation of Dental Hygiene status and Dental Hygiene treatment planning;
(E) Medical histories/terminology;
(F) Dental/Medical emergencies.
(G) Apply pit, resin or composite fissure sealants
At least 75% of instructional hours shall be devoted to the subjects specified
in this subsection.
(2) Business Administration and Practice Management.
(f) Length of Program. The program shall be not less than 150 hours in length.
Note Authority cited: Section
1614, Business and Professions Code. Reference: Section
1768, Business and Professions Code.
14. Establishment
of Future Meeting Dates
COMDA needs to decide
whether it wishes to continue meeting in conjunction
with the Dental Board, or to meet separately. Following
are the benefits of each (the drawbacks would be
the opposite for each option):
Meet with Board
1. Opportunity for COMDA
members to view Board meetings, and Board members
to view COMDA meetings
2. Opportunity for COMDA
and Board members to become better acquainted.
3. The COMDA Chair,
the two members who serve on both COMDA and the
Board, COMDA and the Board’s legal counsel,
and COMDA staff attend both COMDA and Board meetings – travel
time and costs would perhaps be less than having
two separate meetings.
4. Interested parties
may save time and money by attending both meetings
over a span of 2 to 3 days, rather than having
two separate meetings.
Meet 2 to 4 weeks
Before the Board Meeting
1. COMDA meeting dates
would be more certain, rather than potential changes
at the last minute to fit into the Board’s
meeting schedule.
2. If COMDA makes changes
to agenda items that are going before the Board,
there is time to make appropriate changes so that
they are not handed out to the Board members the
same afternoon or the next day, which can result
in the tabling of an item.
3. If the COMDA meeting
goes longer than expected (and it is very difficult
to predict the length of any particular meeting),
the COMDA members who also serve on the Board may
have to leave to conduct Board business. Their
input will be lost, and there is the potential
that a quorum would be lost as well.
4. If the COMDA meeting
goes longer than expected, COMDA’s legal counsel
(who is also legal counsel to the Board) may have
to leave to attend the Board meeting.
Board Meeting Dates
Following are the dates
that have been set by the Dental Board for 2004:
March 11-12 – San
Diego
May 13-14 – San
Francisco
August 19-20 – Los
Angeles
November 4-5 - Sacramento
COMMITTEE
ON DENTAL AUXILIARIES
Draft
Meeting Minutes - January 29, 2004
Members Present: Shanda
Wallace, RDH, Chairperson; LaDonna Drury-Klein,
RDA, Vice Chair; Linda Gipson, RDH, Secretary;
Kevin Biggers, Public Member; Teresita Churchill,
RDA; Darla Dale, RDH; Marlyn Hiroto, RDA; Sonia
Molina, DDS
Members Absent: Coragene
Savio, DDS
Staff Present: Karen
R. Wyant, Executive Officer; Dyna Leonard, Associate
Analyst; Bob Miller, DCA Legal Counsel; Donna Kantner,
Staff
1. Call to
Order/ Roll Call/ Establishment of Quorum
Chairperson Wallace
called the meeting to order at 9:05 am; roll was
called by Secretary Gipson and a quorum established.
New member Kevin Biggers was introduced and gave
a brief biography.
2. Approval
of November 6, 2003 Meeting Minutes
Minutes of the November
6, 2003, COMDA meeting were accepted with no changes.
3. Report
of the Chair
Chairperson Wallace
reported that over the last few months she has
been working with the Executive Officer to keep
abreast of changes and made appointments to COMDA's
various Subcommittees. She indicated that notices
are going out regarding Subcommittee appointments.
4. Report
of the Executive Officer
Executive Officer Wyant
reported that examination statistics are contained
in the packet, along with budget information, noting
that the budget will once again be tight this year.
In response to a question regarding exam costs
from Chair Wallace, Wyant noted that budget projections
are sometimes not related to actual line item expenditures,
monies are pulled from other items as necessary.
She explained that this is not unusual, and to
pursue a budget realignment would involve a great
deal of work, taking staff away from other projects.
