Chapter 16 – BOARD OF Dental Examiners

SUBCHAPTER 16A – ORGANIZATION

21 ncac 16A .0101 DEFINITIONS

As used in this Chapter:

(1) "Applicant" means a person applying for any license or permit issued by the Board;

(2) "Board" means the North Carolina State Board of Dental Examiners;

(3) "Candidate" means a person who has applied and been accepted for examination to practice dentistry or dental hygiene in North Carolina;

(4) "Current license" means a license that is renewed by the licensing board;

(5) "CPR certification" means that the licensee has completed a CPR course that meets American Red Cross or American Heart Association standards for certification and that provides manikin testing on the subjects of cardio-pulmonary resuscitation. The course must also cover the use of an automatic external defibrillator, unconscious and conscious choking and rescue breathing, provided that the foregoing requirements shall not be interpreted in any way that violates the Americans with Disabilities Act. The manikin testing shall be provided by an instructor who is present with the students;

(6) "Internship" means practice in an educational training program. Internship does not mean practice under an intern permit while holding an unrestricted general dental or dental specialty license issued by a state, U.S. territory or the District of Columbia;

(7) "Unrestricted license" means a license that is not under suspension or inactivation, or subject to the terms of a consent order or other disciplinary action imposed by the jurisdiction that issued the license, or limited by supervision or location requirements;

(8) Except where otherwise defined by these Rules or by statute, "supervision," "direct supervision," and "supervision and direction" means that the dentist overseeing treatment is present in the same facility or location and available during the performance of the acts that are being performed pursuant to that dentist's order, control, and approval and that the dentist must examine and evaluate the results of such acts; and

(9) Except where otherwise defined by these Rules or by statute, "direction" or "under direction" means that the dentist ordering treatment does not have to be present in the same facility or location during the performance of the acts that are being performed pursuant to that dentist's order, control, and approval, but that dentist shall be responsible for all consequences or results arising from such acts.

History Note: Authority G.S. 90-28; 90-29(a); 90-29.3; 90-29.4; 90-29.5; 90-30; 90-48; 90-224; 90-224.1; 90-226;

Eff. September 3, 1976;

Readopted Eff. September 26, 1977;

Amended Eff. May 1, 1991; May 1, 1989; September 1, 1988; October 1, 1986;

Temporary Amendment Eff. January 1, 2003;

Amended Eff. May 1, 2011; January 1, 2004;

Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. January 9, 2018;

Amended Eff. October 1, 2019.

21 NCAC 16A .0102 ORGANIZATION

21 NCAC 16A .0103 FUNCTIONS

History Note: Authority G.S. 90‑22 et seq.; 90‑26; 90‑43; 90‑48; 90‑221 et. seq.;

Eff. September 3, 1976;

Readopted Eff. September 26, 1977;

Amended Eff. March 1, 1985;

Repealed Eff. October 1, 1986.

21 NCAC 16A .0104 LOCATION

History Note: Authority G.S. 90-26; 90-43; 90-48;

Eff. May 1, 1989;

Amended Eff. February 1, 2008; September 1, 2001; May 1, 1991;

Repealed Eff. September 1, 2013.

21 NCAC 16A .0106 PETITION FOR PREDETERMINATION

An individual who wishes to file a petition for a predetermination of whether the individual's criminal history will likely disqualify the individual from obtaining a dental license or dental hygiene license shall submit a petition on the forms furnished by the Board at www.ncdentalboard.org that shall include the petitioner's:

(1) legal name;

(2) mailing, physical, and email addresses;

(3) social security number;

(4) date of birth;

(5) telephone number;

(6) place(s) of residence for the past seven years;

(7) employment history since the commission of the crime(s);

(8) criminal record report prepared no more than 60 days prior to the date of petition by Castle Branch, Inc., or another reporting service designated by the Board in accordance with G.S. 93B-8.1(b6), the cost of which shall be borne by the petitioner;

(9) copies of all documents in the court file related to any conviction reported on the petition or noted on the criminal record report, certified by the clerk of court or other judicial official;

(10) written statement describing the circumstances surrounding the commission of the crimes;

(11) written statement of any rehabilitation efforts, if applicable;

(12) rehabilitative drug or alcohol treatments, if applicable;

(13) Certificate of Relief granted pursuant to G.S. 15A-173.2, if applicable;

(14) affidavits or other written documents, including character references, that the petitioner wishes the Board to consider in responding to the petition;

(15) written statement certifying that the information and documentation submitted with the petition is complete and accurate to the best of the petitioner's knowledge;

(16) fee of forty-five dollars ($45.00) for a petition for predetermination; and

(17) notarized signature.

History Note: Authority G.S. 90-29; 90-30; 90-41; 90-48; 90-223; 90-224; 90-229; 93B-8.1;

Eff. April 1, 2020.

21 NCAC 16A .0105 SUSPENSION OF AUTHORITY TO EXPEND FUNDS

If the Board's authority to expend funds is suspended pursuant to G.S. 93B-2(d), the Board shall continue to issue and renew licenses, registrations, and permits and to collect all fees pursuant to G.S. 90-39 and the rules of this Chapter, but all fees tendered shall be placed in an escrow account maintained by the Board for this purpose. Once the Board's authority is restored, the funds shall be moved from the escrow account into the general operating account.

History Note: Authority G.S. 90-28; 90-39; 93B-2(d);

Eff. October 1, 2019.

SUBCHAPTER 16B - LICENSURE DENTISTS

SECTION .0100 - GENERAL PROVISIONS

21 NCAC 16B .0101 EXAMINATION REQUIRED; EXEMPTIONS

(a) Persons seeking a license to practice dentistry in North Carolina shall pass Board approved written and clinical examinations, as set forth in Rule .0303 of this Subchapter, before receiving a license.

(b) The examination requirement in Paragraph (a) of this Rule shall not apply to persons who do not hold a North Carolina dental license and who are:

(1) volunteers pursuant to G.S. 90-21.107;

(2) persons holding an unexpired instructor's license issued by the Board and seeking a dental license pursuant to Rule .0502 of this Subchapter; or

(3) persons seeking a dental license pursuant to a Board rule setting forth a different examination requirement, such as:

(A) by military endorsement pursuant to Rules .1001 and .1002 of this Subchapter; or

(B) by credentials pursuant to Rule .0501 of this Subchapter.

History Note: Authority G.S. 90-21.107; 90-28; 90-30; 90-36; 90-48;

Eff. September 3, 1976;

Readopted Eff. September 26, 1977;

Amended Eff. September 1, 2014; September 1, 2013; March 1, 2006; May 1, 1991; May 1, 1989; January 1, 1983;

Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. January 9, 2018;

Amended Eff. December 1, 2023; October 1, 2019.

21 NCAC 16B .0102 NO RECIPROCAL ARRANGEMENT

History Note: Authority G.S. 90‑28; 90‑30; 90‑36; 90‑48;

Eff. September 3, 1976;

Readopted Eff. September 26, 1977;

Amended Eff. May 1, 1989;

Expired Eff. February 1, 2018 pursuant to G.S. 150B-21.3A.

SECTION .0200 - QUALIFICATIONS

21 NCAC 16B .0201 IN GENERAL

(a) An applicant for licensure as a dentist shall be a graduate of and have a DMD or DDS degree from a university or college accredited by the Commission on Dental Accreditation of the American Dental Association.

(b) Graduates of foreign colleges may apply for licensure after completing at least two years in a dental school accredited by the Commission on Accreditation of the American Dental Association, graduating with a DMD or DDS degree from that dental school, and passing Board approved written and clinical examinations, as set out in these Rules.

History Note: Authority G.S. 90-28; 90-30; 90-48;

Eff. September 3, 1976;

Readopted Eff. September 26, 1977;

Amended Eff. September 1, 2014; August 1, 2009; March 1, 2006; May 1, 1989; October 1, 1986;

Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. January 9, 2018.

21 NCAC 16B .0202 STUDENT MAY APPLY

Applications for a dental license shall be accepted from students currently enrolled in schools of dentistry accredited by the Commission on Dental Accreditation of the American Dental Association. Applications shall be automatically denied if the applicant fails to complete the required course of study or fails a Board approved licensure examination.

History Note: Authority G.S. 90-28; 90-30; 90-48;

Eff. September 3, 1976;

Readopted Eff. March 1, 2006; September 26, 1977;

Amended Eff. September 1, 2014;

Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. January 9, 2018.

21 NCAC 16B .0203 TRANSCRIPTS REQUIRED

History Note: Authority G.S. 90‑28; 90‑30; 90‑48;

Eff. September 3, 1976;

Readopted Eff. September 26, 1977;

Amended Eff. May 1, 1989;

Repealed Eff. March 1, 2006.

SECTION .0300 - APPLICATION FOR LICENSURE

21 NCAC 16B .0301 APPLICATION FOR LICENSURE

(a) All applications for licensure as a dentist shall be made on the forms furnished by the Board at www.ncdentalboard.org and shall include the following information:

(1) full name;

(2) street address as of the date of the application;

(3) permanent street address;

(4) preferred mailing address for all information;

(5) telephone number;

(6) email address;

(7) age;

(8) date of birth;

(9) place of birth;

(10) citizenship or immigration status, with verifying documentation;

(11) social security number;

(12) marital status;

(13) any other name by which the applicant was known in the past, accompanied by a certified copy of a court order of name change, if applicable;

(14) all resident addresses for the 10 years preceding the date of application;

(15) the names, addresses, and phone numbers for two individuals to whom the applicant always provides the applicant's current address;

(16) disclosure and explanation of any bankruptcy proceedings in which the applicant was a named party;

(17) the license number, issuing state, and expiration date for all current drivers' licenses held by the applicant, and the issuing state for all drivers' licenses held in the past by the applicant;

(18) the date of the applicant's previous application for examination by the Board, if applicable;

(19) the date and type of any dental permit or provisional license for which the applicant applied in the past, if applicable;

(20) if the applicant failed an examination administered by a dental board, the date of the examination and jurisdiction of the dental board that administered the examination;

(21) if any dental board has refused to administer an examination to applicant, the jurisdiction of the dental board that refused to administer the examination and the date of the refusal;

(22) the dates upon which the applicant has taken the Dental National Board Examination, the location of the examination, and authorization for the Board to access the examination scores;

(23) if the applicant failed the Dental National Board Examination, the date of the failed examination;

(24) if the applicant has applied for a dental license in any other state or foreign country, the date of the application and whether the license was issued to the applicant;

(25) all employment held by the applicant for the past 10 years other than dentistry;

(26) if the applicant was terminated from employment within the past 10 years, an explanation regarding the termination;

(27) all dental licenses from other jurisdictions ever held by the applicant, including type of licensure, license number, and dates of licensure;

(28) if the applicant has ever been suspended or otherwise disqualified, or reprimanded, censured, or otherwise disciplined by any licensing board, professional organization, or while the applicant was holding public office, a written statement disclosing:

(A) the facts that formed the basis for the discipline;

(B) the date of the discipline;

(D) the name and address of the authority in possession of records related to discipline;

(29) if the applicant has ever been the subject of a complaint with any licensing board, professional organization, or while the applicant was holding public office, a written statement disclosing:

(A) the facts that gave rise to the complaint;

(B) the date of the complaint;

(D) the name and address of the authority in possession of records related to the complaint;

(30) if the applicant has ever been reported to the National Practitioner Data Bank or the Healthcare Integrity and Protection Data Bank, a written statement disclosing:

(A) the facts that formed the basis for the report;

(B) the date of the report; and

(31) if the applicant is a diplomate, board-eligible, or a declared specialist in any branch of dentistry, a statement of specialty and how he or she is qualified;

(32) if the applicant has taken any post-graduate training or refresher courses, other than continuing education courses, since receiving his or her dental degree, a written statement of the dates, locations, and names of the training or refresher courses;

(33) if the applicant has ever been dropped, suspended, expelled, or disciplined by any post-secondary school or college, a written statement disclosing:

(A) the facts leading to the discipline;

(B) the date of the discipline; and

(34) if the applicant has ever been denied admission to any college or post-secondary school for a reason other than academic qualifications, a written statement explaining the reason for the admission denial;

(35) if the applicant has ever served in the armed forces of the United States or any other country, a written statement explaining:

(A) whether the applicant has been separated from service;

(B) the nature of the separation;

(D) dates of service;

(E) the facts leading to any charges or complaints made or filed against the applicant while the applicant was serving in the armed forces, and the outcome of the charges or complaints;

(F) the facts leading to any disciplinary proceedings instituted against the applicant while serving in the armed forces, and the outcome of the proceedings; and

(G) if the applicant was ever a defendant in any court martial, the facts giving rise to those proceedings and the outcome of the proceedings;

(36) a statement of whether the applicant has registered under the Military Selective Service Act;

(37) a statement of whether the applicant has ever:

(A) been summoned to court or before a magistrate for the violation of any law or ordinance or for the commission of any felony or misdemeanor;

(B) been arrested for the violation of any law or ordinance or for the commission of any felony or misdemeanor;

(C) been taken into custody for the violation of any law or ordinance or for the commission of any felony or misdemeanor;

(D) been indicted for the violation of any law or ordinance or for the commission of any felony or misdemeanor;

(E) been convicted or tried for the violation of any law or ordinance or for the commission of any felony or misdemeanor;

(F) been charged with the violation of any law or ordinance or for the commission of any felony or misdemeanor; or

(G) pleaded guilty to the violation of any law or ordinance or for the commission of any felony or misdemeanor;

(38) if the applicant has been admitted to practice dentistry in any jurisdiction, a certified statement disclosing all the dental practices at which the applicant has worked from dental school graduation to the date of the application, including:

(A) the dates during which the applicant was employed as a dentist or engaged in practice;

(B) the addresses of offices of places at which the applicant was employed or practicing, and the names and addresses of all employers, partners, associates, or other dentists sharing office space;

(D) the reason for the termination of each employment or period of private practice;

(39) if the applicant has ever held any other health care license, a written statement disclosing:

(A) the type of license held by the applicant;

(B) the dates the applicant held the license; and

(40) if the applicant has ever held hospital privileges and those privileges were suspended or revoked, a written statement disclosing the date, location, and reason the privileges were suspended or revoked;

(41) if the applicant has ever held a federal Drug Enforcement Administration license or registration number and, if that license or registration number has ever been revoked, suspended, or surrendered, a written statement disclosing the date, location, and reason for the revocation, suspension, or decision to surrender the license or registration number;

(42) the applicant's post-high school, pre-dental education, including the name and location of the schools the applicant attended and the period of attendance;

(43) each degree conferred upon the applicant, including the date of the degree and institution;

(44) copies of the applicant's transcripts of undergraduate college;

(45) the name and location of each dental school that the applicant attended, the period of attendance, the degree conferred upon applicant, and the institution that conferred the degree;

(46) a statement disclosing and explaining any current condition or impairment, including substance abuse, alcohol abuse, or a mental, emotional, or nervous disorder or condition, that in any way affects the ability to practice dentistry. For purposes of this Rule, "current" means recently enough that the condition or impairment may affect the applicant's ability to function as a dentist as set out in G.S. 90-41(a)(2) and (7). If the applicant contends that the condition or impairment is reduced or ameliorated because the applicant is receiving ongoing treatment or participating in a monitoring or support program, the applicant may provide information regarding the treatment or program, and may include any verification demonstrating that the applicant has complied with all provisions and terms of any drug treatment program, or impaired dentists or other impaired professionals program;

(47) a photograph of the applicant, taken within six months prior to the date of the application;

(48) a completed fingerprint record card and signed release of information form authorizing the Board to request a fingerprint-based criminal history record check from the North Carolina State Bureau of Investigation (SBI);

(49) a copy of an unexpired CPR certificate; and

(50) if the applicant holds, or has held in the past, a dental license in any other state or jurisdiction, a copy of a National Practitioner Data Bank Report concerning the applicant that was obtained within six months prior to the date the Report is submitted to the Board.

(b) The applicant shall submit to the Board the notarized application form with all the information and materials listed in Paragraph (a) of this Rule, accompanied by the nonrefundable application fee set forth in 21 NCAC 16M .0101.

(c) In addition to the requirements of Paragraphs (a) and (b) of this Rule, the applicant shall request the applicable entity to send the following required information or documents to the Board office, with each document in an unopened envelope sealed by the entity involved:

(1) the applicant's official transcripts from a dental school accredited by the Commission on Dental Accreditation of the American Dental Association;

(2) if the applicant is licensed in other states, a certificate of the applicant's licensure status from the dental regulatory authority or other occupational or professional regulatory authority, accompanied by a disclosure of any disciplinary action taken or investigation pending, from all licensing jurisdictions where the applicant holds or has ever held a dental license or other occupational or professional license; and

(3) examination scores required by Rule .0303(b) of this Subchapter that shall include the American Board of Dental Examiners (ADEX) dental licensure examinations.

(d) The Board shall receive all information and documentation set forth in Paragraphs (a) through (c) of this Rule and the applicant's passing scores on all examinations required by Rule .0303 of this Subchapter for the application to be complete. Applications that are not completed within one year of being submitted to the Board shall be disregarded as expired without a refund of the application fee.

(e) Any applicant who changes his or her address shall notify the Board office in writing within 10 business days.

(f) Any license obtained through fraud or by any false representation shall be revoked.

History Note: Authority G.S. 90-28; 90-30; 90-39; 90-41; 90-48;

Eff. September 3, 1976;

Readopted Eff. September 26, 1977;

Amended Eff. September 1, 2014; March 1, 2006;

Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. January 9, 2018;

Amended Eff. March 1, 2020.

21 NCAC 16B .0302 CONSENT FOR BOARD INVESTIGATION

In making application, the applicant authorizes the Board to verify the information contained in the application or to seek such further information pertinent to the applicant's qualifications or character as the Board may deem proper. The applicant consents that his character and reputation may be inquired into, and waives any right he may have to recover damages against the Board, any member thereof or its agents, or any person who answers a Board inquiry in good faith and without malicious intent.

History Note: Authority G.S. 90‑28; 90‑30; 90‑48;

Eff. September 3, 1976;

Readopted Eff. September 26, 1977;

Amended Eff. May 1, 1989;

Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. January 9, 2018.

21 NCAC 16B .0303 Board approved EXAMINATIONS

(a) All applicants for dental licensure shall achieve a passing score of at least 80 percent on the Board's sterilization and jurisprudence examinations. Applicants may take reexamination in accordance with Rule .0317 of this Section.

(b) All applicants for dental licensure shall achieve passing scores on the examination administered by the Joint Commission on National Dental Examinations and clinical examinations administered by Board approved testing agencies. The Board shall determine which testing agencies are approved based on the requirements set forth in Paragraphs (c) and (d) of this Rule.

(c) To qualify as an approved testing agency, the test-development agency shall allow a representative of the Dental Board to serve on the agency's Board of Directors and the Examination Review Committee for the limited purpose of allowing Dental Board input in the development and administration of the examination.

(d) To qualify as an approved testing agency, the clinical examination administered by a testing agency shall:

(1) include procedures performed on human subjects or an alternative method that simulates human subjects, including manikins, as part of the assessment of restorative clinical competencies;

(2) include evaluations in clinical periodontics and at least three of the following subject matter areas:

(A) endodontics, clinical abilities testing;

(B) amalgam preparation and restoration;

(D) posterior ceramic or composite preparation and restoration;

(E) prosthetics, written or clinical abilities testing;

(F) oral diagnosis, written or clinical abilities testing; or

(G) oral surgery, written or clinical abilities testing; and

(3) provide the following:

(A) anonymity between applicants and examination graders;

(B) standardization and calibration of graders;

(D) conjunctive scoring, which is scoring that requires applicants to earn a passing grade on all sections or areas tested and that does not allow weighted, averaged, or overall scoring to compensate for failures in individual subject areas;

(E) a minimum passing score set by the testing agency for each subject area tested;

(F) an annual review of the examination conducted by the testing agency;

(G) a task analysis performed by the testing agency at least once every seven years that surveys dentists nationwide to determine the content of the examination;

(H) a system of quality assurance to ensure uniform, consistent administration of the examination at each testing site; and

(I) a system of quality assurance that does not permit a dental instructor to grade candidates at any institution at which the instructor is employed.

(e) The Board shall accept examination scores for five years following the date of the examinations. Each applicant shall request the applicable entity to send the applicant's scores to the Board office. Individuals who apply for licensure more than five years after the examination date shall re-take the examination.

(f) The applicant shall comply with all requirements of the testing agency in applying for and taking the examination.

History Note: Authority G.S. 90-30; 90-48;

Eff. September 3, 1976;

Readopted Eff. September 26, 1977;

Amended Eff. September 1, 2014; June 1, 2009; March 1, 2006; August 1, 1998; March 1, 1988;

Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. January 9, 2018;

Amended Eff. December 1, 2022; October 1, 2019.

21 ncac 16b .0304 OTHER REQUIREMENTS

21 ncac 16b .0305 TIME FOR FILING

21 NCAC 16B .0306 FOREIGN GRADUATES

21 NCAC 16B .0307 EXAMINATIONS

21 NCAC 16B .0308 PATIENTS AND SUPPLIES FOR CLINICAL EXAM

21 NCAC 16B .0309 SCOPE OF CLINICAL EXAMINATION

History Note: Authority G.S. 90‑28; 90‑30; 90-41; 90‑48;

Eff. September 3, 1976;

Readopted Eff. September 26, 1977;

Amended Eff. August 1, 2002 August 1, 1998; January 1, 1994; May 1, 1991; May 1, 1989; March 1, 1988; October 1, 1986; January 1, 1983;

Temporary Amendment Eff. January 1, 2003;

Amended Eff. January 1, 2004; April 1, 2003;

Repealed Eff. March 1, 2006.

21 NCAC 16B .0310 CLINICAL OPERATIVE DENTISTRY

21 NCAC 16B .0311 ORAL SURGERY: RADIOGRAPHS: INTERPRETATION AND DIAGNOSIS

21 NCAC 16B .0312 REMOVABLE PROSTHODONTICS

21 NCAC 16B .0313 PERIODONTICS

History Note: Authority G.S. 90‑28; 90‑30; 90‑48;

Eff. September 3, 1976;

Readopted Eff. September 26, 1977;

Amended Eff. January 1, 1983;

Repealed Eff. October 1, 1986.

21 NCAC 16B .0314 SIMULATED CLINICAL PROCEDURES

History Note: Authority G.S. 90‑28; 90‑30; 90‑48;

Eff. January 1, 1983;

Repealed Eff. October 1, 1986.

21 ncac 16b .0315 REEXAMINATION

History Note: Authority G.S. 90-28; 90-30; 90-48;

Eff. January 1, 1983;

Amended Eff. April 1, 2003; August 1, 2002; May 1, 1991; May 1, 1989; October 1, 1986;

Repealed Eff. March 1, 2006.

21 NCAC 16B .0316 ORAL EXAMINATION: INSTRUCTORS

History Note: Authority G.S. 90‑28; 90‑30; 90‑48;

Eff. October 1, 1986;

Repealed Eff. May 1, 1989.

21 ncac 16b .0317 REEXAMINATION

(a) Any applicant who has passed the written examination but has failed the clinical examination must also re-take the written examination unless the applicant successfully passes the clinical examination within one year after passing the written examination. The Board will not accept scores from the written portion of the examination that are more than one year old.

(b) Any applicant who has failed the written portion of the examination may retake the written portion of the examination two additional times during the 12 month period from the date of the initial examination. The applicant must wait a minimum of 72 hours before attempting to retake a written examination.

(c) Any applicant who has failed the written portion of the examination three times shall successfully complete an additional Board approved course of study in the area(s) of deficiency exhibited on the examination. Such applicant must send evidence of the additional study, along with the application, before being admitted for reexamination.

History Note: Authority G.S. 90-28; 90-30; 90-48;

Eff. November 1, 2008;

Amended Eff. September 1, 2013;

Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. January 9, 2018.

21 NCAC 16B .0318 TEMPORARY LIMIted LICENSE during state of emergency

History Note: Authority G.S. 90-28; 90-28.5; 90-30; 90-39; S.L. 2020-3, s. 4.38; S.L. 2020-97, s. 3.20;

Emergency Adoption Eff. May 22, 2020 to expire pursuant to S.L. 2020-3, s. 4.38.(e);

Emergency Adoption Expired Eff. August 1, 2020 pursuant to S.L. 2020-3, s. 4.38.(e);

Emergency Adoption Eff. October 22, 2020 to expire pursuant to S.L. 2020-97, s. 3.20;

Emergency Adoption Expired Eff. March 31, 2021.

SECTION .0400 – LICENSURE BY BOARD CONDUCTED EXAMINATION

21 NCAC 16B .0401 APPLICATION FOR BOARD CONDUCTED EXAMINATION

21 NCAC 16B .0402 TIME FOR FILING

21 NCAC 16B .0403 EXAMINATION conducted by the board

21 NCAC 16B .0404 PATIENTS AND SUPPLIES FOR BOARD CONDUCTED CLINICAL EXAMINATION

21 NCAC 16B .0405 SCOPE OF BOARD CONDUCTED CLINICAL EXAMINATION

History Note: Authority G.S. 90-28; 90-30; 90-39; 90-41; 90-48;

Eff. March 1, 2006;

Amended Eff. February 1, 2008;

Repealed Eff. September 1, 2014.

21 ncac 16b .0406 BOARD CONDUCTED REEXAMINATION

History Note: Authority G.S. 90-28; 90-30; 90-48;

Eff. April 1, 2006;

Repealed Eff. September 1, 2014.

SECTION .0500 – LICENSURE BY CREDENTIALS

21 ncac 16b .0501 DENTAL LICENSURE BY CREDENTIALS

(a) Except for instructors applying under Rule .0502 of this Section, an applicant for a dental license by credentials shall submit to the Board:

(1) a notarized application form provided by the Board at www.ncdentalboard.org that includes the information and materials required by Rule .0301(a) of this Subchapter;

(2) the non-refundable licensure by credentials fee set forth in 21 NCAC 16M .0101;

(3) an affidavit from the applicant stating for the five year period set out in G.S. 90-36(c)(1):

(A) the dates that and locations where the applicant has practiced dentistry;

(B) that the applicant has provided at least 5,000 hours of clinical care to patients, not including postgraduate training, residency programs, or an internship; and

(C) that the applicant has held an active, unrestricted dental license issued by another U.S. state or U.S. territory, without any period of interruption; and

(4) a statement disclosing and explaining any investigations, malpractice claims, or state or federal agency complaints, judgments, or settlements that are related to licensure and are not disclosed elsewhere in the application.

