CPR Requirements for Dentists and Dental Hygienists
Every dentist and dental hygienist practicing in Wisconsin must hold a current cardiopulmonary resuscitation (CPR) certificate unless the licensee has obtained a waiver from the Wisconsin Dentistry Examining Board. A waiver from the board must be based on a medical evaluation documenting physical inability to comply and shall be issued by the board only if it is satisfied that another person with current certification in CPR is immediately available to the licensee when patients are present [see
Wis. Admin. Code § DE 5.02(24)].
Failure to hold a current CPR certificate constitutes unprofessional conduct and is grounds for disciplinary action [see
Wis. Admin. Code § DE 5.02(24),
Wis. Stat. § 447.07(1) and § 447.07(3)(a)].
The Wisconsin Department of Health Services website contains a
list of approved CPR course providers.
The DHS website also offers the following statement about course requirements:
Any course offered by the above providers that includes the following is approved by this department to fulfill the cardiopulmonary resuscitation (CPR) and automated external defibrillator (AED) training objectives for persons who are required, as a condition of licensure, certification, or registration to be proficient in CPR or in the use of an AED.
- Instruction of CPR
- Instruction in the use of an AED
- Verified course completion through a certification/completion card
- Certification not to exceed two years
On-line CPR courses are only acceptable if they provide classroom, hands-on/instructor-led skill training and assessment.
Credential holders (dentists and dental hygienists) are expected to maintain their own CPR training records in accordance with the obligation to maintain continuing education records [see
Wis. Admin. Code § DE 13.03(10) and § DE 13.04(9)]. If an investigation of a credential holder occurs these CPR records may be requested and if available must be provided.
A protective barrier for the provision of mouth-to-mouth resuscitation during CPR is required in a dental office for those employees covered by the
OSHA Bloodborne Standard. Examples include bag-to-mouth resuscitation devices, CPR pocket masks, or positive pressure oxygen [see
Wis. Admin. Code § DE 11.08(1)(a)(5) and (6), § DE 11.08(1)(b)(5) and (6) and OSHA Standards 29 CFR § 1910.1030 (d)(3)(i).
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Sleep Related Breathing Disorders
The treatment of Sleep Related Breathing Disorders (SRBD) may involve several components including: comprehensive patient screening, physician diagnosis of SRBD, prescription for treatment of the SRBD, treatment, follow-up assessment and monitoring.
Dentists are prohibited from practicing outside of their scope of practice [see
Wis. Admin. Code § DE 5.02(3)]. Some elements of the treatment of (SRBD) may fall within the scope of the practice of dentistry. Others may fall outside that scope and should be performed by a physician.
Wis. Stat. § 447.01(8)(a) defines dentistry as “Examining into the fact, condition or cause of dental health or dental disease or applying principles or techniques of dental science in the diagnosis, treatment or prevention of or prescription for any of the lesions, dental diseases, disorders or deficiencies of the human oral cavity, teeth, investing tissues, maxilla or mandible, or adjacent associated structures.”
The definition also includes, “Engaging in any of the practices, techniques or procedures included in the curricula of accredited dental schools.” § 447.01(8)(f).
Thus, dentists may perform tasks such as assessment, treatment and monitoring to the extent that these activities fall within their scope of practice.
In addition to the requirement that dentists not practice outside of their scope, dentists are also prohibited from "practicing in a manner which substantially departs from the standard of care ordinarily exercised by a dentist or dental hygienist which harms or could have harmed a patient." [See
Wis. Admin. Code § DE 5.02(5).]
One commonly accepted standard of care is the following treatment protocol for Oral Appliance (OA) Therapy for SRBD issued by the American Academy of Dental Sleep Medicine (AADSM):
- Medical Assessment.
- Referral by dentist to physician to diagnose the SRBD – be it snoring, UARS (upper airway resistance syndrome), or obstructive sleep apnea; then returned to dentist for oral appliance therapy, if appropriate. Or referral by physician for OA therapy, if appropriate.
- A copy of the diagnostic sleep study or pulse oximetry report forwarded to the dentist.
- Dentist to assess and recommend the choice of appliance and relevant fees. Different types of OA design variations, both MRDs (mandibular repositioning device) and TRDs (tongue repositioning device), should be shown to the patient. The rationale for appliance selection should be explained to the patient. Documentation of this should be made in the patient’s records.
- Informed consent is highly recommended prior to insertion of the appliance.
- Dentist to initiate therapy and titrate the OA to obtain optimum results based on patient symptoms and resolution of snoring and/or restriction in further jaw movement.
- After adequate titration, dentist refers patient back to physician for assessment of OA treatment of SRBD.
- Final adequate or complete resolution of SRBD is determined by the referring physician (usually with PSG (polysomnography) or pulse oximetry). If the patient is medically diagnosed with only simple snoring, the dentist may complete therapy without referral back to physician.
- If the medical assessment shows continued SRBD, the patient is referred back to the dentist to continue further titration.
- In specific cases, often when the initial titration has not been sufficient, the patient returns a second time to their physician for assessment. If UARS or OSA are still present, the referring physician may recommend an alternative form of therapy.
- An annual dental assessment is recommended for all snoring, UARS, or Obstructive Sleep Apnea OA patients since the SRBD tends to get worse over time. The dental recall examination evaluates complications, compliance, device deterioration, and the need for possible additional titration.
The diagnosis of obstructive sleep apnea and the prescription of the appropriate treatment should be made by a qualified physician. Once the oral appliance therapy has been prescribed by a physician, then the oral appliance device should be fit by a qualified dentist with training and experience in dental sleep medicine.