She reported that there
is currently a moratorium on regulations, however
COMDA is moving forward on regulations that have
previously been approved. Bob Miller, DCA Legal
Counsel, noted that this is a six-month moratorium.
Wyant stated that there are several regulations
in the pipeline that will continue, but if the
one-year maximum processing time expires, the regulatory
process must begin all over again with new hearings.
Tim Hart, CDA, noted
that they had obtained an explanation from the
Governor's order indicating that regulations that
were pending at the time of the Executive Order
would be decided at the Cabinet level on a case-by-case
basis as to whether they would proceed. He felt
that the regulations should continue to move forward
on this basis. Wyant noted that this had been COMDA's
intent. Miller noted that at least one Department
has received an exemption to the Order, although
he did not know how difficult this would be. Hart
believed that the Agency Secretary would be the
person to determine this. Wyant noted that the
process would still need to go through the Department's
Legal Office and the Director of DCA as a matter
of course.
5. Legislation
of Interest to COMDA a. AB539 - 3rd and 4th
Year Dental Students applying for RDH licensure
Executive Officer Wyant
reported that AB539 has begun to move forward in
the Legislature. She will continue to express COMDA's
wishes, however she indicated that the bill is
moving forward at this time.
6. Review
of RDA Educational Programs and Courses/ Recommendations
to the Board
This item was tabled.
7. Proposed
New Regulation 1070.3 - Approval of Pit and
Fissure Sealant Courses
Vice Chair Drury-Klein
reported that all interested parties were asked
to submit their comments by the end of December.
She noted that it was decided that she would be
the one contact point for the dissemination of
information. She reported that she had consolidated
all information that she had received and that
the last page is a compilation of single or individual
comments that were the only comments of their kind.
All other comments were consolidated by consensus.
Chair Wallace noted the difficulty of compiling
all the information received and thanked Drury-Klein
for her efforts.
Member Hiroto asked
that the characteristics and safe use of curing
lights be added to page 4, Item (5) (I). Barbara
Blade, educator, noted that this was addressed
on page 3, Item (I). Earl Johnson, California Association
of Orthodontists felt that assistants should not
be adjusting occlusion at all. He noted that he
was referring to page 4, item (O). Barbara Blade
responded that as Program Coordinator for UCLA,
that the scope of that program was learning to
apply pit and fissure sealants. She noted that
at that time, since 1987, the Dental Board has
approved this duty as part of the sealant process.
She reported that adjustment of sealants is minor,
the amount of adjustment is approximately 3%, and
done by means of a slow-speed handpiece. She felt
that if this program is approved, the person would
be considered trained to perform the procedure,
indicating that there has been no report of patient
harm occurring.
Drury-Klein asked if
Item (i) O should include the usage of the slow-
speed handpiece. With an affirmation from Blade,
it was moved (Drury-Klein/Churchill) to add "by
the use of a slow speed handpiece" to that
language. Member Hiroto asked if this would exclude
other means such as floss or strips. Wyant noted
that the language under consideration relates to
course curriculum, and if the intent is to prevent
the use of high speed handpieces in practice, this
language change would not accomplish that. The
regulation allowing RDAs to perform the duty would
have to be amended.
Joanne Galliano, CDHEA,
felt it unnecessary to specify what device is to
be used, believing the language should be retained
as is. She felt that educational institutions will
not be teaching duties that are not within the
standard of care of the community.
Member Molina asked
if it is usual that the dentist checks occlusion.
Drury-Klein responded that yes, as a directly supervised
duty the dentist must check the procedure. Member
Molina indicated that she was comfortable with
assistants adjusting occlusion. Joan Greenfield,
RDA educator, suggested that the language be left
as is, noting that in the past changes had to be
made because language was too specific. Earl Johnson
noted that occlusion is not that simple, sometimes
requiring the use of a burr, which is beyond the
scope of assistants. Chair Wallace clarified that
this is a directly supervised duty. A motion to
add slow-speed handpiece to the language failed.