(b) In addition to the requirements of Paragraph (a) of this Rule, an applicant for a dental license by credentials shall request the applicable entity to send the following required information or documents, in a sealed envelope or via secure electronic transmission, directly from the entity to the Board office:

(1) the applicant's official transcripts from a dental school or college accredited by the Commission on Dental Accreditation of the American Dental Association ("CODA") showing the applicant graduated with a DDS or DMD degree;

(2) a certificate of the applicant's licensure status from the dental regulatory authority or other occupational or professional regulatory authority and a disclosure of any disciplinary action taken or investigation pending, from all licensing jurisdictions where the applicant holds or has ever held a dental license or other occupational or professional license;

(3) scores from:

(A) the National Board Dental Examination administered by the Joint Commission on National Dental Examinations; and

(B) a clinical examination accepted by the Board based on the criteria set out in Rule .0303(d) of this Subchapter;

(4) a report of any pending or final malpractice actions against the applicant verified by any malpractice insurance carrier covering the applicant; and

(5) a letter of coverage history from all current and all previous malpractice insurance carriers covering the applicant.

(c) An application shall be complete when the Board receives all information and documentation set forth in Paragraphs (a) and (b) of this Rule and the applicant's passing scores on all examinations required by this Rule. Partial applications that are not completed within one year of the date the first document is submitted to the Board shall be disregarded as expired without a refund of the application fee.

(d) An applicant for dental licensure by credentials shall pass the Board's written examinations in sterilization and jurisprudence as set out in Rule .0303(a) of this Subchapter. Individuals who do not pass either written examination after three attempts within one year in accordance with Rule .0317(b) of this Subchapter shall not be eligible for reexamination under Rule .0317(c) of this Subchapter and may not reapply for licensure by credentials.

(e) If an applicant graduated with a certificate or a degree from a CODA-accredited advanced dental education program, the applicant shall be subject to all the requirements of this Rule, except:

(1) the applicant is not required to hold a dental license issued by any U.S. state or territory; and

(2) the applicant shall satisfy the educational credentials requirement set out in Subparagraph (b)(1) of this Rule by requesting the applicable entity to send directly to the Board office, in a sealed envelope or via secure electronic transmission:

(A) official transcripts from any school or college showing the applicant graduated with a general dental degree; and

(B) official transcripts from a school or college showing the applicant graduated with a certificate or a degree from a CODA-accredited advanced dental education program in the school.

(f) Any applicant who changes his or her address shall notify the Board office in writing within 10 business days.

(g) Any license obtained through fraud or by any false representation shall be revoked.

History Note: Authority G.S. 90-28; 90-36; 90-41;

Temporary Adoption Eff. January 1, 2003;

Eff. January 1, 2004;

Recodified from 21 NCAC 16B .0401 Eff. March 1, 2006;

Amended Eff. September 1, 2014; February 1, 2010;

Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. January 9, 2018;

Amended Eff. December 1, 2023; March 1, 2020.

21 NCAC 16B .0502 DENTAL LICENSURE VIA Instructor'S license

(a) An applicant for license by credentials who holds an unexpired instructor's license issued by the Board shall submit to the Board:

(1) a notarized application form provided by the Board at www.ncdentalboard.org that includes information and materials required by Rule .0301(a) of this Subchapter;

(2) a letter of recommendation from the applicant's employing dental school or academic medical center; and

(3) the non-refundable licensure by credentials fee set forth in 21 NCAC 16M .0101.

(b) An application shall be complete when the Board receives all information and documentation required by this Rule. Partial applications that are not completed within one year of the date the first document is submitted to the Board shall be disregarded as expired without a refund of the application fee.

(d) Any license obtained through fraud or by any false representation shall be revoked.

History Note: Authority G.S. 90-28; 90-36; 90-41;

Eff. December 1, 2023.

SECTION .0600 – LIMITED VOLUNTEER DENTAL LICENSE

21 NCAC 16B .0601 LIMITED VOLUNTEER DENTAL LICENSE

(a) An applicant for a limited volunteer dental license shall submit to the Board:

(1) a notarized application form provided by the Board at www.ncdentalboard.org that includes the information and materials required by Rule .0301(a) of this Subchapter;

(2) the non-refundable limited volunteer dental licensure fee set forth in 21 NCAC 16M .0101;

(3) an affidavit from the applicant stating:

(A) for the five consecutive years preceding the date of the application, the dates that and locations where the applicant has practiced dentistry;

(B) that the applicant has provided at least 1,000 hours per year of clinical care to patients for at least five years, not including post graduate training, residency programs or an internship; and

(C) that the applicant has provided at least 500 hours of clinical care to patients within the five years preceding the date of the application, not including post graduate training, residency programs or an internship; and

(b) In addition to the requirements of Paragraph (a) of this Rule, an applicant for a limited volunteer dental license shall satisfy the requirements in Rule .0501(b) of this Subchapter.

(c) The Board shall receive all information and documentation required under Paragraphs (a) and (b) of this Rule and the applicant's passing scores on all examinations required by Rule .0303 of this Subchapter for the application to be complete. Applications that are not completed within one year of being submitted to the Board shall be disregarded as expired without a refund of the application fee.

(d) An applicant for limited volunteer dental license shall pass written examinations as set out in Rule .0303(a) of this Subchapter. Applicants who do not pass the written examination after three attempts in one year may not reapply for a limited volunteer dental license.

(e) A North Carolina licensee who holds an active dental license may request his or her active dental license be converted to a limited volunteer dental license by submitting a written request to the Board office. A North Carolina active licensee making this request is not subject to Paragraphs (a) through (d) of this Rule.

(f) Any applicant who changes his or her address shall notify the Board office in writing within 10 business days.

(g) Any license obtained through fraud or by any false representation shall be revoked.

History Note: Authority G.S. 90-28; 90-37.1;

Temporary Adoption Eff. January 1, 2003;

Eff. January 1, 2004;

Recodified from 21 NCAC 16B .0501 Eff. March 1, 2006;

Amended Eff. September 1, 2014;

Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. January 9, 2018;

Amended Eff. March 1, 2020.

SECTION .0700 – INSTRUCTOR'S LICENSE

21 ncac 16b .0701 INSTRUCTOR'S LICENSE

(a) An applicant for an instructor's license shall submit to the Board:

(1) a notarized application form provided by the Board at www.ncdentalboard.org that includes the information and materials required by Rule .0301(a) of this Subchapter;

(2) the non-refundable instructor's licensure fee set forth in 21 NCAC 16M .0101; and

(3) a statement disclosing and explaining any investigations, malpractice claims, or state or federal agency complaints, judgments, or settlements that are related to licensure and are not disclosed elsewhere in the application.

(b) In addition to the requirements of Paragraph (a) of this Rule, an applicant for an instructor's license shall request the applicable entity to send the following required information or documents to the Board office, with each document in an unopened envelope sealed by the entity involved:

(1) if the applicant is or has ever been employed as a dentist by or under contract with a government agency or a nonprofit or for-profit organization, a certification letter of the applicant's current status and disciplinary history from each agency or organization where the applicant is or has been employed or under contract;

(2) a certificate of the applicant's licensure status from the dental regulatory authority or other occupational or professional regulatory authority and information regarding all disciplinary actions taken or investigations pending, from all licensing jurisdictions where the applicant holds or has ever held a dental license or other occupational or professional license;

(3) a report of any pending or final malpractice actions against the applicant, verified by the malpractice insurance carrier covering the applicant;

(4) a letter of coverage history from all current and all previous malpractice insurance carriers covering the applicant; and

(5) a certification letter from the dean or director that the applicant has met or been approved under the credentialing standards of a dental school or an academic medical center with which the person is to be affiliated, and certification that the school or medical center is accredited by the American Dental Association's Commission on Accreditation or the Joint Commission on Accreditation of Health Care Organizations.

(c) The Board shall receive all information and documentation set forth in Paragraphs (a) and (b) of this Rule for the application to be complete. Applications that are not completed within one year of being submitted to the Board shall be disregarded as expired without a refund of the application fee.

(d) Any applicant who changes his or her address shall notify the Board office in writing within 10 business days.

(e) Any license obtained through fraud or by any false representation shall be revoked.

History Note: Authority G.S. 90-28; 90-29.5;

Temporary Adoption Eff. January 1, 2003;

Eff. January 1, 2004;

Recodified from 21 NCAC 16B .0601 Eff. March 1, 2006;

Amended Eff. September 1, 2014;

Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. January 9, 2018;

Amended Eff. March 1, 2020.

section .0800 – special restricted licenses

21 NCAC 16B .0801 TEMPORARY VOLUNTEER DENTAL PERMIT

(a) An applicant for a temporary volunteer dental permit shall submit to the Board an application form provided by the Board at www.ncdentalboard.org that includes the following information:

(1) full name;

(2) street address;

(3) employer name and address, and the applicant's position title;

(4) work, home, and cellular telephone numbers;

(5) fax number;

(6) email address;

(7) any other name by which the applicant was known in the past;

(8) social security number;

(9) citizenship or immigration status, with verifying documentation;

(10) authorization to work in the United States;

(11) dental education, including dental school name, address, and the applicant's graduation date, and any other dental post-graduate education;

(12) all dental licenses from other states ever held by the applicant, including state, license number, date issued, and licensure status as of the application date;

(13) if the applicant has ever been denied a license or the privilege of taking a dental licensure or competency examination by any dental licensing authority or examining body, a written statement disclosing the details, jurisdiction, and date;

(14) if the applicant is not engaged in the practice of dentistry as of the application date, the last month and year when the applicant practiced;

(15) if the applicant has been charged with or convicted of any crime within the 10 years preceding the application date, excluding traffic violations but including driving while impaired offenses, a written statement disclosing the details and copies of the charges and judgment;

(16) if the applicant has any contagious or infectious disease, a written statement disclosing the details;

(17) a statement disclosing and explaining any current condition or impairment, including substance abuse, alcohol abuse, or a mental, emotional, or nervous disorder or condition, that in any way affects the ability to practice dentistry. For purposes of this Rule, "current" means recently enough that the condition may affect the applicant's ability to function as a dentist as set out in G.S. 90-41(a)(2) and (7). If the applicant contends that the condition or impairment is reduced or ameliorated because the applicant is receiving ongoing treatment or participating in a monitoring or support program, the applicant may provide information regarding the treatment or program, and may include any verification demonstrating that the applicant has complied with all provisions and terms of any drug treatment program, or impaired dentists or other impaired professionals program;

(18) the type of facility and addresses of all facilities where the applicant will provide temporary volunteer dental services in North Carolina;

(19) the dates on which the applicant intends to provide temporary volunteer dental services in North Carolina;

(20) the names of all North Carolina licensed dentists who will direct or supervise the applicant at each location where the applicant will provide temporary volunteer dental services;

(21) a copy of an unexpired CPR certificate;

(22) a photograph of the applicant taken within six months preceding the application date;

(23) a completed fingerprint record card and signed release of information form authorizing the Board to request a fingerprint-based criminal history record check from the North Carolina State Bureau of Investigation (SBI); and

(24) a signed, notarized statement by the applicant affirming the applicant has not been disciplined by any dental board or agency, the information in the application is accurate, and no fee will be charged or accepted for any dental services provided.

(b) In addition to the requirements of Paragraph (a) of this Rule, the applicant shall request the applicable entity or person to send the following required information or documents to the Board office, with each document in an unopened envelope sealed by the entity involved:

(1) a statement from all jurisdictions in which the applicant is now or has ever been licensed, disclosing the applicant's disciplinary history and current status of the applicant's license; and

(2) a statement signed by a North Carolina licensed dentist agreeing to provide supervision or direction to the temporary volunteer dentist, stating when and where the supervision or direction will occur and affirming that no fee or monetary compensation of any kind will be paid to the applicant for dental services performed.

(c) The Board shall receive all items set forth in Paragraphs (a) and (b) of this Rule for the application to be complete. Applications that are not completed within one year of being submitted to the Board shall be disregarded as expired.

(d) The holder of a temporary volunteer dental permit shall notify the Board within five days of any changes in the practice location or facility disclosed under Paragraph (a) of this Rule.

(e) To renew the temporary volunteer dental permit, the licensee shall submit to the Board:

(1) an affidavit or notarized statement verifying the location and type of facility where the applicant will practice, the duration of the practice, the name of the supervising dentist, that no fee will be charged or accepted, and that the information in the original application submitted under Paragraph (a) of this Rule is correct and requires no update or correction; and

(2) the information required in Paragraph (b) of this Rule.

The Board shall receive all items set forth in this Paragraph for the renewal application to be complete before the deadline for renewing applications. The applicant shall report any changes to submitted information within five days of when the licensee knew or should have known of the changes.

(f) Any applicant who changes his or her address shall notify the Board office in writing within 10 business days.

(g) Any license obtained through fraud or by any false representation shall be revoked.

History Note: Authority G.S. 90-29; 90-37.2; 90-41;

Eff. February 1, 2008;

Amended Eff. September 1, 2014;

Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. January 9, 2018;

Amended Eff. March 1, 2020.

SECTION .0900 – EXEMPTIONS FOR ACTIVE MILITARY

21 NCAC 16B .0901 DEFINITIONS

The following definitions apply only to this Section;

(1) "Dental Board" – the North Carolina State Board of Dental Examiners.

(2) "Eligible licensees" – all dentists currently licensed by and in good standing with the North Carolina State Board of Dental Examiners who are serving in the armed forces of the United States and who are eligible for an extension of time to file a tax return pursuant to G.S. 105-249.2.

(3) "Extension period" – the time period disregarded pursuant to 26 U.S.C. 7508.

(4) "Good standing" – a dentist whose license is not suspended, revoked or subject to a probationary order.

History Note: Authority G.S. 90-28; 93B-15;

Eff. April 1, 2010;

Amended Eff. September 1, 2014;

Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. January 9, 2018.

21 NCAC 16B .0902 EXEMPTIONS GRANTED

(a) Eligible licensees are granted a waiver of their mandatory continuing education requirements.

(b) Eligible licensees are granted an extension period in which to pay license renewal fees and comply with all other requirements imposed by the Dental Board as conditions for maintaining licensure and current sedation permits.

History Note: Authority G.S. 90-28; 93B-15;

Eff. April 1, 2010;

Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. January 9, 2018.

SECTION .1000 - licensure by military endorsement

21 ncac 16b .1001 DENTAL LICENSURE BY ENDORSEMENT BASED ON MILITARY SERVICE

(a) An applicant for a dental license by endorsement based on military service shall submit to the Board:

(1) a notarized application form provided by the Board at www.ncdentalboard.org that includes the information and materials required by Rule .0301(a) of this Subchapter; and

(2) written evidence demonstrating the applicant has satisfied the conditions set forth in G.S. 93B-15.1(a), including engaging in the active practice of dentistry for at least 1,000 hours per year for at least two of the five years preceding the date of the application.

(b) In addition to the requirements of Paragraph (a) of this Rule, an applicant for licensure by endorsement based on military service shall satisfy the requirements in Rule .0501(b) of this Subchapter.

(c) The Board shall receive all information and documentation required under Paragraphs (a) and (b) of this Rule for the application to be complete. Applications that are not completed within one year of being submitted to the Board shall be disregarded as expired.

(d) Any applicant who changes his or her address shall notify the Board office in writing within 10 business days.

(e) Any license obtained through fraud or by any false representation shall be revoked.

History Note: Authority G.S. 90-30(b); 90-41; 93B-15.1;

Eff. September 1, 2013;

Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. January 9, 2018;

Amended Eff. March 1, 2020.

21 ncac 16b .1002 DENTAL LICENSURE BY ENDORSEMENT BASED ON STATUS AS MILITARY SPOUSE

(a) An applicant for a dental license by endorsement based on the applicant's status as a military spouse shall submit to the Board:

(1) a notarized application form provided by the Board at www.ncdentalboard.org that includes the information and materials required by Rule .0301(a) of this Subchapter; and

(2) written evidence demonstrating the applicant is married to an active member of the U.S. military and the applicant satisfies the conditions set forth in G.S. 93B-15.1(b), including engaging in the active practice of dentistry for at least 1,000 hours per year for at least two of the five years preceding the date of the application.

(b) In addition to the requirements of Paragraph (a) of this Rule, an applicant for licensure by endorsement based on status as a military spouse shall satisfy the requirements in Rule .0501(b) of this Subchapter.

(d) Any applicant who changes his or her address shall notify the Board office in writing within 10 business days.

(e) Any license obtained through fraud or by any false representation shall be revoked.

History Note: Authority G.S. 90-30(b); 90-36; 90-41; 93B-15.1;

Eff. September 1, 2013;

Amended Eff. September 1, 2014;

Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. January 9, 2018;

Amended Eff. March 1, 2020.

SECTION .1100 - REINSTATEMENT

21 NCAC 16B .1101 APPLICATION FOR REINSTATEMENT AND PROOF OF COMPETENCY

(a) Any person desiring to practice dentistry in North Carolina whose North Carolina dental license has been revoked, suspended, retired, or expired shall submit to the Board an application for reinstatement. All applications for reinstatement of a dental license shall be submitted on forms furnished by the Board at www.ncdentalboard.org and shall include:

(1) original dental license number and date of issuance;

(2) full name;

(3) street address as of the date of the application;

(4) telephone number;

(5) email address;

(6) citizenship or immigration status, with verifying documentation;

(7) a statement disclosing and explaining the nature, facts, and disposition of any matter where the applicant has ever:

(A) been summoned to court or before a magistrate for the violation of any law or ordinance or for the commission of any felony or misdemeanor;

(B) been arrested for the violation of any law or ordinance or for the commission of any felony or misdemeanor;

(C) been taken into custody for the violation of any law or ordinance or for the commission of any felony or misdemeanor;

(D) been indicted for the violation of any law or ordinance or for the commission of any felony or misdemeanor;

(E) been convicted or tried for the violation of any law or ordinance or for the commission of any felony or misdemeanor;

(F) been charged with the violation of any law or ordinance or for the commission of any felony or misdemeanor; or

(G) pleaded guilty to the violation of any law or ordinance or for the commission of any felony or misdemeanor;

(8) whether the applicant is under investigation as of the date of the application or has ever been investigated by the Board or any other licensing board;

(9) whether the applicant has ever had a civil lawsuit related to the practice of dentistry settled;

(10) all dental licenses from other jurisdictions ever held by the applicant, including dates of licensure;

(11) a statement disclosing all the applicant's dental practices from dental school graduation to the date of the application, including:

(A) the dates during which the applicant was engaged in practice as a dentist;

(B) the addresses of the offices or places at which the applicant was employed or practicing, and the names and addresses of all employers, partners, associates, or persons sharing office space;

(D) the reason for the termination of each employment or period of private practice;

(12) a statement disclosing and explaining any current condition or impairment, including substance abuse, alcohol abuse, or a mental, emotional, or nervous disorder or condition, that in any way affects the ability to practice dentistry. For purposes of this Rule, "current" means recently enough that the condition or impairment may affect the applicant's ability to function as a dentist as set out in G.S. 90-41(a)(2) and (7). If the applicant contends that the condition or impairment is reduced or ameliorated because the applicant is receiving ongoing treatment or participating in a monitoring or support program, the applicant may provide information regarding the treatment or program, and may include any verification demonstrating that the applicant has complied with all provisions and terms of any drug treatment program, or impaired dentists or other impaired professionals program;

(13) two letters of character reference from non-family members;

(14) a copy of a National Practitioner Data Bank report concerning the applicant that was obtained within six months prior to the date the report is submitted to the Board;

(15) documentation of the applicant's completion of continuing education courses, as set out in 21 NCAC 16R .0200, in amounts equal to the number of hours required for renewal of a dental license; and

(16) a copy of an unexpired CPR certificate.

(b) The applicant shall submit to the Board the notarized application form for reinstatement with all the information and materials listed in Paragraph (a) of this Rule, accompanied by the nonrefundable reinstatement application fee set forth in 21 NCAC 16M .0101(a)(8) and the renewal fees set forth in 21 NCAC 16M .0101(a)(2) and (b).

(c) In addition to the requirements of Paragraphs (a) and (b) of this Rule, if the applicant is or has ever been licensed in other states, the applicant shall request the dental regulatory authority or other occupational or professional regulatory authority of each licensing jurisdiction where the applicant holds or has ever held a dental license to send to the Board office, in an unopened envelope sealed by the authority, a certificate of the applicant's licensure status accompanied by a disclosure of any disciplinary action taken or investigation pending.

(d) An applicant whose North Carolina license has been revoked, suspended, retired, or expired for more than one year shall submit to the Board a completed fingerprint record card and signed release of information form authorizing the Board to request a fingerprint-based criminal history record check from the North Carolina State Bureau of Investigation.

(e) An applicant for reinstatement whose North Carolina dental license has been revoked, suspended, retired, or expired for two to five years shall take refresher courses as specified by the Board if the Board determines that the applicant lacks skills or knowledge to practice dentistry. Refresher courses for an applicant whose license was revoked or suspended shall relate to the deficiencies that led to the imposition of discipline. Refresher courses for an applicant whose license has been retired or expired shall be specified by the Board taking into account the amount of time the license has been retired or expired and the applicant's level of experience.

(f) An applicant for reinstatement whose North Carolina dental license has been revoked, suspended, retired, or expired for more than five years shall pass the American Board of Dental Examiners dental licensure clinical examinations before applying for reinstatement.

(g) The Board shall receive all information and documentation set forth in Paragraphs (a) through (e) of this Rule and the applicant's passing scores on any examinations required under Paragraph (f) of this Rule for the application to be complete. Applications that are not completed within one year of being submitted to the Board shall be disregarded as expired without a refund of the application fees.

(h) Any applicant who changes his or her address shall notify the Board office in writing within 10 business days.

(i) Any license obtained through fraud or by any false representation shall be revoked.

History Note: Authority G.S. 90-30; 90-41; 90-42;

Eff. September 1, 2014;

Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. January 9, 2018;

Amended Eff. September 1, 2020.

SUBCHAPTER 16C - LICENSURE DENTAL HYGIENISTS

SECTION .0100 - GENERAL PROVISIONS

21 NCAC 16C .0101 LICENSURE

(a) All dental hygienists shall be licensed by the Board before practicing dental hygiene in this State. All persons desiring to practice dental hygiene in this State shall pass Board approved written and clinical examinations, as set forth in Rule .0303 of this Subchapter, before receiving a license.

(b) The examination requirement set forth in Paragraph (a) of this Rule shall not apply to persons who do not hold a North Carolina dental hygiene license who are seeking volunteer licenses pursuant to G.S. 90-21.107, or licensure by military endorsement pursuant to 21 NCAC 16G .0107 or .0108.

History Note: Authority G.S. 90-223; 90-224;

Eff. September 3, 1976;

Readopted Eff. September 26, 1977;

Amended Eff. September 1, 2014; September 1, 2013; June 1, 2006; May 1, 1989; January 1, 1983;

Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. January 9, 2018;

Amended Eff. July 1, 2022; October 1, 2019.

21 NCAC 16C .0102 NO RECIPROCAL ARRANGEMENT

History Note: Authority G.S. 90‑223; 90‑224; 90‑226;

Eff. September 3, 1976;

Readopted Eff. September 26, 1977;

Amended Eff. May 1, 1989;

Expired Eff. February 1, 2018 pursuant to G.S. 150B-21.3A.

SECTION .0200 ‑ QUALIFICATIONS

21 NCAC 16C .0201 IN GENERAL

History Note: Authority G.S. 90‑28; 90‑48; 90‑223; 90‑224;

Eff. September 3, 1976;

Readopted Eff. September 26, 1977;

Repealed Eff. May 1, 1989.

21 NCAC 16C .0202 STUDENT MAY APPLY

The Board shall accept dental hygienist applications from students currently enrolled in schools of dental hygiene. Applications shall automatically be denied if the applicant fails to complete the required course of study or fails a Board approved licensure examination.

History Note: Authority G.S. 90-223; 90-224;

Eff. September 3, 1976;

Readopted Eff. September 26, 1977;

Amended Eff. September 1, 2014; June 1, 2006; May 1, 1989;

Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. January 9, 2018.

21 ncac 16c .0203 TRANSCRIPTS REQUIRED

History Note: Authority G.S. 90‑223; 90‑224;

Eff. September 3, 1976;

Readopted Eff. September 26, 1977;

Amended Eff. April 1, 2003; January 1, 1994; May 1, 1989;

Repealed Eff. June 1, 2006.