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Laser use by Dental Hygienist
It is the position of the Wisconsin Dental Examining Board that utilization of a laser device by a hygienist, is allowed when used within the scope of practice of dental hygiene and in adherence to
Wis. Stat. § 447.06(2)(b), § 447.06(2)(c), § 447.06(2)(d), and
- At this time, laser use within the scope of dental hygiene practice is as an adjunct device to scaling and root planning.
- Training is necessary and should include a hands-on proficiency course provided by a recognized sponsor of continuing education, in accordance with the current rules for continuing education.
- Licensees utilizing laser technology should maintain documentation of the satisfactory completion of the formal continuing education or training.
Sources of Continuing Education:
A program will qualify for CE credits if it is sponsored or recognized by a local, state, regional, national, or international dental or medical professional organization. It will also qualify if it is a college-level course that is offered by a post-secondary institution accredited by the American Dental Association (ADA) or another CE approval entity.
Continuing Education Resources:
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The Dentistry Examining Board reviews dental health care records as a part of screening and/or investigation of a complaint. This provides us exposure to records very different in content, accuracy and style. We highly recommend it include:
1. Written and dated medical history –
signed by the patient.
2. Written examination chart with procedure
Consent form signed by the patient is highly recommended.
5. Anesthetic type, amount administered any unusual reactions.
6. All prescriptions ordered.
Other important recommendations:
1. Never use pencil. Black pen or type is best.
2. Print legibly.
3. Sign or initial every entry.
4. Do not use white out. Cross out incorrect entry with one line; make correction, date and initial.
5. Avoid acronyms that are only understood by the author.
6. If any other staff member is writing in the patient’s record, the credential holder (dentist or dental hygienist) is still responsible for its accuracy.
Finally, if your records are requested as part of an investigation, do not rewrite or attempt to “improve” them in any way. Falsification, withholding, concealing, and/or destruction of the patient health care record with the intent to obstruct an investigation or prosecution is a violation under Wis. Stat. § 146.83 (4)(a), (b), and (c).
Proper recordkeeping should be a consistent well-understood standard for everyone in the office. Its indication of a standard of care is clearly apparent. Its impact on an investigation is tremendous.
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Use of Dermal Fillers and Botox
At the January 4, 2012 meeting of the Dentistry Examining Board the following policy position was adopted:
The use of dermal fillers and botox by a licensed dentist in the state of Wisconsin is allowable for functional, therapeutic, and aesthetic treatment purposes in accordance with the practice of dentistry as defined in Wis. Stats. § 447.01. It is expected that dentists will obtain appropriate training to be able to perform such services competently. Such training shall be provided by organizations or institutions recognized to provide continuing education courses in accordance with Wis. Stat. § 447.056.
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Conscious Sedation Advertising
At the September 10, 2003 meeting of the Dentistry Examining Board (DEB) the following policy position was adopted:
It is the DEB’s position that the use of the phrase “sleep dentistry” or “snooze dentistry” in any advertisement for oral conscious sedation services that are offered to the public, constitutes unprofessional advertising in violation of
Wis. Admin. Code § DE 6.02(1).
DE 6.02(1) states that it is unprofessional advertising for a dentist to publish or communicate statements or claims in any media which are false, fraudulent, or deceptive. The Board believes that the use of the phrase “sleep dentistry” or “snooze dentistry” is a false, misleading, and deceptive claim if used to describe the administration of oral medications for the purpose of achieving conscious sedation in patients. Accordingly, the use of such statements or claims in any advertising media must cease. The utilization of such statements or claims will be considered a violation of
Wis. Admin. Code § DE 6.02(1), and may result in disciplinary action by the Board.
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RE: Diagnosis and Treatment of Dental Diseases Resulting From the Use of Tobacco Products
Based upon several provisions contained in
Wis. Stat. ch. 447, including
Wis. Stat. § 447.01(2),
which defines “dental disease” and
Wis. Stat. § 447.01 (8), which defines “dentistry”, as well as a review of
the information of records obtained by the Board during its extensive fact-gathering process, it is
my opinion that the diagnosis and treatment of dental diseases that are caused by or the result of
the use of tobacco products by dental patients is within the scope of the practice of dentistry.
First, the Legislature by its enactment of
Wis. Stat. ch. 447, has established the scope of
practice of dentistry. The Legislature has defined the term “dentistry” in
Wis. Stat. § 447.01(8) to mean
“the examination, diagnosis, treatment, planning or care of conditions within the human oral
cavity or its adjacent tissues and structures”. The statute further states that dentistry includes the
following (in part):
(a) Examining into the fact, condition or cause of dental health or dental disease or
applying principles or techniques of dental science in the diagnosis, treatment or
prevention of or prescription for any of the lesions, dental diseases, disorders or
deficiencies of the human oral cavity, teeth, investing tissues, maxilla or mandible, or
adjacent associated structures.
(e) Prescribing or administering drugs in the course of or incident to the rendition of
dental services, or as part of a representation that dental services have been or will be
(f) Engaging in any of the practices, techniques or procedures included in the curricula
of accredited dental schools.
(h) Developing a treatment plan for a dental patient to treat, operate, prescribe or advise
for the patient by any means or instrumentality.
The term “dental disease” is defined in
Wis. Stat. § 447.01(2) to mean “any pain, injury, deformity,
physical illness or departure from complete dental health or the proper condition of the human
oral cavity or any of its parts”.
- Opinion of Legal Counsel
- Adopted by the Board on January 6, 2010