Member Molina asked
to move to strike Item O. There was no second to
the motion. Executive Officer Wyant reiterated
that this regulation does not control what duties
can be performed, simply what is contained in the
curriculum of the course. She noted that Section
1086 would need to be amended to address how the
duty is actually performed. Chair Wallace asked
if there were any other motions. It was M/S/P (Drury-Klein/Hiroto)
not to specify devices in the language, simply
stating "adjust occlusion and evaluate or
correct proximal areas when indicated".
Member Molina noted
that as an endodontist, many times occlusal misadjustment
is not taken into account as seriously as it might
be. Drury-Klein noted that this is a directly supervised
procedure, and as such the dentist may choose not
to delegate the duty if they wish. Member Molina
responded that then there would not be any need
for regulations. Chair Wallace noted that in the
absence of any further motions, the indication
is to accept the language as it stands. Earl Johnson
still felt that this was changing the fabric of
the scope of practice. Joan Greenfield noted that
we are talking about 896 EF assistants adjusting
minimally with rubber cups and points.
Barbara Blade added
that there is another area that does not appear
in the comments, and speaking for the Alliance,
she asked that COMDA to consider adding that the
RDA educator have specific clinical competence
requirements or hours of practice. She noted that
by simply requiring that they take the course they
could conceivably take the course on Friday and
teach it on Saturday. Drury-Klein apologized for
not reflecting that issue in the compilation.
Barbara Blade noted
that it is difficult to specify a number of experiences,
but felt there should be a period of time before
evaluations were allowed. Greenfield felt that
Item (1) specified sufficient faculty requirements
that would cover this area. Wyant noted that this
does not address any time period that the person
has been placing sealants. Greenfield noted that
the Alliance had discussed that perhaps additional
training in evaluation should be required rather
than more time placing sealants, adding that CADAT
would offer such a course to educators. She indicated
that the course could be open to dentists, RDH,
EF or whomever would need additional education
and training in evaluation. There were no further
motions to change the language of (c)(1).
With regard to the language
of (c)(1), Tim Hart, CDA, noted that there is no
such thing as DDS, the term has gone back to dentist
in the DPA. There was a consensus to modify the
language accordingly.
Melody Randolph, RDA
educator, Western Career College, noted that their
program is modular, and it may be difficult to
implement a pit and fissure component with coronal
polishing as a prerequisite. She indicated the
difficulty of getting patients, asking that perhaps
testing of both procedures be concurrent on one
patient. Greenfield noted that courses that teach
sealants require coronal polishing, it is a sequence
of events and coronal polishing is a precursor
to pit and fissure sealants. Blade felt coronal
polishing must be a prerequisite to any pit and
fissure sealant course. Melody Randolph noted that
she was not suggesting that the courses be combined,
only that final evaluation and testing be done
concurrently.
Tim Hart, CDA, recommended
that in item (f)(3), protective eyewear should
be required for each student rather than each piece
of equipment, to which members agreed.
It was M/S/P (Drury-Klein/Molina)
to accept the language as amended and move the
regulation to the Board for approval. Motion passed
unanimously.
8. Proposed
Changes to Regulation 1081.1 - RDA Practical
Examination Requirements
Wyant noted that at
some point the list of testable procedures needs
to be considered in light of the new duties that
a pending change to the regulations would allow.
It was M/S/P (Drury-Klein/Churchill) to add all
of the new duties to the list of testable procedures,
authorized the Executive Officer to take the proposed
regulatory change directly to the Board when finalized,
and referred the issue of which duties should actually
be tested in the future to the RDA practical examination
subcommittee.
9. Proposed
Changes to Business and Professions Code Section
1645.1 - Required Coronal Polishing and Radiation
Safety Courses for RDAs
Executive Officer Wyant
reported that in implementing the new law requiring
RDAs to become certified in radiation safety and
coronal polishing by January 1, 2005, COMDA staff
has mailed out several thousand notices to RDAs
regarding the requirements, which has put a tremendous
workload on staff. She also noted that she has
received many letters from RDAs protesting the
new requirements. She asked that COMDA consider
extending the deadline one year, noting that any
changes would not be implemented until October
or November, but that it may still affect thousands
of RDAs who had not become certified by that point
in time.