SECTION .0300 - APPLICATION

21 NCAC 16C .0301 APPLICATION FOR LICENSURE

(a) All applications for licensure as a dental hygienist shall be made on the forms furnished by the Board at www.ncdentalboard.org and shall include the following information:

(1) full name;

(2) street address as of the date of the application;

(3) permanent street address:

(4) preferred mailing address for all information;

(5) telephone number;

(6) email address;

(7) age;

(8) date of birth;

(9) place of birth;

(10) citizenship or immigration status, with verifying documentation;

(11) social security number;

(12) marital status;

(13) any other name by which the applicant was known in the past, accompanied by a certified copy of a court order of name change, if applicable;

(14) all resident addresses for the past 10 years preceding the date of application;

(15) the names, addresses, and phone numbers for two individuals to whom the applicant always provides the applicant's current address;

(16) disclosure and explanation of any bankruptcy proceedings in which the applicant was a named party;

(17) the license number, issuing state, and expiration date for all current drivers' licenses held by the applicant, and the issuing state for all drivers' licenses held in the past by the applicant;

(18) the date of the applicant's previous application for examination by the Board, if applicable;

(19) the date and type of any dental hygiene license for which the applicant applied in the past, if applicable;

(20) if the applicant failed an examination administered by a dental board, the date of the examination and jurisdiction of the dental board that administered the examination;

(21) if any dental board has refused to administer an examination to applicant, the jurisdiction of the dental board that refused to administer the examination and the date of the refusal;

(22) the dates upon which the applicant has taken the Dental Hygiene National Board Examination, the location of each examination, and authorization for the Board to access the examination scores;

(23) if the applicant failed the Dental Hygiene National Board Examination, the date of the examination that he or she failed;

(24) if the applicant has applied for a dental hygiene license in any other state or foreign country, the date of the application and whether the license was issued to the applicant;

(25) all employment held by the applicant for the past 10 years;

(26) if the applicant was terminated from employment within the past 10 years, an explanation regarding the termination;

(27) all dental hygiene licenses from other jurisdictions ever held by the applicant, including type of licensure, license number, and dates of licensure;

(28) places of employment at which the applicant has practiced dental hygiene, including the name of the employer, the address of the employer, dates of employment, and the reason for leaving the employment;

(29) if the applicant has ever been suspended or otherwise disqualified, or reprimanded, censured, or otherwise disciplined by any licensing board, professional organization, or while the applicant was holding public office, a written statement disclosing:

(A) the facts that formed the basis for the discipline;

(B) the date of the discipline;

(D) the name and address of the authority in possession of records related to discipline;

(30) if the applicant has ever been the subject of a complaint with any licensing board, professional organization, or while the applicant was holding public office, a written statement disclosing:

(A) the facts that gave rise to the complaint;

(B) the date of the complaint;

(D) the name and address of the authority in possession of records related to the complaint;

(31) if the applicant has ever been reported to the National Practitioner Data Bank or the Healthcare Integrity and Protection Data Bank, a written statement disclosing:

(A) the facts that formed the basis for the report;

(B) the date of the report; and

(32) if the applicant has ever been dropped, suspended, expelled, or disciplined by any post-secondary school or college for any cause, a written statement disclosing:

(A) the facts leading to the discipline;

(B) the date of the discipline; and

(33) if the applicant has ever been denied admission to any college or post-secondary school for a reason other than academic qualifications, a written statement explaining the reason for the admission denial;

(34) if the applicant has ever served in the armed forces of the United States or any other country, a written statement explaining:

(A) whether the applicant has been separated from service;

(B) the nature of the separation;

(D) dates of service;

(E) the facts leading up to any charges or complaints made or filed against the applicant while the applicant was serving in the armed forces, and the outcome of the charges or complaints;

(F) the facts leading to any disciplinary proceedings instituted against the applicant while the applicant was serving in the armed forces, and the outcome of the proceedings; and

(G) if the applicant was ever a defendant in any court martial, the facts giving rise to those proceedings and the outcome of the proceedings;

(35) a statement of whether the applicant has registered under the Military Selective Service Act;

(36) a statement of whether the applicant has ever:

(A) been summoned to court or before a magistrate for the violation of any law or ordinance or for the commission of any felony or misdemeanor;

(B) been arrested for the violation of any law or ordinance or for the commission of any felony or misdemeanor;

(C) been taken into custody for the violation of any law or ordinance or for the commission of any felony or misdemeanor;

(D) been indicted for the violation of any law or ordinance or for the commission of any felony or misdemeanor;

(E) been convicted or tried for the violation of any law or ordinance or for the commission of any felony or misdemeanor;

(F) been charged with the violation of any law or ordinance or for the commission of any felony or misdemeanor; or

(G) pleaded guilty to the violation of any law or ordinance or for the commission of any felony or misdemeanor;

(37) the applicant's high school education including the name, location, and period of attendance for each school, and the date of graduation;

(38) any college or university education other than dental hygiene, including the name, location, and period of attendance for each school, and the date of graduation;

(39) the applicant's dental hygiene education including the name, location, and period of attendance for each school, and date of graduation;

(40) a statement disclosing and explaining any current condition or impairment, including substance abuse, alcohol abuse, or a mental, emotional, or nervous disorder or condition, that in any way affects the ability to practice dental hygiene. For purposes of this Rule, "current" means recently enough that the condition or impairment may affect the applicant's ability to function as a dental hygienist as set out in G.S. 90-229(a)(4) and (13). If the applicant contends that the condition or impairment is reduced or ameliorated because the applicant is receiving ongoing treatment or participating in a monitoring or support program, the applicant may provide information regarding the treatment or program, and may include any verification demonstrating that the applicant has complied with all provisions and terms of any drug treatment program, or impaired dental hygienists or other impaired professionals program;

(41) a photograph of the applicant, taken within six months prior to the date of the application;

(42) a completed fingerprint record card and signed release of information form authorizing the Board to request a fingerprint-based criminal history record check from the North Carolina State Bureau of Investigation (SBI);

(43) a copy of an unexpired CPR certificate; and

(44) if the applicant holds, or has held in the past, a dental hygiene license in any other state or jurisdiction, a copy of a National Practitioner Data Bank Report concerning the applicant that was obtained within six months prior to the date the report is submitted to the Board.

(1) proof of graduation from high school or its equivalent;

(2) the applicant's official transcripts from a dental hygiene program accredited by the Commission on Dental Accreditation of the American Dental Association;

(3) if the applicant is licensed in other states, a certificate of the applicant's licensure status from the dental regulatory authority or other occupational or professional regulatory authority, accompanied by a full disclosure of any disciplinary action taken or investigation pending, from all licensing jurisdictions where the applicant holds or has ever held a dental hygiene license or other occupational or professional license; and

(4) examination scores required by Rule .0303(b) of this Subchapter which shall include the American Board of Dental Examiners (ADEX) dental hygiene licensure examinations.

(e) Any applicant who changes his or her address shall notify the Board office in writing within 10 business days.

(f) Any license obtained through fraud or by any false representation shall be revoked.

History Note: Authority G.S. 90-223; 90-224; 90-229(a)(4) and (13);

Eff. September 3, 1976;

Readopted Eff. September 26, 1977;

Amended Eff. September 1, 2014; September 1, 2013; June 1, 2006; May 1, 1989;

Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. January 9, 2018;

Amended Eff. March 1, 2020.

21 NCAC 16C .0302 CONSENT FOR BOARD INVESTIGATION

In making application, the applicant authorizes the Board to verify the information contained in the application or to seek such further information pertinent to the applicant's qualifications or character as the Board may deem proper. The applicant consents that his or her character and reputation may be inquired into, and waives any right he or she may have to recover damages against the Board, any member thereof, or its agents, or from any person who answers a Board inquiry in good faith without malicious intent.

History Note: Authority G.S. 90‑223; 90‑224;

Eff. September 3, 1976;

Readopted Eff. September 26, 1977;

Amended Eff. May 1, 1989;

Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. January 9, 2018.

21 NCAC 16C .0303 BOARD APPROVED EXAMINATIONS

(a) All applicants for dental hygiene licensure shall achieve passing scores on the Board's sterilization and jurisprudence examinations. Reexamination shall be governed by Rule .0311 of this Section.

(b) All applicants for dental hygiene licensure shall achieve passing scores on the examination administered by the Joint Commission on National Dental Examinations and clinical examinations administered by Board approved testing agencies. The Board shall determine which testing agencies are approved based on the requirements set forth in Paragraphs (c) and (d) of this Rule.

(c) To qualify as an approved testing agency, the test-development agency shall allow a representative of the Dental Board to serve on the agency's Board of Directors and Examination Review Committee for the limited purpose of allowing Dental Board input in the development and administration of the examination.

(d) To qualify as an approved testing agency, the clinical examination administered by a testing agency shall:

(1) include procedures performed on human subjects or an alternative method that simulates human subjects, including manikins, as part of the assessment of clinical competency;

(2) include probing, supra- and subgingival scaling, and soft tissue management; and

(3) provide the following:

(A) anonymity between applicants and examination graders;

(B) standardization and calibration of graders;

(E) a minimum passing score set by the testing agency for each subject area tested;

(F) an annual review of the examination conducted by the testing agency;

(G) a task analysis performed by the testing agency at least once every seven years that surveys dentists nationwide to determine the content of the examination;

(H) a system of quality assurance to ensure uniform, consistent administration of the examination at each testing site; and

(I) a system of quality assurance that does not permit a dental hygiene instructor to grade candidates at any institution at which the instructor is employed.

(e) The Board shall accept examination scores for five years following the date of the examination. Individuals who apply for licensure more than five years after the examination date shall re-take the examination. Each applicant shall request the applicable entity to send the applicant's scores to the Board office.

(f) The applicant shall comply with all requirements of the testing agency in applying for and taking the examination.

History Note: Authority G.S. 90-224;

Eff. September 3, 1976;

Readopted Eff. September 26, 1977;

Amended Eff. September 1, 2014; June 1, 2009; June 1, 2006; May 1, 1989; March 1, 1988;

Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. January 9, 2018;

Amended Eff. December 1, 2022; September 1, 2020.

21 NCAC 16C .0304 OTHER REQUIREMENTS

21 ncac 16c .0305 TIME FOR FILING

21 NCAC 16C .0306 EXAMINATIONS

21 NCAC 16C .0307 CLINICAL EXAMINATION

21 NCAC 16C .0308 SUPPLIES

21 NCAC 16C .0309 PATIENT

21 ncac 16c .0310 REEXAMINATION

History Note: Authority G.S. 90-223; 90-224; 90-229;

Eff. September 3, 1976;

Readopted Eff. September 26, 1977;

Amended Eff. August 1, 2002; January 1, 1994; May 1, 1991; May 1, 1989; March 1, 1988; October 1, 1986; January 1, 1983;

Temporary Amendment Eff. January 1, 2003;

Amended Eff. January 1, 2004; April 1, 2003;

Repealed Eff. June 1, 2006.

21 NCAC 16C .0311 REEXAMINATION

(a) Any applicant who passed the written examination but failed the clinical portion of any Board approved examination shall also re-take the written examination unless the applicant successfully passes the clinical examination within one year of passing the written examination. The Board shall not accept scores from the written examination that are more than one year old.

(b) Any applicant who failed the written examination may retake the written portion of the examination two additional times during a one year period and need not retake the clinical portion of the examination. The applicant shall wait at least 72 hours before attempting to retake the written examination. If the applicant does not pass the written portion of the examination upon the second reexamination, the applicant shall retake the written and clinical portions of the examination upon subsequent reexamination.

(c) Any applicant who failed the written or clinical portions of the examination three times shall successfully complete an additional Board approved course of study in the area(s) of deficiency exhibited on the examination. Such applicant must send evidence of the additional study, along with the application, before being admitted for reexamination.

History Note: Authority G.S. 90-223; 90-224;

Eff. September 1, 2014;

Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. January 9, 2018.

21 NCAC 16C .0312 TEMPORARY LIMIted LICENSE during state of emergency

History Note: Authority G.S. 90-28.5; 90-223; 90-224; S.L. 2020-3, s. 4.38; S.L. 2020-97, s. 3.20;

Emergency Adoption Eff. May 22, 2020 to expire pursuant to S.L. 2020-3, s. 4.38.(e);

Emergency Adoption Expired Eff. August 1, 2020 pursuant to S.L. 2020-3, s. 4.38.(e);

Emergency Adoption Eff. October 22, 2020 to expire pursuant to S.L. 2020-97, s. 3.20;

Emergency Adoption Expired Eff. March 31, 2021.

SECTION .0400 – LICENSURE BY EXAMINATION CONDUCTED BY THE BOARD

21 NCAC 16C .0401 APPLICATION FOR EXAMINATION CONDUCTED BY THE BOARD

21 NCAC 16C .0402 TIME FOR FILING

21 NCAC 16C .0403 EXAMINATION CONDUCTED BY THE BOARD

21 NCAC 16C .0404 PATIENTS AND SUPPLIES FOR BOARD CONDUCTED CLINICAL EXAMINATION

21 NCAC 16C .0405 BOARD CONDUCTED REEXAMINATION

History Note: Authority G.S. 90-223; 90-224; 90-224.1;

Eff. June 1, 2006;

Amended Eff. July 1, 2010; February 1, 2008;

Repealed Eff. September 1, 2014.

SECTION .0500 – LICENSURE BY CREDENTIALS

21 NCAC 16C .0501 DENTAL HYGIENE LICENSURE BY CREDENTIALS

(a) An applicant for a dental hygiene license by credentials shall submit to the Board:

(1) a notarized application form provided by the Board at www.ncdentalboard.org that includes the information and materials required by Rule .0301(a) of this Subchapter;

(2) the nonrefundable licensure by credentials fee set forth in 21 NCAC 16M .0102;

(3) an affidavit from the applicant stating for the two year period set out in G.S. 90-224.1(c)(1):

(A) the dates that and locations where the applicant has practiced dental hygiene;

(B) that the applicant has provided at least 2,000 hours of clinical care to patients; and

(C) that the applicant holds an active, unrestricted dental hygiene license issued by another U.S. state or any U.S. territory, and has done so without any period of interruption; and

(b) In addition to the requirements of Paragraph (a) of this Rule, an applicant for a dental hygiene license by credentials shall request the applicable entity to send the following required information or documents, in a sealed envelope or via secure electronic transmission, directly from the entity to the Board office:

(1) the applicant's official transcripts from a dental hygiene program accredited by the Commission on Dental Accreditation of the American Dental Association;

(2) a certificate of the applicant's licensure status from the regulatory authority or other occupational or professional regulatory authority and a disclosure of all disciplinary actions taken or investigations pending, from all licensing jurisdictions where the applicant holds or has ever held a dental hygiene license or other occupational or professional license;

(3) scores from:

(A) the National Board Dental Hygiene Examination administered by the Joint Commission on National Dental Examinations; and

(B) a clinical examination accepted by the Board based on the criteria set out in Rule .0303(d) of this Subchapter;

(4) a report of any pending or final malpractice actions against the applicant verified by any malpractice insurance carrier covering the applicant; and

(5) a letter of coverage history from all current and all previous malpractice insurance carriers covering the applicant.

For purposes of this Rule, "secure electronic transmission" means an electronic method of communication that ensures that completeness, integrity, and confidentiality of information are maintained during transmission.

(d) An applicant for dental hygiene licensure by credentials shall pass the Board's written examinations in sterilization and jurisprudence as set out in Rule .0303(a) of this Subchapter. Applicants who do not pass either written examination after three attempts within one year in accordance with Rule .0311(b) of this Subchapter shall not be eligible for reexamination under Rule .0311(c) of this Subchapter and may not reapply for licensure by credentials.

(e) Any applicant who changes his or her address shall notify the Board office in writing within 10 business days.

(f) Any license obtained through fraud or by any false representation shall be revoked.

History Note: Authority G.S. 90-223; 90-224.1; 90-229;

Temporary Adoption Eff. January 1, 2003;

Eff. January 1, 2004;

Recodified from Rule .0401 Eff. June 1, 2006;

Amended Eff. September 1, 2014; February 1, 2010;

Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. January 9, 2018;

Amended Eff. July 1, 2023; March 1, 2020.

section .0600 – reinstatement of dental hygiene license

21 NCAC 16C .0601 application for reinstatement and PROOF OF COMPETENCY

(a) Any person desiring to practice dental hygiene in North Carolina whose North Carolina dental hygiene license has been revoked, suspended, retired, or expired shall submit to the Board an application for reinstatement. All applications for reinstatement of a dental hygiene license shall be made on the forms furnished by the Board at www.ncdentalboard.org and shall include:

(1) original dental hygiene license number and date of issuance;

(2) full name;

(3) street address as of the date of the application;

(4) telephone number;

(5) email address;

(6) citizenship or immigration status, with verifying documentation;

(7) a statement disclosing and explaining the nature, facts, and disposition of any matter where the applicant has ever:

(A) been summoned to court or before a magistrate for the violation of any law or ordinance or for the commission of any felony or misdemeanor;

(B) been arrested for the violation of any law or ordinance or for the commission of any felony or misdemeanor;

(C) been taken into custody for the violation of any law or ordinance or for the commission of any felony or misdemeanor;

(D) been indicted for the violation of any law or ordinance or for the commission of any felony or misdemeanor;

(E) been convicted or tried for the violation of any law or ordinance or for the commission of any felony or misdemeanor;

(F) been charged with the violation of any law or ordinance or for the commission of any felony or misdemeanor; or

(G) pleaded guilty to the violation of any law or ordinance or for the commission of any felony or misdemeanor;

(8) whether the applicant is under investigation as of the date of the application or has ever been investigated by the Board or any other licensing board;

(9) whether the applicant has ever had a civil lawsuit related to the practice of dental hygiene settled;

(10) all dental hygiene licenses from other jurisdictions ever held by the applicant, including dates of licensure;

(11) a statement disclosing all the applicant's dental hygiene practices, including:

(A) the dates during which the applicant was employed as a dental hygienist;

(B) the name and address of each employer; and

(12) a statement disclosing and explaining any current condition or impairment, including substance abuse, alcohol abuse, or a mental, emotional, or nervous disorder or condition, that in any way affects the ability to practice dental hygiene. For purposes of this Rule, "current" means recently enough that the condition or impairment may affect the applicant's ability to function as a dental hygienist as set out in G.S. 90-229(a)(4) and (13). If the applicant contends that the condition or impairment is reduced or ameliorated because the applicant is receiving ongoing treatment or participating in a monitoring or support program, the applicant may provide information regarding the treatment or program, and may include any verification demonstrating that the applicant has complied with all provisions and terms of any drug treatment program, or impaired dental hygienists or other impaired professionals program;

(13) two letters of character reference from non-family members;

(14) a copy of a National Practitioner Data Bank report concerning the applicant that was obtained within six months prior to the date the report is submitted to the Board;

(15) documentation of the applicant's completion of continuing education courses, as set out in 21 NCAC 16I, in amounts equal to the number of hours required for renewal of a dental hygiene license; and

(16) a copy of an unexpired CPR certificate.

(b) The applicant shall submit to the Board the notarized application form for reinstatement with all the information and materials listed in Paragraph (a) of this Rule, accompanied by the nonrefundable reinstatement application fee set forth in 21 NCAC 16M .0102(a)(3) and the renewal fees set forth in 21 NCAC 16M .0102(a)(2) and (b).

(c) In addition to the requirements of Paragraphs (a) and (b) of this Rule, if the applicant is or has ever been licensed in other states, the applicant shall request the dental regulatory authority or other occupational or professional regulatory authority of each licensing jurisdiction where the applicant holds or has ever held a dental hygiene license to send to the Board office, in an unopened envelope sealed by the authority, a certificate of the applicant's licensure status accompanied by a disclosure of any disciplinary action taken or investigation pending.

(d) An applicant whose North Carolina license has been revoked, suspended, retired, or expired for more than one year shall submit to the Board a completed fingerprint record card and signed release of information form authorizing the Board to request a fingerprint-based criminal history check from the North Carolina State Bureau of Investigation.

(e) An applicant for reinstatement whose North Carolina dental hygiene license has been revoked, suspended, retired, or expired for two to five years shall take refresher courses as specified by the Board if the Board determines that the applicant lacks skills or knowledge to practice dental hygiene. Refresher courses for an applicant whose license was revoked or suspended shall relate to the deficiencies that led to the imposition of discipline. Refresher courses for an applicant whose license has been retired or expired shall be specified by the Board taking into account the amount of time the license has been retired or expired and the applicant's level of experience.

(f) An applicant for reinstatement whose North Carolina dental hygiene license has been revoked, suspended, retired, or expired for more than five years shall pass the American Board of Dental Examiners dental hygiene licensure clinical examinations before seeking reinstatement.

(h) Any applicant who changes his or her address shall notify the Board office in writing within 10 business days.

(i) Any license obtained through fraud or by any false representation shall be revoked.

History Note: Authority G.S. 90-223; 90-224; 90-229;

Eff. September 1, 2014;

Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. January 9, 2018;

Amended Eff. September 1, 2020.

SUBCHAPTER 16D ‑ PROVISIONAL LICENSURE: DENTISTS

SECTION .0100 ‑ GENERAL PROVISIONS

21 NCAC 16D .0101 ELIGIBILITY REQUIREMENTS

(a) Persons shall be eligible for provisional licensure under the provisions of G.S. 90-29.3 if they have been licensed to practice dentistry in another jurisdiction for a period of at least two years immediately preceding the date of application for provisional licensure.

(b) An applicant for provisional licensure must present to the Board documentary evidence satisfactory to the Board that he is in good standing with the dental licensing agencies of all jurisdictions wherein he is currently licensed to practice dentistry.

(c) No person shall be eligible for provisional licensure who has been censured, disciplined, or punished by any dental licensing agency or dental organization for violation of professional ethics or the laws of any jurisdiction.

History Note: Authority G.S. 90‑28; 90‑29.3; 90‑48;

Eff. September 3, 1976;

Readopted Eff. September 26, 1977;

Amended Eff. January 1, 1994; June 1, 1991; May 1, 1989;

Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. January 9, 2018.

21 ncac 16d .0102 RESTRICTIONS ON PRACTICE

(a) Any provisional license issued to a member of the faculty of an educational institution shall limit the practice of such provisional licensee to the confines of the facilities provided by the educational institution of which he is a faculty member.

(b) The dental practice of a provisional licensee shall be restricted to a specific facility or, to a geographic location, or to a specialized field of dentistry, or any combination thereof. Direction by a dentist licensed in North Carolina shall also be required. Such dentist shall provide direction over the functions performed by the licensee and shall be responsible for all consequences or results arising from the licensee's practice of dentistry.

(c) For purposes of this Section, the acts of a provisional licensee are deemed to be under the direction of a licensed dentist when performed in a locale where a licensed dentist is not always required to be physically present during the performance of such acts and such acts are being performed pursuant to the dentist's order, control, and approval.

History Note: Authority G.S. 90‑29.3;

Eff. September 3, 1976;

Readopted Eff. September 26, 1977;

Amended Eff. August 1, 2002; January 1, 1994; May 1, 1989;

Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. January 9, 2018.

21 NCAC 16D .0103 PATIENT RECORDS

History Note: Authority G.S. 90-29.3;

Eff. September 3, 1976;

Readopted Eff. September 26, 1977;

Repealed Eff. September 1, 2014.

21 NCAC 16D .0104 APPLICATION FOR PROVISIONAL LICENSE

(a) An applicant for a provisional dental license shall submit to the Board:

(1) a notarized application form provided by the Board at www.ncdentalboard.org that includes the information and materials required by 21 NCAC 16B .0301(a);

(2) the nonrefundable provisional licensure fee set forth in 21 NCAC 16M .0101;

(3) a letter from a North Carolina licensed dentist stating he or she will supervise the applicant; and

(b) In addition to the requirements of Paragraph (a) of this Rule, an applicant for a provisional license shall satisfy the requirements in 21 NCAC 16B .0501(b).

(c) The Board shall receive all items set forth in Paragraphs (a) and (b) of this Rule and the applicant's passing scores on all examinations required by 21 NCAC 16B .0303 for the application to be complete. Applications that are not completed within one year of being submitted to the Board shall be disregarded as expired without a refund of the application fee.

(d) An applicant for a provisional license shall pass written examinations as set out in 21 NCAC 16B .0303(a). Applicants who do not pass the written examination after three attempts within one year may not reapply for provisional licensure.

(e) Any applicant who changes his or her address shall notify the Board office in writing within 10 business days.

(f) Any license obtained through fraud or by any false representation shall be revoked.

History Note: Authority G.S. 90-29.3; 90-41(a);

Eff. September 3, 1976;

Readopted Eff. September 26, 1977;

Temporary Amendment Eff. January 1, 2003;

Amended Eff. December 1, 2014; January 1, 2004;

Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. January 9, 2018;

Amended Eff. March 1, 2020.

21 ncac 16d .0105 EXAMINATION

History Note: Authority G.S. 90‑29.3;

Eff. September 3, 1976;

Readopted Eff. September 26, 1977;

Amended Eff. August 1, 2002;

Expired Eff. February 1, 2018 pursuant to G.S. 150B-21.3A.

SECTION .0200 – EXAMINATIONS

21 NCAC 16D .0201 CLINICAL EXAMINATION

History Note: Authority G.S. 90-28; 90-29.5; 90-48;

Eff. January 1, 1983;

Repealed Eff. September 1, 2009.

21 NCAC 16D .0202 ORAL EXAMINATION

History Note: Authority G.S. 90‑28; 90‑29.5; 90‑48;

Eff. January 1, 1983;

Repealed Eff. October 1, 1986.

SUBCHAPTER 16E ‑ PROVISIONAL LICENSURE: DENTAL HYGIENIST

21 NCAC 16E .0101 ELIGIBILITY REQUIREMENTS

History Note: Authority G.S. 90‑226;

Eff. September 3, 1976;

Readopted Eff. September 26, 1977;

Amended Eff. May 1, 1989;

RRC Objection November 21, 2002 and rule was returned to agency on February 20, 2003.

21 NCAC 16E .0102 RESTRICTIONS ON PRACTICE

The dental hygiene practice of a provisional licensee shall be restricted to the dental practice location designated in the application for provisional licensure.

History Note: Authority G.S. 90‑226;

Eff. September 3, 1976;

Readopted Eff. September 26, 1977;

Amended Eff. May 1, 1989;

Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. January 9, 2018;

Amended Eff. March 1, 2020.

21 NCAC 16E .0103 APPLICATION FOR PROVISIONAL LICENSE

(a) An applicant for a provisional dental hygiene license shall submit to the Board:

(1) a notarized application form provided by the Board at www.ncdentalboard.org that includes the information and materials required by 21 NCAC 16C .0301(a);

(2) the nonrefundable provisional licensure application fee set forth in 21 NCAC 16M .0102;

(3) a letter from a North Carolina licensed dentist stating he or she will supervise the applicant; and

(b) In addition to the requirements of Paragraph (a) of this Rule, an applicant for a provisional license shall satisfy the requirements in 21 NCAC 16C .0501(b).

(c) The Board shall receive all items set forth in Paragraphs (a) and (b) of this Rule and the applicant's passing scores on all examinations required by 21 NCAC 16C .0303 for the application to be complete. Applications that are not completed within one year of being submitted to the Board shall be disregarded as expired without a refund of the application fee.

(d) An applicant for a provisional license shall pass written examinations as set out in 21 NCAC 16C .0303(a). Applicants who do not pass the written examination after three attempts within one year may not reapply for provisional licensure.

(e) Any applicant who changes his or her address shall notify the Board office in writing within 10 business days.

(f) Any license obtained through fraud or by any false representation shall be revoked.

History Note: Authority G.S. 90-226; 90-229(a); 90-232;

Eff. September 3, 1976;

Readopted Eff. September 26, 1977;

Amended Eff. May 1, 1989;

Temporary Amendment Eff. January 1, 2003;

Amended Eff. December 1, 2014; January 1, 2004;

Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. January 9, 2018;

Amended Eff. March 1, 2020.

21 ncac 16e .0104 EXAMINATION

As a condition precedent to issuing a provisional license, the Board may require an applicant to demonstrate professional competency by appearing before the Board for oral examination, written examination(s), clinical evaluation or any combination thereof.

The Board shall consider the applicant's training, experience, gaps in practice history and malpractice and disciplinary history in determining whether proof of competency will be required.

History Note: Authority G.S. 90‑226; 90-229(a)(5).

Eff. September 3, 1976;

Readopted Eff. September 26, 1977;

Amended Eff. December 1, 2014; August 1, 2002; May 1, 1989;

Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. January 9, 2018.

SUBCHAPTER 16F ‑ PROFESSIONAL CORPORATIONS

SECTION .0100 - SCOPE

21 NCAC 16F .0101 CERTIFICATION OF LICENSURE REQUIRED

History Note: Authority G.S. 90‑48;

Eff. September 3, 1976;

Readopted Eff. September 26, 1977;

Repealed Eff. May 1, 1989.

21 NCAC 16F .0102 APPLICATION FOR CERTIFICATION OF LICENSURE

(a) For purposes of formation of a professional entity, an application for certification that all proposed owners of shares of stock in a professional corporation or association or all proposed managers and members of a professional limited liability company are licensed to practice dentistry in North Carolina shall be submitted on a form available on the Board's website, www.ncdentalboard.org, or by letter to the Board's office requesting such certification, and shall include:

(1) the information and materials set out in Rule .0104(a) and (b) of this Subchapter; and

(2) the names, addresses, and North Carolina dental license numbers of the proposed incorporators of a professional corporation or association or the members who executed the articles of organization of the professional limited liability company.

(b) For an existing professional entity to issue or transfer shares of stock or an ownership interest to another person, an application for certification that the person proposed to acquire shares or an ownership interest is licensed to practice dentistry in North Carolina shall be submitted on a form available on the Board's website, www.ncdentalboard.org, and shall include the name of the professional entity and the name, address, and dental license number of the person proposed to acquire the shares or ownership interest.

History Note: Authority G.S. 55B-4; 55B-6; 57D-2-01; 57D-2-02; 90‑48;

Eff. September 3, 1976;

Readopted Eff. September 26, 1977;

Amended Eff. April 1, 1994; May 1, 1989;

Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. February 9, 2018;

Amended Eff. July 1, 2022.

21 ncac 16f .0103 CORPORATE OR LIMITED LIABILITY COMPANY NAME

Corporation or limited liability company designations shall consist only of the use of the words "Professional Association," "P.A.", "Professional Corporation," or "P.C." for professional corporations and "Professional Limited Liability Company", or "P.L.L.C." for professional limited liability companies.

All names shall also contain only the name or surname of one or more of the shareholders or members and may include the words:

(1) "Associate(s);" "D.D.S.;" "D.M.D.;" and

(2) the geographic location of the company.

The company name may not be false, deceptive or misleading.

History Note: Authority G.S. 55B-5; 57D-2-01; 90-48;

Eff. September 3, 1976;

Readopted Eff. September 26, 1977;

Amended Eff. May 1, 2011; August 1, 2009; August 1, 2002; April 1, 1994; May 1, 1989;

Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. January 9, 2018.

21 NCAC 16F .0104 CERTIFICATE OF REGISTRATION

(a) Each professional entity shall submit an application for a certificate of registration on the form available on the Board's website, www.ncdentalboard.org, and shall include the following information:

(1) name of the company;

(2) street address of the company;

(3) mailing address of the company, if different from the street address;

(4) email address of the company;

(5) name, address, and dental license number of each shareholder or member, and each dentist to be employed by the company once it is registered;

(6) name, address, and occupation of each corporation director and officer, or each limited liability company manager; and

(7) disclosure of any disciplinary action taken by or investigation pending before the Board with respect to any licensed dentist identified as an incorporator, officer, director, shareholder, member, manager, or employee.

(b) The application shall be:

(1) signed and notarized in accordance with Rule .0110 of this Subchapter;

(2) accompanied by a statement of the capacity in which the person signs and the person's authority to submit the application on behalf of the professional entity;

(3) submitted to the Board with all the information listed in Paragraph (a) of this Rule; and

(4) accompanied by the registration fee of fifty dollars ($50.00).

(c) In addition to the requirements set out in Paragraphs (a) and (b) of this Rule, a certificate of registration shall not be issued until the Board receives a copy of the certificate of incorporation and articles of incorporation of the professional corporation or association, or a copy of the articles of organization of the professional limited liability company, accompanied by certification of filing from the Secretary of State as set forth in G.S. 55D-17.

(d) The initial certificate of registration shall remain effective for one year from the date of issuance, unless suspended or terminated as provided in G.S. 55B-13, and each subsequent renewal of the certificate shall be effective for a period of one year from the date of issue.

History Note: Authority G.S. 55B‑10; 57D-2-01; 57D-2-02; 90‑48;

Eff. September 3, 1976;

Readopted Eff. September 26, 1977;

Amended Eff. August 1, 2009; April 1, 1994; May 1, 1989;

Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. January 9, 2018;

Amended Eff. July 1, 2022; September 1, 2020.

21 NCAC 16F .0105 APPLICATION FOR RENEWAL or reinstATEMENT

(a) The certificate of registration shall be renewed each year based on the anniversary of the date of issuance. Within 30 days after the anniversary date, the professional entity shall submit its application for renewal upon a form available on the Board's website, www.ncdentalboard.org, and shall include the following information:

(1) name of the company as shown on the certificate of registration;

(2) name of the company as of the date of the application for renewal, if the company name has been amended;

(3) street address of the company;

(4) mailing address of the company, if different from the street address;

(5) email address of the company;

(6) name, address, and dental license number of each shareholder or member, and each dentist practicing under the company;

(7) name, address, and occupation of each corporation director and officer, or each limited liability company manager; and

(8) disclosure of any disciplinary action taken by, or investigation pending before, the Board with respect to any licensed dentist identified as an incorporator, officer, director, shareholder, member, manager, or employee.

(b) The application shall be submitted by the president or vice president of the professional corporation or association or by a manager of the professional limited liability company to the Board with all the information listed in Paragraph (a) of this Rule, accompanied by the renewal fee of twenty-five dollars ($25.00).

(c) If the application for renewal of the certificate of registration is not submitted within 30 days after the anniversary of the date of issuance, the certificate of registration shall be suspended. The professional entity may apply for reinstatement of the certificate of registration by satisfying the requirements of Paragraphs (a) and (b) of this Rule including payment of the renewal fee, plus payment of the penalty fee of ten dollars ($10.00) as set out in G.S. 55B-11.

History Note: Authority G.S. 55B‑11; 57D-2-01; 57D-2-02; 90‑48;

Eff. September 3, 1976;

Readopted Eff. September 26, 1977;

Amended Eff. April 1, 1994; May 1, 1989;

Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. January 9, 2018;

Amended Eff. July 1, 2022; September 1, 2020.

21 NCAC 16F .0106 TRANSFER OF STOCK

History Note: Authority G.S. 90‑48;

Eff. September 3, 1976;

Readopted Eff. September 26, 1977;

Repealed Eff. May 1, 1989.

21 NCAC 16F .0107 AMENDMENTS TO ARTICLES OF INCORPORATION OR ORGANIZATION, OR ARTICLES OF DISSOLUTION

Amendments to the articles of incorporation or articles of organization, including amendments made by restated articles of organization, or articles of dissolution shall be forwarded to the Board's office within 10 days after the filing of the same in the office of the Secretary of State of North Carolina.

History Note: Authority G.S. 55B‑12; 57D-2-01; 57D-2-02; 57D-2-22; 57D-2-23; 90‑48;

Eff. September 3, 1976;

Readopted Eff. September 26, 1977;

Amended Eff. April 1, 1994; May 1, 1989;

Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. January 9, 2018;

Amended Eff. July 1, 2022.

21 NCAC 16F .0108 EMPLOYMENT OF DENTAL HYGIENIST

History Note: Authority G.S. 90‑223(b); 90‑233(b);

Eff. September 3, 1976;

Readopted Eff. September 26, 1977;

Amended Eff. April 1, 1994; January 1, 1983;

Expired Eff. February 1, 2018 pursuant to G.S. 150B-21.3A.

21 NCAC 16F .0109 RULES AND REGULATIONS OF THE BOARD APPLY

History Note: Authority G.S. 90‑48;

Eff. September 3, 1976;

Readopted Eff. September 26, 1977;

Repealed Eff. May 1, 1989.

21 NCAC 16F .0110 CORPORATE OFFICERS OR MANAGERS shall EXECUTE DOCUMENTS

All documents required by these Rules to be submitted to the Board by the professional entity shall be executed by the president or vice president of the corporation or by a manager of the limited liability company authorized to submit the documents on behalf of the professional entity, and notarized.

History Note: Authority G.S. 55B‑12; 57D-2-01; 90‑48;

Eff. September 3, 1976;

Readopted Eff. September 26, 1977;

Amended Eff. April 1, 1994; May 1, 1989;

Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. January 9, 2018;

Amended Eff. July 1, 2022.

SUBCHAPTER 16G - DENTAL HYGIENISTS

SECTION .0100 - FUNCTIONS THAT MAY BE DELEGATED

21 NCAC 16G .0101 FUNCTIONS That MAY BE DELEGATED

A dental hygienist may be delegated functions to be performed under the control and supervision of a dentist who shall be responsible for any and all consequences or results arising from performance of such acts and functions. In addition to the functions set out in G.S. 90-221(a) and 21 NCAC 16H .0203, functions that may be delegated to a dental hygienist provided that the dentist first examined the patient and prescribed the procedure include:

(1) performing periodontal screening;

(2) performing periodontal probing;

(3) performing subgingival exploration for or removal of hard or soft deposits;

(4) performing sulcular irrigation;

(5) applying resorbable sulcular antimicrobial or antibiotic agents;

(6) using ultrasonic scalers for prophylaxis;

(7) performing scaling and root planning;

(8) applying oral cancer screening products in preparation for the dentist's examination and diagnosis of oral cancer;

(9) using laser fluorescence detectors in preparation for the dentist's examination and diagnosis of cavities;

(10) applying resin infiltration treatment for incipient smooth surface lesions, following the dentist's diagnosis that the lesion is non-penetrable; or

(11) applying silver diamine fluoride.

History Note: Authority G.S. 90-41; 90-221; 90-223(b); 90-233;

Eff. September 3, 1976;

Readopted Eff. September 26, 1977;

Amended Eff. April 1, 2017; August 1, 2016; April 1, 2015; August 1, 2008; August 1, 2000; May 1, 1989; October 1, 1985; March 1, 1985;

Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. January 9, 2018;

Amended Eff. April 1, 2018.

21 NCAC 16G .0102 FUNCTIONS WHICH SHALL NOT BE DELEGATED

History Note: Authority G.S. 90‑221(a); 90‑223(b);

Eff. September 3, 1976;

Readopted Eff. September 26, 1977;

Amended Eff. May 1, 1989.

Repealed Eff. August 1, 2000.

21 NCAC 16g .0103 PROCEDURES PROHIBITED

Those procedures that require the professional education and skill of a dentist and shall not be delegated to a dental hygienist include:

(1) performing comprehensive examination, diagnosis, and treatment planning;

(2) performing surgical or cutting procedures on hard or soft tissues, including laser, air abrasion, or micro-abrasion procedures;

(3) placing or removing therapeutic sulcular nonresorbable agents;

(4) issuing prescription drugs, medications, or work authorizations;

(5) performing the final placement or intraoral adjustment of a fixed or removable appliance;

(6) performing intraoral occlusal adjustments that affect function, fit, or occlusion of any temporary or permanent restoration or appliance;

(7) performing direct pulp capping or pulpotomy;

(8) placing sutures;

(9) performing final placement or cementation of orthodontic bands or brackets;

(10) performing the placement or cementation of final restorations;

(11) administering any anesthetic by any route except the administration of:

(a) topically-applied agents intended to anesthetize only cutaneous tissue; or

(b) local anesthetics by dental hygienists certified in accordance with G.S. 90-221(a) and this Section, and administered under the direct supervision of a North Carolina licensed dentist;

(12) using a high-speed handpiece intraorally;

(13) performing cementation of endodontic posts;

(14) condensing Amalgam;

(15) using a transcutaneous electrical nerve stimulation (TENS) unit;

(16) applying formocresol;

(17) placing stainless steel crown on permanent or primary teeth;

(18) performing pulp vitality testing;

(19) performing curettage;

(20) placing periodontal or surgical dressing;

(21) performing oral brush biopsy;

(22) taking bite registration or elastometrics;

(23) placing eugenol wick in dry socket;

(24) fabricating or delivering sleep apnea appliance;

(25) removing, replacing, or torqueing either impression or prosthetic implant abutments; and

(26) administering any sedation or general anesthesia pharmacological agents, including drawing a dosage into a syringe.

History Note: Authority G.S. 90‑221(a); 90‑223(b);

Eff. September 3, 1976;

Readopted Eff. September 26, 1977;

Amended Eff. August 1, 2016; August 1, 2008; August 1, 2000; May 1, 1989; March 1, 1985;

Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. January 9, 2018;

Amended Eff. July 1, 2022; September 1, 2020; April 1, 2018.

21 NCAC 16G .0104 DEFINITION: DIRECT CONTROL AND SUPERVISION

History Note: Authority G.S. 90‑223(b);

Eff. September 3, 1976;

Readopted Eff. September 26, 1977;

Repealed Eff. January 1, 1983.

21 NCAC 16G .0105 EMPLOYMENT OF DENTAL HYGIENIST

History Note: Authority G.S. 90‑28; 90‑48; 90‑223(b);

Eff. September 3, 1976;

Readopted Eff. September 26, 1977;

Amended Eff. January 1, 1983;

Repealed Eff. May 1, 1989.

21 NCAC 16G .0106 DENTAL HYGIENE SCHOOL EXTENSION FACILITIES AND OFF CAMPUS CLASSES

(a) Dental hygiene schools may operate extension facilities and conduct off-campus hygiene classes in which dental hygiene services are provided to members of the public at Board approved sites, including non-profit health care facilities serving low income populations, state and county institutions with resident populations, hospitals, state or county health department and area health education centers.

(b) Dental hygiene schools which operate extension facilities or conduct hygiene classes off-campus must notify the Dental Board of the location and nature of each facility or off campus course location, the names of the students assigned thereto, and the names and qualifications of all instructors functioning therein.

(c) No student enrolled in an off-campus dental hygiene class or extension facility may receive fees, compensation or remuneration of any kind for providing dental hygiene services in accordance with G.S. 90-29(c)(4) or G.S. 90-233(c)(2).

History Note: Authority G.S. 90-29(c)(4); 90-233(c)(2);

Eff. November 1, 2009;

Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. January 9, 2018.

21 ncac 16G .0107 DENTAL HYGIENE LICENSURE BY ENDORSEMENT BASED ON MILITARY SERVICE

(a) An applicant for a dental hygiene license by endorsement based on military service shall submit to the Board:

(1) a notarized application form provided by the Board at www.ncdentalboard.org that includes the information and materials required by 21 NCAC 16C .0301(a); and

(2) written evidence demonstrating the applicant has satisfied the conditions set forth in G.S. 93B-15.1(a), including engaging in the active practice of dental hygiene for at least 1,000 hours per year for at least two of the five years preceding the date of application.

(b) In addition to the requirements of Paragraph (a) of this Rule, an applicant for licensure by endorsement based on military service shall satisfy the requirements in 21 NCAC 16C .0501(b).

(d) Any applicant who changes his or her address shall notify the Board office in writing within 10 business days.

(e) Any license obtained through fraud or by any false representation shall be revoked.

History Note: Authority G.S. 90-223; 90-224(c); 90-229; 93B-15.1;

Eff. September 19, 2013;

Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. January 9, 2018;

Amended Eff. March 1, 2020.

21 ncac 16G .0108 DENTAL HYGIENE LICENSURE BY ENDORSEMENT BASED ON STATUS AS MILITARY SPOUSE

(a) An applicant for a dental hygiene license by endorsement based on the applicant's status as a military spouse shall submit to the Board:

(1) a notarized application form provided by the Board at www.ncdentalboard.org that includes the information and materials required by 21 NCAC 16C .0301(a); and

(2) written evidence demonstrating the applicant is married to an active member of the U.S. military and the applicant satisfies the conditions set forth in G.S. 93B-15.1(b), including engaging in the active practice of dental hygiene for at least 1,000 hours per year for at least two of the five years preceding the date of application.

(d) Any applicant who changes his or her address shall notify the Board office in writing within 10 business days.

(e) Any license obtained through fraud or by any false representation shall be revoked.

History Note: Authority G.S. 90-223; 90-224(c); 90-229; 90-232; 93B-15.1;

Eff. September 19, 2013;

Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. January 9, 2018;

Amended Eff. March 1, 2020.

21 ncac 16g .0109 dental hygienist certification to administer local anesthetics

(a) To apply for certification to administer local anesthetics by block or infiltration techniques:

(1) a dental hygienist holding a valid dental hygiene license issued or renewed by the Board on or after October 1, 2021, shall submit to the Board a certificate of completion from a dental hygiene program meeting the requirements set out in G.S. 90-225.2 that was completed within five years prior to the date of the application; or

(2) a dental hygienist licensed in North Carolina or any other state or territory who has been practicing dental hygiene for the two year period set out in G.S. 90-225.3(a)(2) shall submit to the Board evidence that, within five years prior to the date of the application, the applicant completed a course or courses meeting the requirements of G.S. 90-225.3(a)(3), including a certified letter stating the applicant's completion of the required injections in a course. For purposes of this Rule, "certified" shall mean the letter bears:

(A) the notarized signature of a licensed dentist instructor who supervised the applicant's completion of the injections during the course or courses; or

(B) the official seal or stamp of the school, college, or continuing education provider through which the applicant completed the course or courses.

(b) If an applicant completed the course of study required pursuant to G.S. 90-225.2 or G.S. 90-225.3(a)(3) more than five years prior to submitting the application materials set out in Paragraph (a) of this Rule, the applicant shall retake a course or courses meeting the requirements of G.S. 90-225.3(a)(3) before the applicant may be certified to administer local anesthetics, unless the applicant submits documentation showing the applicant has been practicing dental hygiene, including the administration of local anesthetics by infiltration and block techniques, for the two year period prior to the date of the application.

(c) The requirements set out in Paragraph (a) of this Rule are in addition to any other applicable requirements set out in this Chapter for the issuance or renewal of a dental hygiene license.

(d) As a condition to renew a certificate to administer local anesthetics, each dental hygienist shall complete two clock hours of continuing education each calendar year in satisfaction of the requirements of G.S. 90-225.3(c), which may be among those chosen to satisfy the requirements set out in 21 NCAC 16I .0201(a).

(e) A dental hygienist certified in accordance with this Rule shall conduct administration of local anesthetics only under the direct supervision of a North Carolina licensed dentist.

History Note: Authority G.S. 90-221; 90-223; 90-225.2; 90-225.3;

Temporary Adoption Eff. November 1, 2021;

Eff. July 1, 2022.

SUBCHAPTER 16H ‑ DENTAL ASSISTANTS

SECTION .0100 ‑ CLASSIFICATION AND TRAINING

21 NCAC 16H .0101 CLASSIFICATION

Based upon education, training, and experience, a dental assistant shall be categorized as a Dental Assistant I or a Dental Assistant II.

History Note: Authority G.S. 90‑29(c)(9);

Eff. September 3, 1976;

Readopted Eff. September 26, 1977;

Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. January 9, 2018.

21 NCAC 16H .0102 DENTAL ASSISTANT I

(a) A Dental Assistant I is anyone performing any of the permitted or delegable functions under 21 NCAC 16H .0201, who does not satisfy the training and experience requirements for classification as a Dental Assistant II set forth in 21 NCAC 16H .0104, and is not licensed by the Board as a dentist or dental hygienist.

(b) A Dental Assistant I shall have an unexpired CPR certification in effect at all times while performing any of the permitted functions under 21 NCAC 16H .0201.

History Note: Authority G.S. 90‑29(c)(9);

Eff. September 3, 1976;

Readopted Eff. September 26, 1977;

Amended Eff. August 1, 2016;

Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. January 9, 2018.

21 NCAC 16H .0103 DENTAL ASSISTANT II

A Dental Assistant II is an expanded duty assistant who has completed training in accordance with Rule .0104 of this Section. Under direct control and supervision, a Dental Assistant II may be delegated intra-oral procedures in accordance with 21 NCAC 16H .0203 the supervising dentist deems appropriate, with the dentist personally and professionally responsible for any and all consequences or results arising from the performance of said acts. All delegated procedures must be reversible in nature.

History Note: Authority G.S. 90‑29(c)(9);

Eff. September 3, 1976;

Readopted Eff. September 26, 1977;

Amended Eff. August 1, 2000;

Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. January 9, 2018.

21 NCAC 16H .0104 APPROVED EDUCATION AND TRAINING PROGRAMS

(a) To be classified as a Dental Assistant II, an assistant shall have and maintain an unexpired CPR certification and also shall meet one of the following criteria:

(1) completion of:

(A) an ADA-accredited dental assisting program; or

(B) one academic year or longer in an ADA-accredited dental hygiene program;

(2) completion of the Dental Assistant certification examination(s) administered by the Dental Assisting National Board; or

(3) completion of:

(A) employment as a Dental Assistant I for two years of the preceding five, consisting of at least 3,000 hours total;

(B) a 3-hour course in sterilization and infection control; and

(b) A Dental Assistant I who has completed the requirements of Parts (a)(3)(B)-(C) of this Rule but not completed the training pursuant to Part (a)(3)(A) may be trained by a licensed dentist and allowed to perform the functions of a Dental Assistant II, as specified in Rule .0203 of this Subchapter, under the direct control and supervision of a licensed dentist, except that a Dental Assistant I performing the functions of a Dental Assistant II pursuant to this Paragraph shall not perform the coronal polishing function set out in Rule .0203(a)(21) of this Subchapter.

(c) For purposes of this Rule, an unexpired CPR certification is one that is in effect and valid at the time of classification as a Dental Assistant II and remains so at all times while employed as a Dental Assistant II or while performing any of the permitted functions under Rule .0203 of this Subchapter.

(d) A Dental Assistant shall not take radiographs before completing radiology training consistent with G.S. 90-29(c)(12).

History Note: Authority G.S. 90-29(c)(9);

Eff. September 3, 1976;

Readopted Eff. September 26, 1977;

Amended Eff. August 1, 2016; April 1, 2015; August 1, 2000; November 1, 1996; January 1, 1994; September 1, 1998; May 1, 1989; October 1, 1986.

Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. January 9, 2018;

Amended Eff. September 1, 2020.

21 ncac 16H .0105 dental RadioLOGY COURSE AND EXAMINATION requirements

(a) If a dental radiology course and the course's final examination meet the requirements of this Rule, the Board will recognize the course and final examination as satisfying the dental radiology training and equivalency examination requirements set out in G.S. 90-29(c)(12).

(b) For the Board to recognize a dental radiology course and its final examination:

(1) The course shall include at least 7 hours of didactic, lecture-based instruction and at least 14 hours of laboratory instruction.

(2) The course curriculum shall include instruction and training in clinical dental radiology, in the production and use of dental x-rays, and on digital x-ray equipment. The course shall enable the student to:

(A) identify in sequence the steps necessary for operating dental x-ray equipment;

(B) identify the requirements of a diagnostic digital image;

(C) differentiate the effect of variations in amperage, kilo-voltage, distance, and exposure time on the resulting digital images;

(D) identify the terms used to measure radiation;

(E) establish guidelines for maintaining radiation safety and the ALARA ("as low as reasonably achievable") principle;

(F) follow principles of radiologic health practices and radiation biology;

(G) identify radiation safety techniques and monitoring devices;

(H) identify the parts and identification marks on dental x-ray sensors;

(I) identify and compare intraoral sensors according to size and customary usage;

(J) identify methods of sensor handling and storage;

(K) identify and perform in sequence the steps in processing digital images;

(L) differentiate between preliminary interpretation and diagnosis of the digital images;

(M) identify the anatomical landmarks of the face and skull;

(N) identify any dental radiograph according to its location in the maxilla or mandible, and position it on a digital image mount;

(O) identify the types of radiographic errors caused by faulty exposure techniques;

(P) identify the types of radiographic errors caused by incorrect digital mount positioning and angulation of the central ray;

(Q) identify the types of radiographic errors caused by faulty digital processing techniques;

(R) identify the conditions that cause digital images to be fogged;

(S) identify the advance preparations necessary before exposing digital images;

(T) carry out the task of digital image exposure to completion;

(U) use the paralleling technique to produce digital images of diagnostic quality addressing contrast, density, and definition;

(V) explain the principles of digital imaging and quality assurance;

(W) identify errors when using digital imaging in technique and processing;

(X) explain the utilization of beam aligning devices; and

(Y) describe the use of hand-held radiation exposure devices following guidelines from the Radiation Protection Section of the Department of Health and Human Services, Radiology Compliance Branch ("Radiation Protection Section"), which are incorporated by reference, including subsequent amendments and editions, and are available at no cost online at www.ncradiation.net/Xray/dentdose.htm.

(3) The laboratory portion of the course shall have no more than six students per instructor, and shall include practice on dental radiography manikins. Students shall not practice on peer students unless the unit is turned off and all requirements of the Board's sterilization and infection control rule, 21 NCAC 16J .0103, are satisfied. Students shall be required to achieve a passing score of at least 80 percent on a written examination on radiation safety prior to taking radiographs.

(4) To complete the course, students shall be required to achieve a passing score of at least 80 percent on a written examination upon completion of the didactic, lecture-based portion of the course and to achieve a passing score of at least 80 percent on a final laboratory examination. The final laboratory examination shall be conducted on a manikin and include completion of a full mouth series.

(5) The facility used as the training location for the course shall:

(A) assume all overhead costs involved in offering the course;

(B) comply with the Board's rules regarding sanitation, sterilization, and infection control set out in 21 NCAC 16J, the applicable guidelines of the Radiation Protection Section, and the OSHA guidelines and standards related to dentistry, which are incorporated by reference, including subsequent amendments and editions, and are available at no cost online at www.osha.gov/dentistry/standards;

(D) have the number of x-ray machines necessary based on the course curriculum and enrollment to ensure there are no more than two students per machine; and

(E) have facilities for digital radiography.

(6) The didactic and laboratory portions of the course shall be taught by:

(A) an instructor of dental radiography at an institution accredited by the Commission on Dental Accreditation ("CODA"), a list of which is available at no cost at www.ada.org/coda and is incorporated by reference, including subsequent amendments and editions; or

(B) an instructor who has received a certification to teach dental radiography from a CODA-accredited institution, and has completed three hours of continuing education in the area of radiology every other year. The continuing education courses shall be offered by Board-approved continuing education course sponsors as set out in 21 NCAC 16I .0202 or 21 NCAC 16R .0202.

(7) The course sponsor shall provide students with all supplies.

(8) Course advertising shall comply with the Board's rules regarding advertisement of dental services set out in 21 NCAC 16P.

(1) the course outline, syllabus, and handouts;

(2) slides and other lecture materials;

(3) examinations and grading criteria; and

(4) the name, resume, and verification of credentials satisfying Subparagraph (b)(6) of this Rule for all course instructors.

(d) After the course sponsor submits all the information and documents required by Paragraph (c) of this Rule, the course will be reviewed by the Board for compliance with this Rule at the next scheduled Board meeting. The Board may delay reviewing a course until a later meeting if the Board's workload makes the review impracticable. If the Board delays reviewing a course, it shall notify the course sponsor. A course shall be recognized by a majority vote of the Board. A list of recognized courses is available on the Board's website at www.ncdentalboard.org.

(e) Upon receipt of evidence that a previously recognized course is not in compliance with this Rule, the Board will notify the course sponsor in writing of each item of noncompliance. Within 30 days from the date of the notice of noncompliance, the course sponsor shall provide a written response to the Board office which shall respond to each item of noncompliance. The response shall provide documentation of corrections made, and shall show each item is in compliance with this Rule. If the course sponsor fails to respond or correct noncompliance, the Board's recognition of the course shall be withdrawn. As of the date recognition is withdrawn, the course and its examination shall not satisfy the dental radiology training and equivalency examination requirements set out in G.S. 90-29(c)(12).

History Note: Authority G.S. 90-29(c)(12); 90-48;

Eff. July 1, 2023.

SECTION .0200 – PERMITTED FUNCTIONS OF DENTAL ASSISTANT

21 NCAC 16H .0201 GENERAL PERMITTED FUNCTIONS OF DENTAL ASSISTANT I

(a) A Dental Assistant I may assist a dentist as a chairside assistant provided that the acts and functions of the Dental Assistant I do not constitute the practice of dentistry or dental hygiene as set out in G.S. 90-29(b) and G.S. 90-221(a).