She further indicated
that there are a large number of inactive licensees
that feel they should be exempt from this requirement
since they are not currently working, and should
only have to take the courses when they wish to
activate their license. She asked if some accommodation
could be made for inactive licensees. Tim Hart,
CDA, noted CDA would be happy to work with COMDA
staff to pursue such both proposed legislative
changes. It was M/S/P (Drury-Klein/Molina) to pursue
such changes.
10. Proposed
Changes to Regulations 1014 and 1014.1 - Approval
of Radiation Safety Programs
Vice Chair Drury-Klein
noted that she had made proposed changes, and had
sent them to all concerned, however some apparently
did not receive the material. She indicated her
willingness to table the issue until every interested
party has the opportunity to formulate their comments.
Wyant noted that perhaps there are people here
who wish to make their comments at this time. Member
Biggers noted that there were comments received
at the meeting this morning that he would appreciate
the opportunity to read and digest and then consider
the changes at the next meeting. It was M/S/P (Drury-Klein/Biggers)
to table the item to the next meeting.
11. Teaching
Methodology Course for RDA Educational Program
Faculty
Executive Officer Wyant
noted the regulation that mandated this requirement
went into effect about a year ago, reporting that
discussions as to how to implement this have been
less than productive up to this point. She noted
the difficulty of writing a regulation that would
encompass all teaching methodologies. Wyant indicated
that this can be determined on a case by case basis
if standards are not set by regulation, but this
requires staff review time.
Barbara Blade, CADAT,
stated that CADAT has given this matter a great
deal of thought, noting that vocational education
courses have existed for a long time. The problem
is that without regulation, any course can be approved.
There are many aspects of teaching methodology
that is not appropriate to an RDA course.
Vice Chair Drury-Klein
noted that in the absence of the ability to fund
a Subcommittee, she felt that CADAT has done the
groundwork in this area and this could be brought
forward to COMDA for their review and comments.
Member Biggers asked if other organizations than
CADAT could provide input. Drury-Klein noted that
CDHA and others would also be asked for their input.
Drury-Klein suggested starting the process now,
notwithstanding how much time it takes to implement
due to the moratorium on regulations. Wyant noted
that if COMDA wishes, some sort of provisional
approval may be given prior to the regulatory implementation.
JoAnn Galliano, RDH educator, noted that RDH faculty
must have teaching methodology courses. Member
Molina noted that in dental schools it is a requirement.
Staff was directed to
work with interested parties to develop a proposal.
12. Consideration
of RDHAP Educational Program Application of
UOP
Chair Wallace noted
that the application was presented for a distance-learning
course to be given by UOP. It was M/S/P (Subcommittee)
to recommend approval of the program and move it
forward to the Board.
13. Agenda
Items for Future Meetings
Proposed Changes to
Regulations 1014 and 1014.1 - Approval of Radiation
Safety Programs
Teaching Methodology
Course for RDA Educational Program Faculty
14. Establishment
of Future Meeting Dates
Chair Wallace preferred
to meet in conjunction with the Board. Member Molina
noted that it is also an opportunity to converse
with Board members regarding issues. Vice Chair
Drury-Klein noted that meeting on Thursday may
cause conflicts in meetings for members who are
on both Boards, suggesting meeting on Wednesday
rather than Thursday. Wyant noted that this would
increase costs for staff and those members required
to stay for the Dental Board meetings while there
would be little contact with Board members, who
would not be arriving until Thursday. JoAnn Galliano,
CDHA, noted that COMDA's meetings have taken place
on Wednesdays and sometimes the Board has Subcommittee
meetings on Wednesday as well, so this may or may
not resolve those conflicts.
It was a consensus that
COMDA meet on Wednesdays at 1:30pm, setting the
next meeting for Wednesday, March 10.
15. Public
Comment
None.
16. Adjournment
The meeting adjourned
at 11:55am. |