(b) A Dental Assistant I may perform only routine dental assisting procedures such as oral hygiene instruction, chairside assisting, application of topical fluorides or topical anesthetics, and exposure of radiographs, provided that the assistant can show compliance with radiography training consistent with G.S. 90-29(c)(12).

(c) Functions of a Dental Assistant II also may be delegated to a Dental Assistant I in accordance with 21 NCAC 16H .0104(b).

History Note: Authority G.S. 90‑29(c)(9); 90‑48;

Eff. September 3, 1976;

Readopted Eff. September 26, 1977;

Amended Eff. August 1, 2000; May 1, 1989;

Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. January 9, 2018;

Amended Eff. October 1, 2019.

21 NCAC 16H .0202 SPECIFIC PERMITTED FUNCTIONS OF DENTAL ASSISTANT I

History Note: Authority G.S. 90‑29(c)(9); 90‑48;

Eff. September 3, 1976;

Readopted Eff. September 26, 1977;

Amended Eff. November 1, 1996; May 1, 1989.

Repealed Eff. August 1, 2000.

21 NCAC 16h .0203 PERMITTED FUNCTIONS OF DENTAL ASSISTANT II

(a) A Dental Assistant II may perform all acts or procedures that may be performed by a Dental Assistant I as set forth in 21 NCAC 16H .0201. In addition, a Dental Assistant II may be delegated the following functions to be performed under the direct control and supervision of a dentist who shall be responsible for any and all consequences or results arising from the performance of such acts and functions, provided that the dentist first examined the patient and prescribed the procedure:

(1) taking impressions for study models and opposing casts that may be used for the construction of temporary or permanent dental appliances, adjustable orthodontic appliances, nightguards and the repair of dentures or partials;

(2) applying sealants to teeth that do not require mechanical alteration prior to the application of such sealants;

(3) inserting matrix bands and wedges;

(4) placing cavity bases and liners;

(5) placing and removing rubber dams;

(6) cementing temporary restorations using temporary cement;

(7) applying acid etch materials and rinses;

(8) applying bonding agents;

(9) removing periodontal and surgical dressings;

(10) removing sutures;

(11) placing and removing gingival retraction cord;

(12) removing excess cement with hand scaler supragingivally;

(13) flushing, drying, and temporarily closing root canals or pulpotomies;

(14) placing and removing temporary restorations;

(15) placing and tying in or untying and removing orthodontic arch wires, ligature wires, or lock pins;

(16) inserting interdental spacers;

(17) fitting (sizing) orthodontic bands or brackets;

(18) applying dentin desensitizing solutions;

(19) performing extra-oral adjustments that affect function, fit, or occlusion of any restoration or appliance;

(20) initially forming and sizing orthodontic arch wires and placing arch wires after final adjustment and approval by the dentist;

(21) polishing the clinical crown, pursuant to Paragraph (b) of this Rule using only:

(A) a hand-held brush and polishing agents; or

(B) a combination of a slow speed handpiece (not to exceed 10,000 rpm) with attached rubber cup or bristle brush, and polishing agents;

(22) exposing radiographs and cone beam images;

(23) polishing removable appliances extra-orally;

(24) preparing and loading amalgam in carrier;

(25) measuring pulse, blood pressure, and temperature;

(26) using micro-etcher extra-orally;

(27) placing a throat shield in oropharynx during administration of general anesthesia;

(28) delivering dentures to patient for insertion, provided the dentist approves the denture placement; or

(29) removing or replacing healing abutments or cover screws for implants that may be accessed supragingivally.

(b) A Dental Assistant II shall complete a course in coronal polishing identical to that taught in an ADA accredited dental assisting program, or by a licensed North Carolina hygienist or dentist lasting at least seven clock hours before using a slow speed handpiece with rubber cup or bristle brush attachment. The course shall include instruction on dental morphology, the periodontal complex, operation of handpieces, polish aids, and patient safety. A list of ADA accredited programs offering courses in coronal polishing, which is incorporated by reference along with its subsequent amendments and editions, is available at no cost on the American Dental Association's website at http://www.ada.org/en/coda/find-a-program. A coronal polishing procedure shall not be represented to the patient as a prophylaxis. No coronal polishing procedure may be billed as a prophylaxis unless the dentist has performed an evaluation for calculus, deposits, or accretions and a dentist or dental hygienist has removed any substances detected.

History Note: Authority G.S. 90-29(c)(9); 90-41; 90-48;

Eff. September 3, 1976;

Readopted Eff. September 26, 1977;

Amended Eff. August 1, 2016; April 1, 2015; January 1, 2014; September 1, 2009; September 1, 2008; August 1, 2000; October 1, 1996; January 1, 1994; May 1, 1989; October 1, 1985; March 1, 1985;

Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. January 9, 2018;

Amended Eff. April 1, 2018.

21 NCAC 16H .0204 GENERAL PROHIBITED FUNCTIONS OF DENTAL ASSISTANTS I AND II

History Note: Authority G.S. 90‑29(c)(9); 90‑48;

Eff. September 3, 1976;

Readopted Eff. September 26, 1977;

Amended Eff. May 1, 1989.

Repealed Eff. August 1, 2000.

21 NCAC 16h .0205 SPECIFIC PROHIBITED FUNCTIONS OF DENTAL ASSISTANTS I AND II

Those specific functions that shall not be delegated to either a Dental Assistant I or a Dental Assistant II include those procedures prohibited in 21 NCAC 16G .0103 for Dental Hygienists. In addition, those procedures that require the professional education and skill of a Dentist or Dental Hygienist and may not be delegated to a Dental Assistant I or Dental Assistant II shall include:

(1) performing prophylaxis;

(2) performing periodontal screening;

(3) performing periodontal probing;

(4) performing subgingival exploration for or removal of hard or soft deposits;

(5) performing sulcular irrigation;

(6) using ultrasonic scalers for prophylaxis;

(7) applying antibiotic-coated materials;

(8) applying resorbable antimicrobial agents;

(9) performing root planing;

(10) applying oral cancer screening products;

(11) using laser fluorescence detectors in preparation for the dentist's examination and diagnosis of cavities; or

(12) applying resin infiltration treatment for incipient smooth surface lesions, following the dentist's diagnosis that the lesion is non-penetrable.

History Note: Authority G.S. 90‑29(c)(9); 90‑48;

Eff. September 3, 1976;

Readopted Eff. September 26, 1977;

Amended Eff. August 1, 2000; January 1, 1994; May 1, 1989; March 1, 1985;

Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. January 9, 2018;

Amended Eff. April 1, 2018.

21 NCAC 16H .0206 DIRECT CONTROL AND SUPERVISION DEFINED

In any instance in which the rules adopted by the Board or any portion of the North Carolina Dental Practice Act shall require or direct that any act or function be performed by a Dental Assistant I or II under the direct control and supervision of a dentist, the term "direct control and supervision of a dentist" means that the dentist must be present in the office when the act or function is being performed and that the dentist must directly and personally supervise, examine, and evaluate the results of any and all acts and functions lawfully done or performed by any person other than the dentist.

History Note: Authority G.S. 90‑29(c)(9); 90‑48;

Eff. September 3, 1976;

Readopted Eff. September 26, 1977;

Amended Eff. May 1, 1989;

Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. January 9, 2018.

21 NCAC 16H .0207 LIMITED EXCEPTION FOR ASSISTING HYGIENISTS

History Note: Authority G.S. 90-29(c)(9); 90-48; 90-233;

Eff. December 1, 2016;

Expired Eff. May 31, 2019 (Agency did not readopt rule by RRC established deadline).

21 NCAC 16H .0208 LIMITED EXCEPTION FOR ASSISTING HYGIENISTS

A Dental Assistant II may assist a Limited Supervision Hygienist, who is qualified and practicing pursuant to 21 NCAC 16Z .0101-.0103, in providing oral hygiene instruction, applying sealants, applying topical fluorides, applying fluoride varnishes, and while the Hygienist is performing prophylaxis, provided:

(1) The treatment is provided to children in school-based oral health programs under the "ECU School-based Oral Health Expansion Readiness" grant, proposal number 19-0786 and related project number A19-0231, developed by the East Carolina University School of Dental Medicine and funded by The Duke Endowment; and

(2) Prior to any treatment being provided, a licensed North Carolina dentist has:

(a) examined the patient;

(b) ordered in writing the treatment provided to the patient; and

(c) agreed to provide the patient with any necessary additional treatment resulting from the treatment rendered in accordance with this Rule.

History Note: Authority G.S. 90-29(c)(9); 90-48; 90-233;

Eff. October 1, 2019.

subchapter 16i - ANNUAL RENEWAL OF LICENSE AND CONTINUING EDUCATION REQUIREMENTS: DENTAL HYGIENIST

section .0100 - ANNUAL RENEWAL

21 NCAC 16I .0101 APPLICATIONS

(a) A renewal application for a dental hygiene license shall be submitted electronically before midnight on January 31 of each year through the Board's website: www.ncdentalboard.org. The renewal application shall include:

(1) dental hygiene license number;

(2) full name;

(3) mailing address and any secondary address the licensee wishes to provide;

(4) telephone number;

(5) fax number;

(6) email address;

(7) citizenship or immigration status, with verifying documentation;

(8) whether, during the calendar year preceding the application, the licensee has:

(A) been summoned to court or before a magistrate for the violation of any law or ordinance or for the commission of any felony or misdemeanor;

(B) been arrested for the violation of any law or ordinance or for the commission of any felony or misdemeanor;

(C) been taken into custody for the violation of any law or ordinance or for the commission of any felony or misdemeanor;

(D) been indicted for the violation of any law or ordinance or for the commission of any felony or misdemeanor;

(E) been convicted or tried for the violation of any law or ordinance or for the commission of any felony or misdemeanor;

(F) been charged with the violation of any law or ordinance or for the commission of any felony or misdemeanor;

(G) pleaded guilty to the violation of any law or ordinance or for the commission of any felony or misdemeanor;

(H) been disciplined by any professional licensing board; or

(I) had a malpractice suit settled or pending against the licensee;

(9) whether the licensee has been investigated for employee misclassification as an independent contractor within the five years preceding the application;

(10) employment status as a dental hygienist as of the date of the application, including;

(A) whether the licensee is currently working as a dental hygienist;

(B) name of the practice in which the licensee provides services;

(D) type of employer for which the licensee works; and

(E) number of hours the licensee works in an average week;

(11) a report of the licensee's completion of continuing education hours related to clinical patient care during the calendar year preceding the application, or the licensee's exemption from reporting;

(12) whether the licensee holds an unexpired CPR certification;

(13) whether the licensee has been employed as a limited supervision hygienist as set forth in 21 NCAC 16Z during the calendar year preceding the application; and

(14) a written statement certifying that the information submitted is accurate to the best of the licensee's knowledge.

(b) In addition to the requirements of Paragraph (a) of this Rule, the licensee shall mail to the Board the following materials for review by the Board before the license will be renewed:

(1) for each matter existing under Subparagraph (a)(8) of this Rule, a statement describing the nature, facts, and disposition of the matter, and include a copy, certified by the clerk of court or the applicable licensing board, of the disposition or judgment in the matter; and

(2) for each matter under Subparagraph (a)(9) of this Rule, documentation of the results of the investigation.

(c) The Board shall receive all information and documentation set forth in Paragraphs (a) and (b) of this Rule, accompanied by the renewal fees set forth in 21 NCAC 16M .0102, for the renewal application to be complete. If a renewal application is not complete, the license shall not be renewed.

(d) Eligible licensees shall be granted an extension period as set out in Rule .0111 of this Subchapter in which to pay renewal fees, obtain CPR certification, and comply with the Board's continuing education rules.

(e) Any license obtained through fraud or by any false representation shall be revoked.

History Note: Authority G.S. 90-227; 93B-15;

Eff. September 3, 1976;

Readopted Eff. September 26, 1977;

Amended Eff. April 1, 2015; February 1, 2008; April 1, 2003; August 1, 1998; May 1, 1989.

Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. January 9, 2018;

Amended Eff. September 1, 2020.

21 ncac 16i .0102 CONTINUING EDUCATION REQUIRED (recodified to 21 NCAC 16I .0201)

21 ncac 16i .0103 APPROVED COURSES AND SPONSORS (Recodified to 21 NCAC 16I .0202)

21 ncac 16i .0104 REPORTING CONTINUING EDUCATION (Recodified to 21 NCAC 16I .0203)

21 NCAC 16I .0105 PENALTY/NON-COMPLIANCE/CONTINUING EDUCATION REQUIREMENT (Recodified to 21 NCAC 16I .0205

21 NCAC 16I .0106 FEE FOR LATE FILING

If the application for a renewal certificate, accompanied by the renewal fee of eighty-one dollars ($81.00) and annual fee to assist in funding for programs for impaired dentists of twenty-five dollars ($25.00), is not received in the Board's office before the close of business on January 31 of each year, an additional fee of fifty dollars ($50.00) shall be charged for the renewal certificate.

History Note: Authority G.S. 90-227; 90-232;

Eff. September 3, 1976;

Readopted Eff. September 26, 1977;

Amended Eff. May 1, 1989;

Transferred and Recodified from 21 NCAC 16I .0002 Eff. May 1, 1994;

Amended Eff. February 1, 2008; April 1, 2003; August 1, 1998;

Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. January 9, 2018;

Amended Eff. October 1, 2019.

21 NCAC 16I .0107 LICENSE VOID UPON FAILURE TO RENEW

If an application for a renewal certificate, accompanied by the renewal fee and the additional late filing fee, is not received in the Board's office before midnight on March 31 of each year, the license becomes void and the hygienist must petition the Board for reinstatement.

History Note: Authority G.S. 90-227;

Eff. September 3, 1976;

Readopted Eff. September 26, 1977;

Transferred and Recodified from21 NCAC 16I .0003 Eff. May 1, 1994;

Amended Eff. April 1, 2015; February 1, 2008; April 1, 2003; August 1, 2002;

Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. January 9, 2018.

21 NCAC 16I .0108 FORM OF CERTIFICATE

The certificate of renewal of license shall bear the original license number, the full name of the applicant, and the date of issuance.

History Note: Authority G.S. 90-222; 90-223; 90-227;

Eff. September 3, 1976;

Readopted Eff. September 26, 1977;

Amended Eff. May 1, 1991;

Transferred and Recodified from 21 NCAC 16I .0004 Eff. May 1, 1994;

Amended Eff. April 1, 2015;

Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. January 9, 2018.

21 NCAC 16I .0109 CERTIFICATE DISPLAYED

(a) The original license and current certificate of renewal of license for a Dental Hygienist shall at all times be displayed where it is visible to patients receiving treatment at the office where the dental hygienist is employed.

(b) Hygienists providing treatment at more than one office shall only be required to display a current renewal certificate of license at each additional office where they provide dental hygiene services, as long as the original license is displayed in at least one office.

(c) Hygienists shall produce their original license and current renewal certificate on demand of the North Carolina State Board of Dental Examiners or its agents.

History Note: Authority G.S. 90‑227;

Eff. September 3, 1976;

Readopted Eff. September 26, 1977;

Transferred and Recodified from 21 NCAC 16I .0005 Eff. May 1, 1994;

Amended Eff. August 1, 2016;

Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. January 9, 2018.

21 NCAC 16I .0110 DEFINITIONS

The following definitions apply only to this Subchapter:

(1) "Dental Board" -- the North Carolina State Board of Dental Examiners.

(2) "Eligible licensees"-- all hygienists currently licensed by and in good standing with the North Carolina State Board of Dental Examiners who are serving in the armed forces of the United States and who are eligible for an extension of time to file a tax return pursuant to G.S. 105-249.2.

(3) "Extension period" -- the time period disregarded pursuant to 26 U.S.C. 7508.

(4) "Good standing" – a hygienist whose license is not suspended or revoked and who is not practicing under any probationary terms.

History Note: Authority G.S. 90-222; 90-223; 93B-15;

Eff. April 1, 2010;

Amended Eff. April 1, 2015;

Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. January 9, 2018.

21 NCAC 16I .0111 EXEMPTIONS GRANTED

(a) Eligible licensees, as defined in Rule .0110 of this Section, are granted a waiver of their mandatory continuing education requirements for the period allowed pursuant to G.S. 105-249.2

(b) Eligible licensees are granted an extension for the period allowed pursuant to G.S. 105-249.2 in which to pay license renewal fees and comply with all other requirements imposed by the Dental Board as conditions for maintaining licensure.

History Note: Authority G.S. 90-222; 90-223; 93B-15;

Eff. April 1, 2010;

Amended Eff. April 1, 2015;

Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. January 9, 2018.

SECTION .0200 – CONTINUING EDUCATION

21 ncac 16i .0201 CONTINUING EDUCATION REQUIRED

(a) As a condition of license renewal, each dental hygienist shall complete six clock hours of continuing education each calendar year. The hours may be acquired through self-study courses. To count toward the mandatory continuing education requirement, self-study courses shall be related to clinical patient care and offered by a Board-approved sponsor listed in Rule .0202 of this Section. The dental hygienist shall pass a test administered by the self-study course sponsor and obtain a certificate of completion from the sponsor.

(b) An unexpired certification in CPR is required in addition to the mandatory continuing education hours.

(c) Upon receipt of a written request from the dental hygienist, the Board will grant exemptions from the requirements set out in this Rule and in Rule .0206 of this Section as follows:

(1) A dental hygienist who practices not more than 250 clock hours in a calendar year shall be classified as a semi-retired dental hygienist, and shall:

(A) be exempt from the requirement set out in Paragraph (a) of this Rule to complete six clock hours of continuing education each calendar year; and

(B) maintain an unexpired CPR certification.

(2) A retired dental hygienist who does not practice any dental hygiene shall be exempt from all continuing education and CPR certification requirements.

(d) If a dental hygienist who has been exempted from continuing education requirements wishes to resume practicing for more hours than permitted by his or her classification under Paragraph (c) of this Rule, the Board shall require an unexpired CPR certification and continuing education courses for the calendar year in which he or she increases practice hours in accordance with this Rule and Rule .0206 of this Section when reclassifying the dental hygienist. A dental hygienist who has been classified as retired and wishes to resume practice shall satisfy the reinstatement requirements of 21 NCAC 16C .0601.

History Note: Authority G.S. 90-225.1; 90-229;

Eff. May 1, 1994;

Amended Eff. April 1, 2015; November 1, 2008; April 1, 2001; August 1, 1998;

Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. January 9, 2018;

Recodified from 21 NCAC 16I .0102 Eff. January 1, 2020;

Amended Eff. July 1, 2023.

21 ncac 16i .0202 APPROVED COURSES AND SPONSORS

(a) Courses allowed to satisfy the continuing education requirement shall be related to clinical patient care. Hours spent reviewing dental or dental hygiene publications or videos shall not count toward fulfilling the continuing education requirement, with the exception of self study courses as described in Rule .0201 of this Subchapter that are offered by a Board approved continuing education sponsor.

(b) Approved continuing education course sponsors include:

(1) providers recognized by the American Dental Association's Continuing Education Recognition Program, the Academy of General Dentistry, the American Dental Hygienists' Association, or components of such organizations;

(2) North Carolina Area Health Education Centers;

(3) educational institutions with dental, dental hygiene or dental assisting schools or departments;

(4) national, state, or local societies or associations;

(5) local, state, or federal governmental entities; and

(6) Federally Qualified Health Centers.

History Note: Authority G.S. 90‑225.1;

Eff. May 1, 1994;

Amended Eff. November 1, 2008; April 1, 2001; August 1, 1998;

Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. January 9, 2018;

Recodified from 21 NCAC 16I .0103 Eff. January 1, 2020;

Amended Eff. July 1, 2022.

21 ncac 16i .0203 REPORTING CONTINUING EDUCATION

(a) The number of hours completed to satisfy the continuing education requirement shall be indicated on the renewal application form submitted to the Board and certified by the hygienist. Upon request by the Board or its authorized agent, the hygienist shall provide documentation of attendance at courses indicated. Such documentation shall be provided by the organization offering or sponsoring the course. Documentation must include:

(1) the title;

(2) the number of hours of instruction;

(3) the date of the course attended;

(4) the name(s) of the course instructor(s); and

(5) the name of the organization offering or sponsoring the course.

(b) All records, reports and certificates relative to continuing education hours must be maintained by the licensee for at least two years and shall be produced upon request of the Board or its authorized agent.

(1) service on a full-time basis on the faculty of an educational institution with direct involvement in education, training, or research in dental or dental auxiliary programs; or

(2) service on a full-time basis with a federal, state or county government agency whose operation is directly related to dentistry or dental auxiliaries.

Verification of credit hours shall be maintained in the manner specified in this Rule.

(d) Evidence of service or affiliation with an agency as specified in Paragraph (c) of this Rule shall be in the form of verification of affiliation or employment which is documented by a director or an official acting in a supervisory capacity.

(e) Hygienists who work at least 20 hours per week in an institution or entity described in Subparagraph (c)(1) or (2) of this Rule shall receive two hours credit per year for continuing education.

(f) Hygienists may receive one hour of continuing education credits per year for performing at least five hours of dental hygiene on a volunteer basis at any state, city or county operated site approved by the Dental Board. Credit will not be given for less than five hours of volunteer work.

History Note: Authority G.S. 90-225.1;

Eff. May 1, 1994;

Amended Eff. November 1, 2008; September 1, 2008; June 1, 2008; August 1, 2002; April 1, 2001;

Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. January 9, 2018;

Recodified from 21 NCAC 16I .0104 Eff. January 1, 2020.

21 ncac 16i .0204 Reserved for future codification

21 NCAC 16I .0205 PENALTY/NON-COMPLIANCE/CONTINUING EDUCATION REQUIREMENT

(a) If the applicant for a renewal certificate fails to provide proof of completion of reported continuing education hours for the current year as required by Rules .0201 and .0203 of this Subchapter, the Board shall refuse to issue a renewal certificate for the year for which renewal is sought until the licensee completes the required hours of education for the current year and meets all other qualifications for renewal. If the applicant applies for credit for continuing education hours or a reduction of continuing education hours and fails to provide the required documentation upon request, the Board shall refuse to issue a certificate of renewal until the applicant meets the qualifications for credit.

(b) If an applicant fails to meet the qualifications for renewal, including completing the required hours of continuing education and delivering the required documentation to the Board's office before midnight on March 31 of each year, the license becomes void and the holder must petition the Board for reinstatement.

History Note: Authority G.S. 90-225.1; 90-227;

Eff. May 1, 1994;

Amended Eff. April 1, 2015; February 1, 2008; April 1, 2001;

Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. January 9, 2018;

Recodified from 21 NCAC 16I .0105 Eff. January 1, 2020.

21 NCAC 16I .0206 continuing educaTION ON SUBSTANCE ABUSE AND MENTAL HEALTH

(a) Every two calendar years, each dental hygienist shall complete one clock hour of continuing education on substance abuse and mental health. To count toward this requirement, the course shall be:

(1) designed to address relevant issues for dental professionals, including substance abuse, chemical dependency, impairment, and mental health disorders; and

(2) offered by a Board-approved sponsor as set out in Rule .0202(b) of this Section.

(b) The continuing education requirement set out in Paragraph (a) of this Rule may be completed through a self-study course that satisfies Subparagraphs (a)(1) and (2) of this Rule. The dental hygienist shall pass a test administered by the self-study course sponsor and obtain a certificate of completion from the sponsor.

(c) Every two calendar years, a dental hygienist may apply one clock hour of a course meeting the requirements of this Rule toward the total number of continuing education hours required pursuant to Rule .0201(a) of this Section.

History Note: Authority G.S. 90-223; 90-225.1;

Eff. October 1, 2022.

SUBCHAPTER 16J - SANITATION

subchapter 16j - sanitation, sterilization, and infection control

21 NCAC 16J .0101 PREMISES

(a) The premises of a dental facility shall be kept free of rubbish and any substances that create a hazard, as follows:

(1) all floors shall be free of obstacles to cleaning;

(2) reception areas, hallways, treatment areas, office facilities, and other walking surfaces shall be free of obstruction;

(3) all equipment and instruments that have been used for patient dental care shall be handled in accordance with Rule .0103 of this Subchapter; and

(4) solid wastes and medical wastes shall be handled and disposed of in accordance with 15A NCAC 18A .1300, which is incorporated by reference, including subsequent amendments.

(b) The premises shall be kept free of all insects and vermin.

(c) Water shall be piped under pressure to all equipment and fixtures where the use of water is required. The water supply shall meet the requirements in 15A NCAC 18A .1700 or 15A NCAC 18C, which are incorporated by reference, including subsequent amendments.

(d) All plumbing shall comply with applicable local plumbing ordinances and with the North Carolina State Plumbing Code, which is incorporated by reference, including subsequent amendments and editions, and is available at no cost online at https://www.ncosfm.gov/codes/codes-current-and-past.

(e) Comfortable and sanitary conditions for patients and employees shall be maintained at all times, as follows:

(1) floors, including carpeted areas, shall be kept clean, dry, odor free, and in good repair;

(2) walls and ceilings shall be kept clean and in good repair;

(3) doors, windows, and window treatments shall be kept clean and in good repair;

(4) equipment, furniture, and light fixtures, including in reception areas, shall be kept clean and in good repair;

(5) rooms shall be heated, cooled, and ventilated to maintain a temperature between 65°F (19°C) and 85°F (30°C), and ventilation equipment shall be kept clean and in good repair; and

(6) moisture shall be controlled such that there is no evidence of microbial growth on interior surfaces and objects.

(f) All liquid and human waste, including floor wash water, shall be disposed of through trapped drains into a public sanitary sewer system in localities where such system is available. In localities where a public sanitary system is not available, liquid and human waste shall be disposed of in accordance with 15A NCAC 18A .1300 and 15A NCAC 18C.

(g) There shall be functioning toilet facilities on the premises of every dental office. The toilet facilities and fixtures shall be kept clean and in good repair, and shall conform to standards set out in 15A NCAC 18A .1300.

(h) No animals shall be allowed in any area of a dental office where clinical work is being performed, except service animals in accordance with G.S. 168-4.2 and the Americans with Disabilities Act, or certified facility dogs. For purposes of this Rule, a "certified facility dog" shall be defined as a dog that is trained and certified by a program that is accredited by or a member of Assistance Dogs International, Animal Assisted Intervention International, or a similar organization whose purpose is to promote standards of training, placement, and utilization of assistance dogs (an "assistance dog program"). While in the dental office, the facility dog shall be handled by a dentist, dental hygienist, dental assistant, or other employee designated by the dentist who is trained and certified by an assistance dog program.

(i) For purposes of this Rule, "clean" means washed and free from dirt, grime, bodily fluids or tissue, foreign material, or unwanted matter. "Good repair" means capable of being cleaned and used for its intended purpose in a safe manner.

History Note: Authority G.S. 90-41(a)(23); 90-48;

Eff. September 3, 1976;

Readopted Eff. September 26, 1977;

Amended Eff. April 1, 2015; May 1, 1989;

Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. January 9, 2018;

Amended Eff. June 1, 2021.

21 NCAC 16J .0102 HOUSEKEEPING

History Note: Authority G.S. 90‑23; 90‑48;

Eff. September 3, 1976;

Readopted Eff. September 26, 1977;

Repealed Eff. May 1, 1989.

21 NCAC 16J .0103 STERILIZATION AND INFECTION CONTROL

(a) All instruments or equipment used in the treatment of dental patients shall be sterilized according to manufacturer specifications.

(b) All settings in which licensees engage in the practice of dentistry or dental hygiene ("dental settings") shall comply with the recommendations and guidelines of the Centers for Disease Control and Prevention ("CDC") for infection prevention and control directed at or applicable to dental settings. The CDC recommendations and guidelines are incorporated by reference, including subsequent amendments and editions, and are available at no cost online at https://www.cdc.gov.

(c) All licensees are responsible for utilizing and maintaining sterilization and infection control techniques and precautions as required by this Rule to prevent the cross contamination and transmission of infection to all persons.

History Note: Authority G.S. 90-41(a)(23); 90-48; 90-233(a5);

Eff. September 3, 1976;

Readopted Eff. September 26, 1977;

Amended Eff. February 1, 2008; May 1, 1991;

Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. January 9, 2018;

Amended Eff. June 1, 2021.

SUBCHAPTER 16K ‑ DENTAL SCHOOL EXTENSION FACILITIES

21 NCAC 16K .0101 AUTHORITY FOR DESIGNATION

21 NCAC 16K .0102 SUPERVISION AND DIRECTION

History Note: Authority G.S. 90‑29(c)(4);

Eff. September 3, 1976;

Readopted Eff. September 26, 1977;

Repealed Eff. May 1, 1989.

21 NCAC 16K .0103 INSTRUCTORS TO BE APPROVED

All dentists acting as instructors in dental school extension facilities shall be approved by that official of a North Carolina school of dentistry who is generally responsible for faculty appointments.

History Note: Authority G.S. 90-29(c)(4);

Eff. September 3, 1976;

Readopted Eff. September 26, 1977;

Amended Eff. April 1, 2015; May 1, 1989;

Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. January 9, 2018.

21 NCAC 16K .0104 NO FEES FOR SERVICES

Any student enrolled in a dental school extension facility shall receive no fees, compensation or remuneration of any kind or nature for dental services rendered by him other than for expenses incurred or such subsistence allowance as is authorized and permitted by the agency or entity wherein or for which said services are rendered in accordance with G.S. 90‑29(c)(4).

History Note: Authority G.S. 90‑29(c)(4);

Eff. September 3, 1976;

Readopted Eff. September 26, 1977;

Amended Eff. May 1, 1989;

Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. January 9, 2018.

21 NCAC 16K .0105 EXTENSION OF SCHOOL OF DENTISTRY

History Note: Authority G.S. 90‑29(c)(4);

Eff. September 3, 1976;

Readopted Eff. September 26, 1977;

Repealed Eff. May 1, 1989.

21 NCAC 16K .0106 REPORTS TO BOARD

Every North Carolina school of dentistry shall keep the Board informed of the:

(1) location and kind of patients seen at each dental school extension facility;

(2) names of the students assigned there; and

(3) names and qualifications of all instructors functioning therein.

History Note: Authority G.S. 90-29(c)(4);

Eff. September 3, 1976;

Readopted Eff. September 26, 1977;

Amended Eff. April 1, 2015; May 1, 1989;

Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. January 9, 2018.

SUBCHAPTER 16L ‑ BOARD OF DENTAL ELECTIONS

21 NCAC 16L .0101 BALLOTS

Ballots shall contain the name and practicing address of each nominee.

History Note: Authority G.S. 90‑22;

Eff. September 3, 1976;

Readopted Eff. September 26, 1977;

Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. January 9, 2018.

21 NCAC 16L .0102 NOTICE TO NOMINEE

Each nominee shall be notified by the Secretary of the Board of Elections of his nomination before midnight May 20.

History Note: Authority G.S. 90‑22;

Eff. September 3, 1976;

Readopted Eff. September 26, 1977;

Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. January 9, 2018.

21 NCAC 16L .0103 NOMINATED BOARD MEMBER DISQUALIFIED FROM VOTE

History Note: Authority G.S. 90‑22;

Eff. September 3, 1976;

Readopted Eff. September 26, 1977;

Repealed Eff. May 1, 1989.

21 ncac 16L .0104 SOLICITATIONS FOR VOTES

Solicitations for votes shall not:

(1) be false or misleading or imply endorsement by the Board;

(2) contain a material misrepresentation of fact;

(3) misrepresent credentials, degrees, education, or experience of the candidate;

(4) include false or misleading testimonials or endorsements;

(5) mislead or deceive because only partial disclosure of relevant facts are made;

(6) contain representations or implications that the solicitation materials were generated by the Board; or

(7) use or refer to the Board's name or any variation of the Board's name on the candidate's letterhead, envelopes, postcards or other printed or electronic media. The candidate may indicate that he or she is a candidate for election to the Board.

History Note: Authority G.S. 90-22; 90-48;

Eff. April 1, 2003;

Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. January 9, 2018.

SUBCHAPTER 16M - FEES PAYABLE

section .0100 - fees payable

21 NCAC 16M .0101 DENTISTS

(a) The following fees shall be payable to the Board:

(1) Application for general dentistry license $ 395.00

(2) Renewal of general dentistry license $ 289.00

(3) Application for instructor's license or renewal thereof $ 140.00

(4) Application for provisional license $ 100.00

(5) Application for intern permit or renewal thereof $ 150.00

(6) Certificate of license to a resident dentist desiring to change

to another state or territory $ 25.00

(7) Duplicate license $ 25.00

(8) Reinstatement of license $ 225.00

(9) Fee for late renewal of any license or permit $ 50.00

(10) Application for license by credentials $2000.00

(11) Application for limited volunteer dental license $ 100.00

(12) Renewal of limited volunteer dental license $ 25.00

(13) Board conducted examination processing fee $ 805.00

(14) Application for license by endorsement $ 395.00

(b) Each dentist renewing a license to practice dentistry in North Carolina shall be assessed a fee of forty dollars ($40.00), in addition to the annual renewal fee, to be contributed to the operation of the North Carolina Caring Dental Professionals.

History Note: Authority G.S. 90-28; 90-39; 90-48; 150B-19(5); 93B-15.1;

Eff. September 3, 1976;

Readopted Eff. September 26, 1977;

Amended Eff. August 1, 1998; December 1, 1994; May 1, 1989; March 1, 1988; May 1, 1987;

Temporary Amendment Eff. October 28, 1998;

Amended Eff. August 1, 2000;

Temporary Amendment Eff. January 1, 2003;

Amended Eff. September 19, 2013; May 1, 2011; April 1, 2006; March 1, 2004; January 1, 2004; April 1, 2003;

Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. January 9, 2018.

21 NCAC 16M .0102 DENTAL HYGIENISTS

(a) The following fees shall be payable to the Board:

(1) Application for examination

conducted by the Board $275.00

(2) Renewal of dental hygiene license $81.00

(3) Reinstatement of license $60.00

(4) Application for provisional licensure $60.00

(5) Certificate to a resident dental hygienist

desiring to change to another state or territory $25.00

(6) Application for license by credentials $750.00

(7) License application processing fee $75.00

(b) Each dental hygienist renewing a license to practice dental hygiene in North Carolina shall be assessed a fee of twenty-five dollars ($25.00), in addition to the annual renewal fee, to be contributed to the operation of the North Carolina Caring Dental Professionals.

History Note: Authority G.S. 90-232; 150B-19(5);

Eff. September 3, 1976;

Readopted Eff. September 26, 1977;

Amended Eff. May 1, 1989; March 1, 1988; May 1, 1987;

Temporary Amendment Eff. August 20, 1999;

Amended Eff. April 1, 2001;

Temporary Amendment Eff. January 1, 2003;

Amended Eff. October 1, 2006; June 1, 2006; March 1, 2004; January 1, 2004; April 1, 2003;

Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. January 9, 2018.

21 NCAC 16M .0103 PRIMARY SOURCE VERIFICATION FEE

All primary source verification requests must be in writing. Primary source verifications shall be provided in writing only for a fee of fifteen dollars ($15.00).

History Note: Authority G.S. 150B-19(5);

Eff. August 1, 1998;

Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. January 9, 2018.

SUBCHAPTER 16N ‑ RULEMAKING AND ADMINISTRATIVE HEARING PROCEDURES

SECTION .0100 ‑ PETITIONS FOR ADOPTION OF RULES

21 NCAC 16N .0101 PETITION FOR RULEMAKING HEARINGS

Any person wishing to submit a petition requesting the adoption, amendment or repeal of a rule by the Board shall address the petition to the Board's office. The envelope containing the petition should clearly bear the notation: RULEMAKING PETITION RE: and then the subject area, for example, DENTAL PRACTICE ACT or DENTAL HYGIENE ACT.

History Note: Authority G.S. 150B‑16;

Eff. August 25, 1977;

Amended Eff. May 1, 1989; March 1, 1985;

Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. January 9, 2018.

21 NCAC 16N .0102 CONTENTS OF PETITION

The petition shall include the following information:

(1) An indication of the subject area to which the petition is directed; for example, "This is a petition to hold a rulemaking hearing to amend Rule .0000 of Subchapter X pertaining to delegable duties to dental auxiliaries";

(2) Either a draft of the proposed rule or a summary of its contents;

(3) Reasons for the proposal;

(4) The effect on existing rules or orders;

(5) Any data supporting the proposal;

(6) Affect of the proposed rule on existing practices in the area involved, including cost factors;

(7) Names of those most likely to be affected by the proposed rule, with addresses if reasonably known; and

(8) Name and address of each petitioner.

History Note: Authority G.S. 150B‑16;

Eff. August 25, 1977;

Amended Eff. May 1, 1989;

Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. January 9, 2018.

21 NCAC 16N .0103 DISPOSITION OF PETITIONS

(a) The Board will determine whether the public interest would be served by the adoption, amendment or repeal of the requested rule. Prior to making this determination, the Board may:

(1) Request additional information from the petitioner;

(2) Contact interested persons or those likely to be affected by the proposed rule and request comments; and

(3) It may use any other appropriate method for obtaining information on which to base its determination. It will consider all the contents of the petition submitted plus any other information obtained by the means described herein.

(b) The Board shall act on a petition at its next regularly scheduled meeting or within 120 days after submission of a petition.

History Note: Authority G.S. 150B‑16;

Eff. August 25, 1977;

Amended Eff. May 1, 1989; October 1, 1986; January 1, 1983;

Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. January 9, 2018.

SECTION .0200 ‑ NOTICE OF RULEMAKING HEARINGS

21 NCAC 16N .0201 NOTICE OF PROCEEDINGS

History Note: Authority G.S. 90‑28; 90‑48; 90‑223(b); 150B‑12; 150B‑60;

Eff. August 25, 1977;.

Amended Eff. October 1, 1986;

Repealed Eff. May 1, 1989.

21 NCAC 16N .0202 NOTICE OF MAILING LIST

Any person or agency desiring to be placed on the mailing list for the Board's rulemaking notices may file a written request in the Board's office. The letter of request should state those particular subject areas within the authority of the Board concerning which notice is desired. The Board may require reasonable postage and stationery costs to be paid by those requesting such notices.

History Note: Authority G.S. 90‑48; 90‑223(b); 150B‑12(c);

Eff. August 25, 1977;

Amended Eff. May 1, 1989; March 1, 1985;

Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. January 9, 2018.

21 NCAC 16N .0203 ADDITIONAL INFORMATION

History Note: Authority G.S. 90‑48; 90‑223(b); 150B‑12;

Eff. August 25, 1977;

Amended Eff. March 1, 1985;

Expired Eff. February 1, 2018 pursuant to G.S. 150B-21.3A.

SECTION .0300 ‑ RULEMAKING HEARINGS

21 NCAC 16N .0301 REQUEST TO PARTICIPATE

History Note: Authority G.S. 90-48; 150B-12(a);

Eff. August 25, 1977;

Amended Eff. May 1, 1989;

Repealed Eff. April 1, 2014.

21 NCAC 16N .0302 CONTENT OF REQUEST: GENERAL TIME LIMITATIONS

Presentations at Board rule making hearings shall be limited to 15 minutes unless the Board prescribes some other time limit.

History Note: Authority G.S. 90-48; 90-223(b); 150B-12(a);

Eff. August 25, 1977;

Amended Eff. April 1, 2014; May 1, 1989;

Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. January 9, 2018.

21 NCAC 16N .0303 RECEIPT OF REQUEST: SPECIFIC TIME LIMITS

History Note: Authority G.S. 90-48; 90-223(b); 150B-12(a);

Eff. August 25, 1977;

Amended Eff. May 1, 1989.

Repealed Eff. April 1, 2014.

21 NCAC 16N .0304 WRITTEN SUBMISSIONS

Any person may file a written submission containing data, comments or arguments after publication of notice of a rulemaking hearing up to the date of hearing. The Board may in its discretion grant an additional 30 days after a hearing for further comment and argument. These written comments should be sent to the Board's office. They should clearly state the rule or proposed rule to which such comments are addressed.

History Note: Authority G.S. 90‑48; 90‑223(b); 150B‑12;

Eff. August 25, 1977;

Amended Eff. May 1, 1989; March 1, 1988; October 1, 1986; March 1, 1985;

Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. January 9, 2018.

21 NCAC 16N .0305 BOARD PRESIDENT TO PRESIDE: POWERS AND DUTIES

The president of the Board shall preside at a rulemaking hearing and shall be authorized to do the following:

(1) Grant any extension of time in connection with a request for the presentation of oral data, views or arguments;

(2) Recognize any prospective speaker;

(3) Extend or shorten the time allotted for any particular presentation; and

(4) Direct the overall proceedings including management of any questions directed to any speaker by any Board member.

History Note: Authority G.S. 90‑48; 90‑223(b); 150B‑12(a);

Eff. August 25, 1977;

Amended Eff. May 1, 1989;

Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. January 9, 2018.

21 NCAC 16N .0306 STATEMENT OF REASONS FOR DECISION

History Note: Authority G.S. 90‑28; 150B‑60(4); 90‑48; 90‑223(b); 150B‑12(e);

Eff. August 25, 1977;

Repealed Eff. May 1, 1989.

21 NCAC 16N .0307 RECORD OF PROCEEDINGS

A record of all rulemaking proceedings will be maintained in the Board's office for as long as the rule is in effect, and for five years thereafter, following filing. This record will contain: the original petition if any, the notice, all written memoranda and information submitted, and any record or summary of oral presentations, if any. A record of the rulemaking proceedings will be available for public inspection during the regular office hours of the Board.

History Note: Authority G.S. 90‑48; 90‑223(b); 150B‑12(e);

Eff. August 25, 1977;

Amended Eff. May 1, 1989;

Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. January 9, 2018.

21 NCAC 16N .0308 TEMPORARY RULES

History Note: Authority G.S. 90‑28; 150B‑13;

Eff. August 25, 1977;

Amended Eff. April 1, 1988;

Repealed Eff. May 1, 1989.

SECTION .0400 ‑ DECLARATORY RULINGS

21 NCAC 16N .0401 SUBJECTS OF DECLARATORY RULINGS

History Note: Authority G.S. 90‑28; 90‑48; 90‑223(b); 150B‑17;

Eff. August 25, 1977;

Amended Eff. October 1, 1986;

Repealed Eff. May 1, 1989.

21 NCAC 16N .0402 SUBMISSION OF REQUEST FOR RULING

All requests for declaratory rulings shall be written and mailed to the Board's office. The envelope containing the request should bear the notation: REQUEST FOR DECLARATORY RULING. The request must include the following information:

(1) Name and address of petitioner;

(2) Statute or rule to which petition relates;

(3) Concise statement of the manner in which petitioner is aggrieved by the rule or statute or its potential application to him; and

(4) A statement of whether an oral hearing is desired and if so, the reason therefor.

History Note: Authority G.S. 150B‑4;

Eff. August 25, 1977;

Amended Eff. May 1, 1989; October 1, 1986; March 1, 1985;

Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. January 9, 2018.

21 NCAC 16N .0403 DISPOSITION OF REQUESTS

(a) When the Board deems it appropriate to issue a declaratory ruling, it shall issue the declaratory ruling as soon as practicable but no longer than the period set out in G.S. 150B-4(a1).

(b) A declaratory ruling proceeding may consist of written submissions or other procedures the Board determines to be in the interests of justice and judicial economy based on the content and circumstances of the request.

(c) Whenever the Board finds good cause exists to deny the request for a declaratory ruling, the Board may deny the request to issue a declaratory ruling. In that event, the Board shall notify the petitioner of its decision in writing, stating the reasons for the denial of the declaratory ruling.

(d) For purposes of Paragraph (c) of this Rule, good cause for the denial of a declaratory ruling request may include one of the following:

(1) the petitioner does not show that the circumstances are changed since the adoption of the rule and a declaratory ruling would be warranted;

(2) at the time the rule was adopted, the Board gave full consideration to the factors specified in the request for a declaratory ruling;

(3) there has been a previous determination of a contested case involving similar factual questions; or

(4) the subject matter of the request is involved in pending litigation in any State or federal court in North Carolina.

History Note: Authority G.S. 150B-4;

Eff. August 25, 1977;

Amended Eff. May 1, 1989; October 1, 1986;

Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. January 9, 2018;

Amended Eff. September 1, 2020.

21 NCAC 16N .0404 RECORD OF DECISION

A record of all declaratory ruling proceedings will be maintained in the Board's office for as long as the ruling is in effect and for five years thereafter. This record will contain: the request, all written submissions filed on the request, whether filed by the petitioner or any other person, and a record or summary of all the oral presentations, if any. Records of declaratory ruling proceedings will be available for public inspection during the Board's regular office hours.

History Note: Authority G.S. 150B‑4;

Eff. August 25, 1977;

Amended Eff. May 1, 1989;

Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. January 9, 2018.

21 NCAC 16N .0405 DEFINITION

History Note: Authority G.S. 90‑28; 150B‑17; 90‑48; 90‑223(b); 150B‑60(4); 150B‑12(e);

Eff. August 25, 1977;

Repealed Eff. May 1, 1989.

SECTION .0500 ‑ ADMINISTRATIVE HEARING PROCEDURES

21 NCAC 16N .0501 RIGHT TO HEARING

When the Board acts, or proposes to act, other than in rulemaking or declaratory ruling proceedings, in a manner that will affect the rights, duties, or privileges of a licensee or applicant for a license or permit, such person has a right to an administrative hearing. When the Board proposes to act in such a manner, it shall give such person notice of his right to a hearing by mailing by certified mail to him at his last known address a notice of the proposed action and a notice of a right to a hearing. Notice of hearing may also be given by any method of service permitted in G.S. 150B-38(c), by a signed acceptance of service from such person, or by delivery to the person's attorney of record who accepts service on behalf of the person.

History Note: Authority G.S. 150B‑38(h);

Eff. August 25, 1977;

Amended Eff. May 1, 1989; November 20, 1980;

Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. January 9, 2018;

Amended Eff. October 1, 2019.

21 NCAC 16N .0502 REQUEST FOR HEARING

(a) Any individual who believes his or her rights, duties, or privileges have been affected by the Board's administrative action, but who has not received a notice of a right to an administrative hearing, may file a request for hearing.

(b) The individual shall submit a request to the Board's office, containing the following information:

(1) Name and address of the petitioner;

(2) A concise statement of the action taken by the Board which is challenged;

(3) A concise statement of the way in which petitioner has been aggrieved; and

(4) A clear and specific statement of request for a hearing.

History Note: Authority G.S. 150B-38;

Eff. August 25, 1977;

Amended Eff. April 1, 2015; May 1, 1989; March 1, 1985; November 20, 1980;

Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. January 9, 2018.

21 NCAC 16N .0503 GRANTING OR DENYING HEARING REQUEST

(a) The Board will decide whether to grant a request for a hearing.

(b) The denial of request for a hearing will be issued immediately upon decision, and in no case later than 60 days after the submission of the request. Such denial shall contain a statement of the reasons leading the Board to deny the request.

(c) Approval of a request for a hearing will be signified by issuing a notice as required by G.S. 150B‑38(b) and explained in Rule .0504 of this Section.

History Note: Authority G.S. 90‑28; 150B‑38;

Eff. August 25, 1977;

Amended Eff. May 1, 1989; April 1, 1988; October 1, 1986; November 20, 1980;

Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. January 9, 2018.

21 NCAC 16N .0504 NOTICE OF HEARING

(a) The Board shall give the party or parties in a contested case a notice of hearing not less than 15 days before the hearing. Said notice shall contain the following information, in addition to the items specified in G.S. 150B‑38(b):

(1) The name, position, address and telephone number of a person at the office of the Board to contact for further information or discussion; and

(2) A statement explaining that the Respondent may be represented by counsel, testify, offer evidence, and cross examine adverse witnesses at the hearing.

(b) If the Board determines that the public health, safety, or welfare requires such action, it may issue an order summarily suspending a license pursuant to G.S. 150B-3. Upon service of the order, the licensee to whom the order is directed shall immediately cease practicing in North Carolina. The Board shall promptly give notice of hearing pursuant to G.S. 150B‑38 following service of the order. The suspension shall remain in effect pending issuance by the Board of a final agency decision pursuant to G.S. 150B‑42.

History Note: Authority G.S. 150B-3; 150B-38;

Eff. August 25, 1977;

Amended Eff. April 1, 2015; May 1, 1989; April 1, 1988; October 1, 1986; November 20, 1980;

Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. January 9, 2018.

21 NCAC 16N .0505 WHO SHALL HEAR CONTESTED CASES

All administrative hearings shall be conducted by a panel consisting of a majority of Board members eligible to vote on the issue, or an administrative law judge designated to hear the case pursuant to G.S. 150B‑40(e).

History Note: Authority G.S. 150B-38; 150B-40;

Eff. August 25, 1997;

Amended Eff. April 1, 2015; March 1, 1988; October 1, 1986; November 20, 1980;

Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. January 9, 2018.

21 NCAC 16N .0506 PETITION FOR INTERVENTION

(a) A person desiring to intervene in a contested case shall file a written petition with the Board's office. The request shall bear the notation: PETITION TO INTERVENE IN THE CASE OF (NAME OF CASE).

(b) The petition shall include the following information:

(1) the name and address of petitioner;

(2) the business or occupation of petitioner;

(3) the name and citation of the hearing in which petitioner is seeking to intervene;

(4) the grounds for intervention or a statement that no grounds exist;

(5) any claim or defense in respect to which intervention is sought; and

(6) a summary of the arguments or evidence petitioner seeks to present.

(d) If the Board determines to allow intervention, it shall send written notice to the petitioner and all parties. In cases of discretionary intervention, such notification shall include a statement of any limitations of time, subject matter, evidence or whatever else the Board deems necessary that are imposed on the intervenor.

(e) If the Board decides to deny intervention it shall send written notice to the petitioner and all parties, stating the reasons for the denial.

History Note: Authority G.S. 150B-38;

Eff. August 25, 1977;

Amended Eff. April 1, 2015; May 1, 1989; March 1, 1985; November 20, 1980;

Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. January 9, 2018.

21 NCAC 16N .0507 TYPES OF INTERVENTION

(a) Intervention of Right. A petition to intervene of right, as provided in the North Carolina Rules of Civil Procedure, Rule 24, will be granted if the petitioner meets the criteria of that rule and his petition is timely.

(b) Permissive Intervention. A petition to intervene permissively, as provided in the North Carolina Rules of Civil Procedure, Rule 24, will be granted if the petitioner meets the criteria of that rule and the Board determines that:

(1) There is sufficient legal or factual similarity between the petitioner's claimed rights, privileges, or duties and those of the parties to the hearings; and

(2) Permitting intervention by the petitioner as a party would aid the purpose of the hearing.

(c) Discretionary Intervention. The Board may allow discretionary intervention, with whatever limits and restrictions are deemed appropriate. Upon the filing of a timely petition, discretionary intervention will be deemed advisable if:

(1) The information petitioner desires to present is relevant, not repetitious and cumulative; and

(2) The petitioner would lend added impact to the arguments of the parties.

History Note: Authority G.S. 150B‑38;

Eff. August 25, 1977;

Legislative Objection Lodged Eff. February 19, 1980;

Amended Eff. November 20, 1980;

Legislative Objection Removed Eff. March 19, 1981;

Amended Eff. May 1, 1989; April 2, 1981;

Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. January 9, 2018.

21 NCAC 16N .0508 DISQUALIFICATION OF BOARD MEMBERS

(a) Self Disqualification. If a Board member determines that personal bias or other factors render that member unable to hear a contested case and perform all duties in an impartial manner, that Board member shall voluntarily decline to participate in the hearing or decision.

(b) Petition for Disqualification. If any party in a contested case believes that a Board member is personally biased or otherwise unable to hear a contested case and perform all duties in an impartial manner, the party may file a sworn, notarized affidavit with the Board. The title of such affidavit shall bear the notation: AFFIDAVIT OF DISQUALIFICATION OF BOARD MEMBER IN THE CASE OF (NAME OF CASE).

(c) Contents of Affidavit. The affidavit shall state all facts the party deems to be relevant to the disqualification of the Board member.

(d) Timeliness and Effect of Affidavit. An affidavit of disqualification shall be considered timely if filed 10 days before commencement of the hearing. Any other affidavit shall be considered timely provided it is filed at the first opportunity after the party becomes aware of facts which give rise to a reasonable belief that a Board member may be disqualified under this Rule. When a petition for disqualification is filed less than 10 days before or during the course of a hearing, the hearing shall continue with the challenged Board member sitting. The petitioner shall have the opportunity to present evidence supporting his or her petition, and the petition and any evidence presented at the hearing shall be made a part of the record. The Board, before rendering its decision, shall decide whether the evidence justifies disqualification. In the event of disqualification, the disqualified member shall not participate in further deliberation or decision of the case.

(e) Procedure for Determining Disqualification:

(1) The Board shall appoint a Board member to investigate the allegations of the affidavit.

(2) The investigator shall report to the Board the findings of the investigation.

(3) The Board shall decide whether to disqualify the challenged individual.

(4) The person whose disqualification is to be determined shall not participate in the decision but may be called upon to furnish information to the other members of the Board.

(5) When a Board member is disqualified, the hearing shall continue with the remaining members sitting, provided that the remaining members still constitute a majority of the Board who are eligible to vote.

(6) If a majority of the members of the Board who are eligible to vote are disqualified pursuant to this Rule, the Board shall petition the Office of Administrative Hearings to appoint an administrative law judge to hear the contested case pursuant to G.S. 150B‑40(e).

History Note: Authority G.S. 150B-38; 150B-40;

Eff. August 25, 1977;

Amended Eff. April 1, 2015; May 1, 1989; October 1, 1986; November 20, 1980;

Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. January 9, 2018.

SECTION .0600 ‑ ADMINISTRATIVE HEARINGS: DECISIONS: RELATED RIGHTS AND PROCEDURES

21 NCAC 16N .0601 FAILURE TO APPEAR

History Note: Authority G.S. 90‑28; 90‑48; 90‑223(b); 150B‑25(a); 150B‑60(4);

Eff. August 25, 1977;

Amended Eff. November 20, 1980;

Repealed Eff. April 1, 1988.

21 NCAC 16N .0602 SIMPLIFICATION OF ISSUES

The parties to a contested case, specifically including the Board, may agree in advance to simplify the hearing by decreasing the number of the issues to be contested at the hearing, accepting the validity of certain proposed evidence, accepting the findings in some other case which relates to the case at hand or agreeing to such other matters as may expedite the hearing.

History Note: Authority G.S. 150B‑38; 150B‑40;

Eff. August 25, 1977;

Amended Eff. May 1, 1989; November 20, 1980;

Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. January 9, 2018.

21 NCAC 16N .0603 SUBPOENAS

(a) A request for subpoenas for the attendance and testimony of witnesses or for the production of documents, either at a hearing or for the purposes of discovery, shall:

(1) be made in writing to the Board;

(2) identify any documents sought with specificity;

(3) include the name and home or business address of all persons to be subpoenaed; and

(4) if known, the date, time, and place for responding to the subpoena.

(b) The Board shall issue the requested subpoenas within three days of the receipt of the request.

(1) the caption of the case;

(2) the name and address of the person subpoenaed;

(3) the date, hour and location of the hearing in which the witness is commanded to appear;

(4) a description of the books, papers, records, or objects the witness is directed to bring with him to the hearing, if any;

(5) the identity of the party on whose application the subpoena was issued; and

(6) a return of service form.

(d) The "return of service" form, as filled out, shall show the name and capacity of the person serving the subpoena, the date the subpoena was delivered to the person directed to make service, the date service was made, the person on whom service was made, the manner in which service was made, and the signature of the person making service.

(e) Subpoenas shall be served as permitted by Rule 45 of the North Carolina Rules of Civil Procedure, as set forth in G.S. 1A-1.

(f) Any person receiving a subpoena from the Board may object thereto by filing a written objection to the subpoena with the Board's office. Such objection shall include a statement of all reasons why the subpoena should be revoked or modified. These reasons may include any basis sufficient in law for holding the subpoena invalid, such as that the evidence is privileged, that the burden of appearance or production outweighs the relevance of the evidence sought, or other undue hardship.

(g) Any objection to a subpoena shall be served on the party who requested the subpoena simultaneously with the filing of the objection with the Board.

(h) The party who requested the subpoena may file a written response to the objection within 10 days of receipt or 7 days prior to the contested case hearing, whichever is sooner. The written response shall be served by the requesting party on the objecting witness simultaneously with the filing of the response with the Board.

(i) After receipt of the objection and response thereto, if any, the Board shall issue a notice to the party who requested the subpoena and the party challenging the subpoena, and shall notify any other party or parties of a hearing.

(j) The Presiding Officer of the Board members hearing the contested case shall conduct the hearing and rule on the objection unless the interests of justice and judicial economy allow the Presiding Officer to involve the other Board members. On the basis of the content of the written objection and the response, the Presiding Officer shall either permit the parties to submit affidavits in advance of the hearing or permit the parties to present evidence and testimony at the hearing, limited to the narrow questions raised by the objection and response.

History Note: Authority G.S. 90-28; 90-48; 90-223(b); 150B-39; 150B-40;

Eff. August 25, 1977;

Legislative Objection Lodged Eff. November 20, 1980;

Legislative Objection Removed Eff. March 19, 1981;

Amended Eff. April 1, 2015; May 1, 1989; March 1, 1988; October 1, 1986; March 1, 1985;

Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. January 9, 2018;

Amended Eff. October 1, 2019.

21 NCAC 16N .0604 FINAL DECISION

The Board will issue the final decision in all contested cases. This decision is the prerequisite "final agency decision" for the right to judicial review.

History Note: Authority G.S. 90‑48; 90‑223(b); 150B‑43;

Eff. August 25, 1977;

Amended Eff. May 1, 1989;

Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. January 9, 2018.

21 NCAC 16N .0605 PROPOSALS FOR DECISIONS

(a) When an administrative law judge conducts a hearing pursuant to G.S. 150B‑40(e), a "proposal for decision" shall be rendered. Any party may file written exceptions to this "proposal for decision" and submit their own proposed findings of fact and conclusions of law. Exceptions and alternative proposals must be received within ten days after the party has received the "proposal for decision" as drafted by the administrative law judge.

(b) Any exceptions to the procedure during the hearing, the handling of the hearing by the administrative law judge, rulings on evidence, or any other matter must be written and refer specifically to pages of the record or otherwise precisely identify the occurrence to which the exception is taken. Exceptions must be filed with the Board within ten days of the receipt of the proposal for decision. The written exceptions must bear the notation: EXCEPTIONS TO THE PROCEEDINGS IN THE CASE (NAME OF CASE).

(c) Any party may present oral argument to the Board upon request. The request must be included with the written exceptions.

(d) Upon receipt of request for further oral argument, notice will be issued promptly to all parties designating the time and place for such oral argument.

(e) Giving due consideration to the proposal for decision and the exceptions and arguments of the parties, the Board may adopt the proposal for decision or may modify it as the Board deems necessary. The decision rendered will be a part of the record and a copy thereof shall be given to all parties. The Board decision becomes the "final agency decision" for the right to judicial review. Said decision will be rendered by the Board within 60 days of the next regularly scheduled meeting following the oral arguments, if any. If there are no oral arguments presented, the decision will be rendered within 60 days of the next regularly scheduled Board meeting following receipt of the written exceptions.

History Note: Authority G.S. 150B‑38; 150B‑40;

Eff. August 25, 1977;

Amended Eff. May 1, 1989; March 1, 1988; October 1, 1986; November 20, 1980;

Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. January 9, 2018.

21 NCAC 16N .0606 FAILURE TO APPEAR

Should a party fail to appear at a scheduled hearing, the Board, or the designated administrative law judge, may proceed with the hearing and make its decision in the absence of the party, provided that the party has been given proper notice. The Board or the administrative law judge may order a continuance in order to give the party another opportunity to appear.

History Note: Authority G.S. 90‑28; 90‑48; 90‑223(b); 150B‑25(a); 150B‑60(4);

Eff. May 1, 1989;

Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. January 9, 2018.

21 NCAC 16N .0607 DISCIPLINARY FACTORS

If the Board concludes that a dentist or dental hygienist (the "Respondent") has violated the Dental Practice Act, the Dental Hygiene Practice Act, or the Board's Rules, it shall consider the following factors relevant to the discipline to be imposed:

(1) The Board shall consider revocation of a license or permit if it concludes that lesser discipline is insufficient to protect the public and that one or more of the following factors applies:

(a) Respondent caused or contributed to a patient's death, permanent organic brain dysfunction, physical injury, or severe medical emergency requiring hospitalization;

(b) Respondent has been convicted of or entered a plea of guilty or nolo contendere to a felony charge; or

(c) Respondent engaged in fraud, dishonesty, misrepresentation, deceit, or fabrication related to the practice of dentistry or dental hygiene, including attempts to obtain or collect any fees.

(2) The Board shall consider revocation or suspension of a license or permit if it concludes that lesser discipline is insufficient to protect the public and that one or more of the following factors applies:

(a) Respondent's ability to practice dentistry or dental hygiene is impaired;

(b) Respondent is mentally, emotionally, or physically unfit to practice dentistry or dental hygiene;

(d) Respondent's violations resulted in harm or potential harm to a patient, the public, or the dental or dental hygiene profession;

(e) Respondent failed to comply with a prior Board decision or consent order;

(f) Respondent's violations demonstrate a lack of honesty, trustworthiness, or integrity;

(g) Respondent has been convicted of or entered a plea of guilty or nolo contendere to charges involving or found liable for acts of fraud, misrepresentation, deceit, or fabrication that are not related to the practice of dentistry or dental hygiene;

(h) Respondent committed multiple instances of negligence or malpractice in treating patients, including failure to complete treatment for patients;

(i) Respondent distributed or caused to be distributed any intoxicant, drug, or narcotic for an unlawful purpose;

(j) Respondent failed to participate in the Board's investigation and disciplinary process;

(k) Respondent aided a person or entity not licensed in this State to perform acts or services that can only be performed by a dentist or dental hygienist licensed in this State; or

(l) Respondent committed any acts set forth in Sub-items (1)(a)-(c) of this Rule.

(3) In all cases, the Board shall consider the following factors in imposing disciplinary measures:

(a) effect of Respondent's violation on a patient or other individuals;

(b) Respondent's elevation of his or her interest above that of the patient or the public;

(d) dishonest or selfish motive for the violation found, or the absence thereof;

(e) a pattern of violations;

(f) Respondent's intent either to commit acts where the harm or potential harm is foreseeable or to cause the harm or potential harm resulting from the acts;

(g) vulnerability of patient or victim, including violations involving an individual with a physical or mental disability or impairment;

(h) Respondent's failure to respond, or provide responsive documents or information, to requests or subpoenas from the Board during an investigation or disciplinary proceedings;

(i) Respondent's obstruction of the disciplinary proceedings by intentionally failing to comply with rules or orders of the Board;

(j) Respondent's submission of false evidence, false statements, or other deceptive practices during the Board's investigation or disciplinary process;

(k) Respondent's refusal to acknowledge the wrongful nature of the violation;

(l) impact of Respondent's actions on the patient's or public's perception of the dental or dental hygiene profession;

(m) Respondent's efforts to make restitution or to rectify consequences of misconduct, or the failure to do so;

(n) Respondent's physical or mental disability or impairment diagnosed by a treating medical professional, which condition caused or contributed to Respondent's conduct in the opinion of the treating medical professional;

(o) the degree of Respondent's rehabilitation, if any, prior to any disciplinary action;

(p) Respondent's voluntary disclosure to the Board or cooperative attitude toward the proceedings;

(q) Respondent's remorse for the violation or effect of the violation;

(r) Respondent's character or reputation in the community;

(s) remoteness in time of any prior violation by or discipline of Respondent;

(t) Respondent's degree of experience in the practice of dentistry or dental hygiene;

(u) imposition of other penalties or sanctions on Respondent for the conduct constituting the violation; and

(v) any other factors found to be pertinent to the consideration of the discipline to be imposed on Respondent.

History Note: Authority G.S. 90-41; 90-229;

Eff. October 1, 2019.

SUBCHAPTER 16O – NITROUS-OXIDE-OXYGEN CONSCIOUS SEDATION

SECTION .0100 ‑ REGISTRATION AND REPORTING

21 NCAC 16O .0101 REGISTRATION

21 NCAC 16O .0102 REPORTING

History Note: Authority G.S. 90‑28; 90‑29(b)(6); 90‑48; 90‑223; 150B‑12;

Eff. May 24, 1978;

Repealed Eff. July 16, 1980.

SECTION .0200 ‑ QUALIFICATIONS OF DENTAL ASSISTANTS AND HYGIENISTS

21 NCAC 16O .0201 EDUCATIONAL REQUIREMENTS

21 NCAC 16O .0202 DEFINITION

21 NCAC 16O .0203 APPROVED COURSE(S)

History Note: Authority G.S. 90‑28; 90‑29(b)(6); 90‑48; 90‑223; 150A‑12;

Eff. May 24, 1978;

Repealed Eff. July 16, 1980.

SECTION .0300 ‑ DEFINITIONS

21 NCAC 16O .0301 CONSCIOUS SEDATION

"Conscious sedation" means the use of drugs for controlling pain or apprehension without rendering the patient unconscious.

History Note: Authority G.S. 90‑29(b)(6); 90‑48; 90‑223;

Eff. July 16, 1980;

Amended Eff. May 1, 1989;

Amended Eff. April 1, 2016 (See S.L. 2016-31);

Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. January 9, 2018.

21 NCAC 16O .0302 MONITORING

"Monitoring" means observation of the patient during the flow of sedation agents and includes reducing the flow of sedation or shutting off equipment controlling such flow. Monitoring does not include increasing the flow of sedation agents.

History Note: Authority G.S. 90‑29(b)(6); 90‑48; 90‑223;

Eff. July 16, 1980;

Amended Eff. May 1, 1989;

Amended Eff. April 1, 2016 (See S.L. 2016-31);

Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. January 9, 2018.

SECTION .0400 ‑ QUALIFICATIONS TO PERFORM FUNCTIONS

21 NCAC 16O .0401 NON‑DELEGABLE FUNCTIONS

Conscious sedation shall not be induced by anyone other than a dentist or a lawfully qualified nurse or anesthetist who does so under the supervision and direction of a dentist or physician.

History Note: Authority G.S. 90‑29(b)(6); 90‑48; 90‑223;

Eff. July 16, 1980;

Amended Eff. May 1, 1989;

Amended Eff. April 1, 2016 (See S.L. 2016-31);

Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. January 9, 2018.

21 NCAC 16O .0402 EDUCATIONAL REQUIREMENTS

(a) A Dental Assistant may aid and assist a licensed dentist in the monitoring of nitrous oxide‑oxygen inhalant sedation by completing a Board‑approved course totaling at least seven hours that covers the following topics:

(1) definitions and descriptions of physiological and psychological aspects of pain and anxiety;

(2) the states of drug‑induced central nervous system depression through all levels of consciousness and unconsciousness, with emphasis on the distinction between the conscious and unconscious state;

(3) respiratory and circulatory physiology, and related anatomy;

(4) pharmacology of agents used in the nitrous oxide techniques being taught, including drug interaction and incompatibility;

(5) patient monitoring, with particular attention to vital signs and reflexes related to consciousness;

(6) prevention, recognition, and management of complications and life threatening situations that may occur during the use of the nitrous oxide techniques, including cardiopulmonary resuscitation;

(7) description and use of ventilation sedation equipment; and

(8) potential health hazards of trace anesthetics, and proposed techniques for elimination of these potential health hazards.

(b) Courses approved to satisfy the educational requirements of this Rule shall be provided and taught by:

(1) an instructor who is a dentist holding an unrestricted license as defined by 21 NCAC 16A .0101(7);

(2) an instructor licensed pursuant to 21 NCAC 16B .0701; or

(3) a dental hygienist or dental assistant under the direction of an instructor who satisfies the requirements of Subparagraph (b)(1) or (b)(2) of this Rule, who shall be physically present and administer nitrous oxide if it is administered in the course.

(c) Courses shall be reviewed at any Board meeting and approved by a majority of the Board to satisfy the educational requirements of this Rule. A list of approved courses is available on the Board's website at www.ncdentalboard.org.

History Note: Authority G.S. 90‑29(b)(6); 90-29(c)(10); 90‑29(c)(13); 90‑48; 90‑223;

Eff. July 16, 1980;

Amended Eff. April 1, 2016; May 1, 1989;

Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. January 9, 2018;

Amended Eff. November 1, 2021.

21 NCAC 16O .0403 PREVIOUS COMPLIANCE

History Note: Authority G.S. 90‑28; 90‑29(b)(6); 90‑48; 90‑223; 150B‑12;

Eff. July 16, 1980;

Repealed Eff. May 1, 1989.

SUBCHAPTER 16P ‑ ADVERTISEMENT OF DENTAL SERVICES

21 NCAC 16P .0101 COMMUNICATIONS CONCERNING DENTAL SERVICES

A dentist shall not make a false or misleading communication about the dentist or the dentist's services. A communication is false or misleading if it:

(1) Contains a material misrepresentation of fact;

(2) Is likely to mislead or deceive because it makes only a partial disclosure of relevant facts;

(3) Is intended or is likely to create false or unjustified expectations of favorable results;

(4) Contains express or implied claims of superiority which cannot reasonably be substantiated by the advertising practitioner; or

(5) Contains other representations or implications which are intended or likely to cause an ordinary, prudent person to misunderstand or be deceived.

History Note: Authority G.S. 90‑41(a)(16),(17),(18); 90‑48;

Eff. March 1, 1985;

Amended Eff. May 1, 1989; October 1, 1986;

Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. January 9, 2018.

21 NCAC 16P .0102 ADS MUST INCLUDE DENTIST'S NAME AND AREA OF PRACTICE

All advertisements of dental services shall contain the name or names of the dentist or dentists whose services are being advertised and shall state whether each dentist is a general dentist or, if qualified, a specialist in the named area of specialization. The dentist's name and designation as a general dentist or specialist shall be stated prominently in the advertisement. The dentist whose services are being advertised shall be personally responsible for determining that the content of the advertisement is not contrary to North Carolina law or Board rules.

History Note: Authority G.S. 90‑41(a)(16),(17),(18); 90‑48;

Eff. March 1, 1985;

Amended Eff. May 1, 1989; October 1, 1986;

Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. January 9, 2018.

21 NCAC 16P .0103 ADVERTISEMENT OF FEES

Advertisements of dental services shall:

(1) Not quote a range of fees for a given service unless the basic factors upon which the actual fees will be determined are disclosed;

(2) Specify any related services which usually are required in conjunction with the advertised services and for which additional fees will be charged; and

(3) If discounts are advertised, state the amount of the discounts. The dentist must be available in the office and provide upon request a list of actual standard fees to which the discounts will be applied.

History Note: Authority G.S. 90‑41(a)(16),(17),(18); 90‑48;

Eff. March 1, 1985;

Amended Eff. May 1, 1989; October 1, 1986;

Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. January 9, 2018.

21 NCAC 16P .0104 TESTIMONIALS AND ENDORSEMENTS

Advertisements for dental services shall not:

(1) Include false or misleading testimonials and endorsements; or

(2) Reveal a patient's identity or personally identifiable facts, data or other information obtained in a professional capacity without first obtaining the patient's consent.

History Note: Authority G.S. 90‑41(a)(16),(17),(18); 90‑48;

Eff. March 1, 1985;

Amended Eff. May 1, 1989; October 1, 1986;

Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. January 9, 2018.

21 ncac 16p .0105 ADVERTISING AS A SPECIALIST

(a) A dentist shall not advertise or otherwise hold himself or herself out to the public as a specialist, or use any variation of the term, in an area of practice if the communication is false or misleading under Rule .0101 of this Section.

(b) It shall be false or misleading for a dentist to hold himself or herself out to the public as a specialist, or any variation of that term, in a practice area unless the dentist:

(1) has completed a qualifying postdoctoral educational program in that area as set forth in Paragraph (c) of this Rule; or

(2) holds a current certification by a qualifying specialty board or organization as set forth in Paragraph (d) of this Rule.

(c) For purposes of this Rule, a "qualifying postdoctoral educational program" is a postdoctoral advanced dental educational program accredited by an agency recognized by the U.S. Department of Education (U.S. DOE).

(d) In determining whether an organization is a qualifying specialty board or organization, the Board shall consider the following criteria:

(1) whether the organization requires completion of an educational program with didactic, clinical, and experiential requirements appropriate for the specialty or subspecialty field of dentistry in which the dentist seeks certification, and the collective didactic, clinical and experiential requirements are similar in scope and complexity to a qualifying postdoctoral educational program. Programs that require solely experiential training, continuing education classes, on-the-job training, or payment to the specialty board shall not constitute a qualifying specialty board or organization;

(2) whether the organization requires all dentists seeking certification to pass a written or oral examination, or both, that tests the applicant's knowledge and skill in the specialty or subspecialty area of dentistry and includes a psychometric evaluation for validation;

(3) whether the organization has written rules on maintenance of certification and requires periodic recertification;

(4) whether the organization has written by-laws and a code of ethics to guide the practice of its members;

(5) whether the organization has staff to respond to consumer and regulatory inquiries; and

(6) whether the organization is recognized by another entity whose primary purpose is to evaluate and assess dental specialty boards and organizations.

(e) A dentist qualifying under Paragraph (d) of this Rule and advertising or otherwise holding himself or herself out to the public as a specialist, or any variation of that term, shall disclose in the advertisement or communication the specialty board by which the dentist was certified and provide information about the certification criteria or where the certification criteria may be located.

(f) A dentist shall maintain documentation of either completion of a qualifying postdoctoral educational program or of his or her current specialty certification and provide the documentation to the Board upon request. Dentists shall maintain documentation demonstrating that the certifying board qualifies under the criteria in Subparagraphs (d)(1) through (6) of this Rule and provide the documentation to the Board upon request.

(g) Nothing in this Section shall be construed to prohibit a dentist who does not qualify to hold himself or herself out to the public as a specialist under Paragraph (b) of this Rule from restricting his or her practice to one or more specific areas of dentistry or from advertising the availability of his or her services, provided that such advertisements do not include the term "specialist," or any variation of that term, and must state that the services advertised are to be provided by a general dentist.

History Note: Authority G.S. 90-41(a)(16),(17),(18); 90-48;

Eff. March 1, 1985;

Amended Eff. April 1, 2003; May 1, 1989;

Readopted Eff. February 1, 2019.

SUBCHAPTER 16Q - GENERAL ANESTHESIA AND SEDATION

SECTION .0100 – GENERAL

21 NCAC 16Q .0101 GENERAL ANESTHESIA AND SEDATION DEFINITIONS

For the purpose of these Rules relative to the administration of minimal conscious sedation, moderate conscious sedation, moderate pediatric conscious sedation, or general anesthesia by or under the direction of a dentist, the following definitions shall apply:

(1) "Analgesia" – the diminution or elimination of pain.

(2) "Anti-anxiety sedative" – a sedative agent administered in a dosage intended to reduce anxiety without diminishing consciousness or protective reflexes.

(3) "Anxiolysis" – pharmacological reduction of anxiety through the administration of a single dose of a minor psychosedative, possibly in combination with nitrous oxide, to children or adults prior to commencement of treatment on the day of the appointment that allows for uninterrupted interactive ability in an awake patient with no compromise in the ability to maintain a patent airway independently and continuously. Nitrous oxide may be administered in addition to the minor psychosedative without constituting multiple dosing for purpose of these Rules.

(4) "ACLS" – Advanced Cardiac Life Support.

(5) "Administer" – to direct, manage, supervise, control, and have charge of all aspects of selection, dosage, timing, and method of delivery to the patient of any pharmacologic agent intended to reduce anxiety or depress consciousness.

(6) "ASA" – American Society of Anesthesiologists.

(7) "Auxiliaries" – non-dentist staff members involved in general anesthesia or sedation procedures.

(8) "BLS" – Basic Life Support.

(9) "Behavior control" – the use of pharmacological techniques to control behavior to a level that dental treatment may be performed without injury to the patient or dentist.

(10) "Behavioral management" – the use of pharmacological or psychological techniques, singly or in combination, to modify behavior to a level that dental treatment may be performed without injury to the patient or dentist.

(11) "Competent" – displaying special skill or knowledge derived from training and experience.

(12) "Conscious sedation" - an induced state of a depressed level of consciousness that retains the patient's ability to maintain an airway without assistance and respond to physical stimulation and verbal commands, and that is produced by pharmacologic or non-pharmacologic agents, or a combination thereof. All dentists who perform conscious sedation shall have an unexpired sedation permit from the Dental Board.

(13) "CRNA" – Certified Registered Nurse Anesthetist.

(14) "Deep sedation" – an induced state of a depressed level of consciousness accompanied by partial loss of protective reflexes, including the ability to maintain an airway without assistance or respond to verbal command, produced by pharmacological agents. All dentists who perform deep sedation shall have an unexpired general anesthesia permit from the Dental Board.

(15) "Deliver" – to assist a permitted dentist in administering sedation or anesthesia drugs by providing the drugs to the patient pursuant to a direct order from the dentist and while under the dentist's direct supervision.

(16) "Direct supervision" – the dentist responsible for the sedation or anesthesia procedure shall be immediately available and shall be aware of the patient's physical status and well being at all times.

(17) "Emergencies manual" – a written manual that documents:

(a) the location of all emergency equipment and medications in each facility;

(b) each staff member's role during medical emergencies; and

(c) the appropriate treatment for laryngospasm, bronchospasm, emesis and aspiration, respiratory depression and arrest, angina pectoris, myocardial infarction, hypertension, hypotension, allergic reactions, convulsions, syncope, bradycardia, hypoglycemia, cardiac arrest, and airway obstruction.

(18) "Enteral" - the administration of pharmacological agents orally, intranasally, sublingually, or rectally.

(19) "ET CO2" —end tidal carbon dioxide.

(20) "Facility" – the location where a permit holder practices dentistry and provides anesthesia or sedation services.

(21) "Facility inspection" – an on-site inspection to determine if a facility where the applicant proposes to provide anesthesia or sedation is supplied, equipped, staffed, and maintained in a condition to support provision of anesthesia or sedation services in compliance with the Dental Practice Act set forth in Article 2 of G.S. 90 and the Board's rules of this Chapter.

(22) "General anesthesia" - the intended controlled state of a depressed level of consciousness that is produced by pharmacologic agents and accompanied by a partial or complete loss of protective reflexes, including the ability to maintain an airway and respond to physical stimulation and verbal commands. All dentists who perform general anesthesia shall have an unexpired general anesthesia permit from the Dental Board.

(23) "Good standing" – a licensee whose license is not suspended or revoked and who is not subject to a current disciplinary order imposing probationary terms.

(24) "Immediately available" – on-site in the facility and available for use without delay.

(25) "Itinerant general anesthesia provider"- a permittee who has complied with Rule .0206 of this Subchapter and who administers general anesthesia at another practitioner's facility.

(26) "Local anesthesia" – the elimination of sensations, including pain, in one part of the body by the regional application or injection of a drug.

(27) "Minimal conscious sedation" – conscious sedation characterized by a minimally depressed level of consciousness, in which the patient retains the ability to independently and continuously maintain an airway and respond normally to tactile stimulation and verbal command, provided to patients 13 years or older, by oral or rectal routes of administration of a single pharmacological agent, in one or more doses, not to exceed the manufacturer's maximum recommended dose, at the time of treatment, possibly in combination with nitrous oxide. Minimal conscious sedation may be provided for behavioral management.

(28) "Minor psychosedative/Minor tranquilizer" – pharmacological agents that allow for uninterrupted interactive ability in a patient with no compromise in the ability to maintain a patent airway continuously and without assistance and carry a margin of safety wide enough to render unintended loss of consciousness unlikely.

(29) "Moderate conscious sedation" – conscious sedation characterized by a drug induced depression of consciousness, during which patients respond to verbal commands, either alone or accompanied by light tactile stimulation, provided to patients 13 years of age or older, by oral, nasal, rectal, or parenteral routes of administration of single or multiple pharmacological agents, in single or multiple doses, within a 24 hour period, including the time of treatment, possibly in combination with nitrous oxide. Moderate conscious sedation may be provided for behavior control by licensed dentists who comply with the terms of Rule .0301 of this Subchapter. A moderate conscious sedation provider shall not use the following:

(a) drugs designed by the manufacturer for use in administering general anesthesia or deep sedation; or

(b) drugs contraindicated for use in moderate conscious sedation.

(30) "Moderate pediatric conscious sedation" - conscious sedation characterized by a drug induced depression of consciousness, during which patients respond to verbal commands, either alone or accompanied by light tactile stimulation, provided to patients up to 18 years of age, or special needs patients, by oral, nasal, rectal, or parenteral routes of administration of single or multiple pharmacological agents, in single or multiple doses, within a 24 hour period, including the time of treatment, possibly in combination with nitrous oxide. Moderate pediatric conscious sedation may be provided for behavior control by licensed dentists who comply with the terms of Rule .0404 of this Subchapter. A moderate pediatric conscious sedation permit holder shall not use the following:

(a) drugs designed by the manufacturer for use in administering general anesthesia or deep sedation; or

(b) drugs contraindicated for use in moderate pediatric conscious sedation.

(31) "Parenteral" - the administration of pharmacological agents intravenously, intraosseously, intramuscularly, subcutaneously, submucosally, intranasally, or transdermally.

(32) "PALS" – Pediatric Advanced Life Support.

(33) "Protective reflexes" – includes the ability to swallow and cough.

(34) "RN" – Registered Nurse licensed by the North Carolina Board of Nursing.

(35) "Sedation Procedure" – process begins when any pharmacological agent is first administered to a patient to induce general anesthesia or sedation and continues until the dentist permit holder determines that the patient has met the recovery and discharge criteria set forth in the applicable rules in this Subchapter.

(36) "Special needs patients" – patients with diminished mental and or physical capacity who are unable to cooperate to receive ambulatory dental care without sedation or anesthesia.

(37) "Supplemental dosing" – the oral administration of a pharmacological agent that results in an enhanced level of conscious sedation when added to the primary sedative agent administered for the purpose of oral moderate conscious sedation, and when added to the primary agent, does not exceed the maximum safe dose of either agent, separately or synergistically.

(38) "Vested adult" – a responsible adult who is the legal parent or guardian, or designee of a legal parent or guardian, entrusted with the care of a patient following the administration of general anesthesia or conscious sedation.

History Note: Authority G.S. 90-30.1; 90-48;

Eff. February 1, 1990;

Temporary Amendment Eff. December 11, 2002;

Amended Eff. June 1, 2017; July 3, 2008; August 1, 2004;

Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. January 9, 2018.

21 NCAC 16Q .0102 APPLICATION FOR GENERAL ANESTHESIA OR SEDATION PERMIT, PERMIT RENEWAL, AND PERMIT REINSTATEMENT

(a) An applicant for a general anesthesia or sedation permit shall be licensed and in good standing with the Board.

(b) All permit applications shall be made on the forms furnished by the Board at www.ncdentalboard.org and shall include:

(1) the full name;

(2) the mailing address;

(3) the North Carolina dental license number;

(4) a telephone number; and

(5) an email address.

(c) In addition to the information in Paragraph (b) of this Rule, all applications for a general anesthesia, moderate conscious sedation, moderate pediatric conscious sedation, or minimal conscious sedation permit shall include:

(1) the addresses of all dental offices where the applicant intends to use general anesthesia or sedation;

(2) dental education, including dental school name, dates attended, degree received, and any other dental post-graduate education or specialty degrees received;

(3) a resume or curriculum vitae;

(4) the names of and copies of unexpired BLS certifications for any auxiliaries that will assist the applicant with general anesthesia or sedation;

(5) a statement disclosing and explaining any instances of patient mortality or morbidity in connection with applicant's prior use of general anesthesia or sedation; and

(6) documentation of the required qualifications for the permit for which the applicant is applying, as set out in Rule .0201, .0301, .0404, or .0504 of this Subchapter.

(d) In addition to the information in Paragraph (b) of this Rule, all applications for an itinerant permit shall include:

(1) North Carolina general anesthesia or sedation permit number; and

(2) a statement of compliance with the requirements for the itinerant permit for which the applicant is applying, as set out in Rule .0206, .0304, or .0406 of this Subchapter.

(e) All applications for renewal of a general anesthesia or sedation permit shall be submitted electronically through the Board's website, www.ncdentalboard.org, and shall include:

(1) the full name;

(2) the permit number and expiration date;

(3) the addresses of all dental offices where the permit holder uses general anesthesia or sedation; and

(4) a statement disclosing and explaining any instances of patient mortality or morbidity in connection with use of general anesthesia or sedation that occurred during the calendar year preceding the application and that were not previously disclosed to the Board.

(f) All applications for reinstatement of a general anesthesia or sedation permit shall be made on forms furnished by the Board at www.ncdentalboard.org and shall include:

(1) the full name;

(2) the permit number and date of issuance;

(3) the mailing address;

(4) the North Carolina dental license number;

(5) the addresses of all dental offices where the applicant intends to use general anesthesia or sedation; and

(6) a statement disclosing and explaining any instances of patient mortality or morbidity in connection with use of general anesthesia or sedation that occurred during the calendar year preceding the application.

(g) Any permit obtained through fraud or by any false representation shall be revoked.

History Note: Authority G.S. 90-28; 90-30.1;

Eff. August 1, 2021.

SECTION .0200 - GENERAL ANESTHESIA

21 NCAC 16Q .0201 GENERAL ANESTHESIA CREDENTIALS AND PERMIT

(a) Before a dentist licensed to practice in North Carolina may administer or supervise a CRNA to administer general anesthesia or perform deep sedation, the dentist shall obtain a general anesthesia permit from the Board by completing the application requirements of this Rule and paying a four hundred seventy-five dollar ($475.00) fee that includes the one-hundred dollar ($100.00) application fee and the three-hundred seventy-five dollar ($375.00) inspection fee. The permit shall be renewed annually and shall be displayed with the current renewal at all times in the permit holder's facility where it is visible to patients receiving treatment.

(b) A dentist applying for a general anesthesia permit shall be in good standing with the Board, has an unexpired ACLS certification, and demonstrates that he or she has one of the following qualifications:

(1) has completed a minimum of two years of advanced training in anesthesiology and related academic subjects beyond the undergraduate dental school level;

(2) has graduated from a program certified by the American Dental Association in Oral and Maxillofacial Surgery;

(3) is a Diplomate of or eligible for examination by the American Board of Oral and Maxillofacial Surgery; or

(4) is a Fellow of the American Dental Society of Anesthesiology.

(c) Before receiving a general anesthesia permit, all applicants shall pass an evaluation and inspection as set out in Rule .0202 of this Section. Every location other than a hospital or credentialed surgery center where a general anesthesia permit holder administers general anesthesia shall pass an inspection as set out in Rule .0204 of this Section.

(d) A dentist who holds a general anesthesia permit may administer any level of sedation without obtaining a separate sedation permit.

(e) A dentist who does not hold a general anesthesia permit may not employ a CRNA to administer general anesthesia services. A dentist who holds a general anesthesia permit may employ a CRNA to administer general anesthesia services under supervision of the dentist.

(f) A general anesthesia permit holder may provide general anesthesia at the office of another licensed dentist, regardless of the permit, if any held, by the hosting dentist. The permit holder shall ensure that the facility where the general anesthesia is administered has been inspected and complies with the requirements set out in Rule .0202 of this Section and shall obtain an itinerant general anesthesia permit and comply with the requirements of Rule .0206 of this Section.

History Note: Authority G.S. 90-28; 90-30.1; 90-39;

Eff. February 1, 1990;

Amended Eff. April 1, 2001; August 1, 2000;

Temporary Amendment Eff. December 11, 2002;

Amended Eff. June 1, 2017; February 5, 2008;

Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. January 9, 2018.

21 NCAC 16Q .0202 GENERAL ANESTHESIA EQUIPMENT AND CLINICAL REQUIREMENTS

(a) A dentist administering general anesthesia shall ensure that the facility where the general anesthesia is administered meets the following requirements:

(1) The facility shall be equipped with the following:

(A) an operatory of size and design to permit access of emergency equipment and personnel and to permit emergency management;

(B) a CPR board or dental chair without enhancements, suitable for providing emergency treatment;

(D) suction equipment as necessary for specific procedures, including non-electrical back-up suction;

(E) positive pressure oxygen delivery system, including full face masks for small, medium, and large patients, and back-up E-cylinder portable oxygen tank apart from the central system;

(F) small, medium, and large oral and nasal airways;

(G) blood pressure monitoring device;

(H) EKG monitor;

(I) pulse oximeter;

(J) automatic external defibrillator (AED);

(K) precordial stethoscope or capnograph;

(L) thermometer;

(M) vascular access set-up as necessary for specific procedures, including hardware and fluids;

(N) laryngoscope with working batteries;

(O) intubation forceps and advanced airway devices;

(P) tonsillar suction with back‑up suction;

(Q) syringes as necessary for specific procedures; and

(R) tourniquet and tape.

(2) The following unexpired drugs shall be maintained in the facility and with access from the operatory and recovery rooms:

(A) Epinephrine;

(B) Atropine;

(D) antihistamine;

(E) antihypertensive;

(F) bronchodilator;

(G) antihypoglycemic agent;

(H) vasopressor;

(I) corticosteroid;

(J) anticonvulsant;

(K) muscle relaxant;

(L) appropriate reversal agents;

(M) nitroglycerine;

(N) antiemetic; and

(O) Dextrose.

(3) The permit holder shall maintain written emergency and patient discharge protocols. The permit holder shall also provide training to familiarize auxiliaries in the treatment of clinical emergencies.

(4) The permit holder shall maintain the following records for 10 years:

(A) Patient's current written medical history, including a record of known allergies and previous surgeries;

(B) Consent to general anesthesia, signed by the patient or guardian, identifying the risks and benefits, level of anesthesia, and date signed;

(D) Patient base line vital signs, including temperature, SPO2, blood pressure, and pulse.

(5) The anesthesia record shall include:

(A) base line vital signs, blood pressure (unless patient behavior prevents recording), oxygen saturation, ET CO2 if capnography is utilized, pulse and respiration rates of the patient recorded in real time at 15 minute intervals;

(B) procedure start and end times;

(D) status of patient upon discharge; and

(E) documentation of complications or morbidity.

(6) The facility shall be staffed with at least two BLS certified auxiliaries, one of whom shall be dedicated to patient monitoring and recording general anesthesia or sedation data throughout the sedation procedure. This Subparagraph shall not apply if the dentist permit holder is dedicated to patient care and monitoring regarding general anesthesia or sedation throughout the sedation procedure and is not performing the surgery or other dental procedure.

(b) During an inspection or evaluation, the applicant or permit holder shall demonstrate the administration of anesthesia while the evaluator observes, and shall demonstrate competency in the following areas:

(1) monitoring of blood pressure, pulse, ET CO2 if capnography is utilized, and respiration;

(2) drug dosage and administration;

(3) treatment of untoward reactions including respiratory or cardiac depression;

(4) sterile technique;

(5) use of BLS certified auxiliaries;

(6) monitoring of patient during recovery; and

(7) sufficiency of patient recovery time.

(c) During an inspection or evaluation, the applicant or permit holder shall demonstrate competency in the treatment of the following clinical emergencies:

(1) laryngospasm;

(2) bronchospasm;

(3) emesis and aspiration;

(4) respiratory depression and arrest;

(5) angina pectoris;

(6) myocardial infarction;

(7) hypertension and hypotension;

(8) syncope;

(9) allergic reactions;

(10) convulsions;

(11) bradycardia;

(12) hypoglycemia;

(13) cardiac arrest; and

(14) airway obstruction.

(d) During the evaluation, the permit applicant shall take a written examination on the topics set forth in Paragraphs (b) and (c) of this Rule. The permit applicant must obtain a passing score on the written examination by answering 80 percent of the examination questions correctly. If the permit applicant fails to obtain a passing score on the written examination that is administered during the evaluation, he or she may be re-examined in accordance with Rule .0204(h) of this Section.

(e) A general anesthesia permit holder shall evaluate a patient for health risks before starting any anesthesia procedure.

(f) Post-operative monitoring and discharge shall include the following:

(1) the permit holder or a BLS certified auxiliary under his or her direct supervision shall monitor the patient's vital signs throughout the sedation procedure until the patient is recovered as defined by Subparagraph (f)(2) of this Rule and is ready for discharge from the office; and

(2) recovery from general anesthesia shall include documentation of the following:

(A) cardiovascular function stable;

(B) airway patency uncompromised;

(D) state of hydration within normal limits;

(E) patient can talk, if applicable;

(F) patient can sit unaided, if applicable;

(G) patient can ambulate, if applicable, with minimal assistance; and

(H) for the special needs patient or a patient incapable of the usually expected responses, the pre-sedation level of responsiveness or the level as close as possible for that patient shall be achieved; and

(3) before allowing the patient to leave the office, the dentist shall determine that the patient has met the recovery criteria set out in Subparagraph (f)(2) of this Rule and the following discharge criteria:

(A) oxygenation, circulation, activity, skin color, and level of consciousness are stable and have been documented;

(B) explanation and documentation of written postoperative instructions have been provided to the patient or a person responsible for the patient at time of discharge; and

History Note: Authority G.S. 90-28; 90-30.1; 90-48;

Eff. February 1, 1990;

Amended Eff. June 1, 2017; November 1, 2013; August 1, 2002; August 1, 2000;

Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. January 9, 2018;

Amended Eff. February 1, 2019; August 1, 2018.

21 ncac 16q .0203 TEMPORARY APPROVAL PRIOR TO SITE EVALUATION

History Note: Authority G.S. 90-28; 90-30.1;

Eff. February 1, 1990;

Amended Eff. August 1, 2002;

Repealed Eff. April 1, 2016.

21 ncac 16q .0204 PROCEDURE FOR GENERAL ANESTHESIA EVALUATION OR INSPECTION and RE-inspection

(a) When both an evaluation and on-site inspection is required, the Board shall designate two or more qualified persons to serve as evaluators, each of whom has administered general anesthesia for at least three years preceding the inspection. Training in general anesthesia shall not be counted in the three years. The fee for an evaluation and on-site inspection shall be three-hundred seventy-five dollars ($375.00). When an on-site inspection involves only a facility and equipment check and not an evaluation of the dentist, the inspection may be accomplished by one evaluator, and the fee for the on-site inspection shall be two-hundred seventy-five dollars ($275.00).

(b) An inspection fee of two-hundred seventy-five dollars ($275.00) shall be due 10 days after the dentist receives notice of the inspection of each additional location at which the dentist administers general anesthesia.

(d) The inspection team shall determine compliance with the requirements of the rules in this Subchapter, as applicable, by assigning a grade of "pass" or "fail."

(e) Each evaluator shall report his or her recommendation to the Board's Anesthesia and Sedation Committee, setting forth the details supporting his or her conclusion. The Committee shall not be bound by these recommendations. The Committee shall determine whether the applicant has passed the evaluation and inspection and shall notify the applicant in writing of its decision.

(f) An applicant who fails an inspection or evaluation shall not receive a permit to administer general anesthesia. If a permit holder's facility fails an inspection, no further general anesthesia procedures shall be performed at the facility until it passes a re-inspection by the Board.

(g) An applicant who fails an inspection or evaluation may request a re-evaluation or re-inspection within 15 days of receiving the notice of failure. The request shall be directed to the Board in writing and shall include a statement of the grounds supporting the re-evaluation or re-inspection. Except as set forth in Paragraph (h) of this Rule, the Board shall require the applicant to receive additional training prior to the re-evaluation to address the areas of deficiency determined by the evaluation. The Board shall notify the applicant in writing of the need for additional training.

(h) A permit applicant who has failed the written examination portion of the evaluation but passed all other aspects of the evaluation and inspection may retake the written examination two additional times at the Board office. The applicant must wait a minimum of 72 hours before attempting to retake a written examination. Any applicant who has failed the written portion of the examination three times shall complete an additional Board approved course of study in the area(s) of deficiency and provide the Board evidence of the additional study before written reexamination.

(i) Re-evaluations and re-inspections shall be conducted by Board-appointed evaluators not involved in the failed evaluation or inspection.

(j) An applicant must complete all the requirements of Rule .0202, including passing the written examination, evaluation and inspection, within 12 months of submitting the application to the Board.

History Note: Authority G.S. 90‑28; 90‑30.1; 90-39;

Eff. February 1, 1990;

Amended April 1, 2016; February 1, 2009; December 4, 2002; January 1, 1994;

Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. January 9, 2018;

Amended Eff. February 1, 2019; August 1, 2018.

21 NCAC 16Q .0205 RESULTS OF SITE EVALUATION AND REEVALUATION

History Note: Authority G.S. 90-28; 90-30.1;

Eff. February 1, 1990;

Amended Eff. August 1, 2002;

Repealed Eff. April 1, 2016.

21 NCAC 16Q .0206 ITINERANT (Mobile) GENERAL ANESTHESIA PERMIT, EQUIPMENT AND EVALUATION

(a) A dentist who holds a general anesthesia permit from the Board and who wishes to provide general anesthesia or other sedation services in the office of another practitioner shall obtain a mobile general anesthesia permit from the Board by completing the application requirements of this Rule and paying a one hundred dollar ($100.00) application fee and a two-hundred seventy-five dollar ($275.00) inspection fee. No mobile permit shall be required to administer general anesthesia in a hospital or credentialed surgery center.

(b) Before a mobile general anesthesia permit may be issued, a general anesthesia permit holder appointed by the Board shall inspect the applicant's equipment and medications to ensure that they comply with Paragraphs (c) and (d) of this Rule.

(1) small, medium, and large supraglottic airways devices;

(2) small, medium, and large anesthesia circuits;

(3) rebreathing device;

(4) scavenging system;

(5) intermittent compression devices;

(6) gastric suction device;

(7) endotracheal tube and pulmonary suction device;

(8) equipment for performing emergency cricothyrotomies and delivering positive pressure ventilation; and

(9) the equipment required by Rule .0202(a)(1) of this Section.

(d) A neuromuscular blocking agent, an anti-malignant hyperthermia agent, and the medications required by Rule .0202(a)(2) of this Section shall be on site, unexpired, and available to the permit holder.

(e) The evaluation and on-site inspection shall be conducted as set out in Rule .0204 of this Section.

(f) Prior to administering general anesthesia or sedation at another provider's office, the mobile permit holder shall inspect the host facility within 24 business hours before each procedure and shall ensure that:

(1) the operatory's size and design permit emergency management and access of emergency equipment and personnel;

(2) there is a CPR board or dental chair without enhancements suitable for providing emergency treatment;

(3) there is lighting to permit performance of all procedures planned for the facility;

(4) there is suction equipment, including non-electrical back-up suction; and

(5) the facility shall be staffed with at least two BLS certified auxiliaries, one of whom shall be dedicated to patient monitoring and recording general anesthesia or sedation data throughout the sedation procedure. This Subparagraph shall not apply if the dentist permit holder is dedicated to patient care and monitoring regarding general anesthesia or sedation throughout the sedation procedure and is not performing the surgery or other dental procedure.

(g) Upon inspection, the permit holder shall document that the facility where the general anesthesia or sedation procedure will be performed was inspected and that it met the requirements of Paragraph (f) of this Rule. The permit holder shall retain the inspection and compliance record required by this Paragraph for 10 years following the procedure and provide these records to the Board upon request.

(h) The mobile general anesthesia permit shall be displayed in the host facility where it is visible to patients receiving treatment.

(i) All applicants for mobile general anesthesia permit shall be in good standing with the Board.

History Note: Authority G.S. 90-28; 90-30.1; 90-39; 90-48;

Eff. June 1, 2017;

Amended Eff. August 1, 2021; August 1, 2018.

21 NCAC 16Q .0207 ANNUAL RENEWAL OF GENERAL ANESTHESIA AND ITinERANT (Mobile) GENERAL ANESTHESIA PERMIT REQUIRED

(a) General anesthesia permits and itinerant general anesthesia permits shall be renewed by the Board annually at the same time as dental licenses. For each permit to be renewed, the permit holder shall pay a one-hundred dollar ($100.00) fee and complete the renewal application requirements of this Rule. If the completed permit renewal application and renewal fee are not received before midnight on January 31 of each year, a fifty dollar ($50.00) late fee shall be charged. The renewal application shall be submitted electronically through the Board's website, www.ncdentalboard.org, and shall include the information required by Rule .0102(e) of this Subchapter and a report of compliance with the conditions for renewal in Paragraph (d) of this Rule.

(b) Any permit holder who fails to renew a general anesthesia permit or itinerant general anesthesia permit before March 31 of each year shall complete a reinstatement application, pay the renewal fee and late fee set out in Paragraph (a) of this Rule, and comply with all conditions for renewal set out in this Rule. Dentists whose general anesthesia permits or itinerant general anesthesia permits have been lapsed for more than 12 calendar months shall pass an inspection and an evaluation as part of the reinstatement process in accordance with Rules .0202 and .0204 of this Section. All applicants for reinstatement of a permit shall be in good standing. All applications for reinstatement of a permit shall be submitted on forms furnished by the Board at www.ncdentalboard.org and shall include the information required by Rule .0102(f) of this Subchapter and a report of compliance with the conditions for renewal set out in Paragraph (d) of this Rule.

(c) A dentist who administers general anesthesia in violation of this Rule shall be subject to the penalties prescribed by Rule .0701 of this Subchapter.

(d) As a condition for renewal of the general anesthesia permit and itinerant general anesthesia permit, the permit holder shall meet the clinical equipment and requirements set out in Rule .0202 of this Section, the itinerant general anesthesia permit holder shall also meet the clinical equipment and requirements set out in Rule .0206 of this Section, and the permit holder shall document the following:

(1) six hours of continuing education each year in one or more of the following areas, which shall be counted toward fulfillment of the continuing education required each calendar year for license renewal:

(A) sedation;

(B) medical emergencies;

(D) pharmacology of drugs and agents used in general anesthesia and IV sedation;

(E) physical evaluation, risk assessment, or behavioral management; or

(F) airway management;

(2) unexpired ACLS certification, which shall not count towards the six hours of continuing education required in Subparagraph (d)(1) of this Rule;

(3) that the permit holder and all auxiliaries involved in anesthesia or sedation procedures have practiced responding to dental emergencies as a team at least once every six months in the preceding year;

(4) that the permit holder and all auxiliaries involved in anesthesia or sedation procedures have read the practice's emergency manual in the preceding year; and

(5) that all auxiliaries involved in sedation procedures have completed BLS certification and three hours of continuing education annually in any of the areas set forth in Subparagraph (d)(1) of this Rule.

(e) Absent a Board order stating otherwise, all permit holders applying for renewal of a general anesthesia permit or itinerant general anesthesia permit shall be in good standing and their office shall be subject to inspection by the Board.

History Note: Authority G.S. 90-28; 90-30.1; 90-31; 90-39; 90-48;

Eff. June 1, 2017;

Amended Eff. August 1, 2021; August 1, 2018.

SECTION .0300 - MODERATE CONSCIOUS SEDATION

21 NCAC 16Q .0301 CREDENTIALS AND PERMITS FOR MODERATE PARENTERAL AND ENTERAL CONSCIOUS SEDATION

(a) Before a dentist licensed to practice in North Carolina may administer or supervise a CRNA employed to administer or RN employed to deliver moderate conscious sedation, the dentist shall obtain a permit from the Board by completing the application requirements in this Rule and paying a fee of three hundred seventy-five dollar ($375.00) that includes the one-hundred dollar ($100.00) application fee and the two-hundred seventy-five dollar ($275.00) inspection fee. The permit shall be renewed annually and shall be displayed with the current renewal at all times in the facility of the permit holder where it is visible to patients receiving treatment.

(b) The permit holder shall provide supervision to any CRNA employed to administer or RN employed to deliver sedation, and shall ensure that the level of the sedation does not exceed the level of the sedation allowed by the permit holder's permit.

(1) Training that may consist of either:

(A) Completion of 60 hours of Board approved didactic training in intravenous conscious sedation, and 30 hours of clinical training that shall include successful management of a minimum of 20 live patients, under supervision of the course instructor, using intravenous sedation. Training shall be provided by one or more individuals who meet the American Dental Association Guidelines for Teaching Pain Control and Sedation to Dentists that is hereby incorporated by reference, including subsequent amendments and editions. The guidelines may be found at www.ada.org/coda; or

(B) Completion of a pre-doctoral dental or postgraduate program that included intravenous conscious sedation training equivalent to that defined in Part (c)(1)(A) of this Rule;

(2) Unexpired ACLS certification; and

(3) That all auxiliaries involved in sedation procedures have unexpired BLS certification.

(d) All applicants for a moderate conscious sedation permit shall be in good standing with the Board.

(e) Prior to issuance of a moderate conscious sedation permit, the applicant shall pass an evaluation and a facility inspection. The applicant shall be responsible for passing the evaluation and inspection of his or her facility.

(f) A dentist who holds a moderate conscious sedation permit shall not intentionally administer deep sedation.

(g) A moderate conscious sedation permit holder may provide moderate conscious sedation at the office of another licensed dentist, regardless of the permit, if any held, by the hosting dentist. The permit holder shall ensure that the facility where the moderate conscious sedation is administered has been inspected and complies with the requirements set out in Rule .0302 of this Section. The permit holder shall also obtain an itinerant moderate conscious sedation permit and comply with the requirements of Rule .0304 of this Section.

History Note: Authority G.S. 90-30.1; 90-39; 90-48;

Eff. February 1, 1990;

Amended Eff. April 1, 2001; August 1, 2000; January 1, 1994;

Temporary Amendment Eff. December 11, 2002;

Amended Eff. June 1, 2017; July 1, 2010, July 3, 2008; August 1, 2004;

Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. January 9, 2018;

Amended Eff. February 1, 2019; August 1, 2018.

21 NCAC 16Q .0302 MODERATE PARENTERAL AND ENTERAL CONSCIOUS SEDATION CLINICAL REQUIREMENTS AND EQUIPMENT

(a) A dentist administering moderate conscious sedation or supervising any CRNA employed to administer or RN employed to deliver moderate conscious sedation shall ensure that the facility where the sedation is administered meets the following requirements:

(1) The facility shall be equipped with the following:

(A) an operatory of size and design to permit access of emergency equipment and personnel and to permit emergency management;

(B) a CPR board or a dental chair without enhancements, suitable for providing emergency treatment;

(D) suction equipment as necessary for specific procedures, including non-electrical back-up suction;

(E) positive pressure oxygen delivery system, including full face masks for small, medium, and large patients and back-up E-cylinder portable oxygen tank apart from the central system;

(F) small, medium, and large oral and nasal airways;

(G) blood pressure monitoring device;

(H) EKG monitor;

(I) pulse oximeter;

(J) automatic external defibrillator (AED);

(K) precordial stethoscope or capnograph;

(L) thermometer;

(M) vascular access set-up as necessary for specific procedures, including hardware and fluids;

(N) laryngoscope with working batteries;

(O) intubation forceps and advanced airway devices;

(P) tonsillar suction with back-up suction;

(Q) syringes as necessary for specific procedures; and

(R) tourniquet and tape.

(2) The following unexpired drugs shall be maintained in the facility and with access from the operatory and recovery rooms:

(A) Epinephrine;

(B) Atropine;

(D) antihistamine;

(E) antihypertensive;

(F) bronchodilator;

(G) antihypoglycemic agent;

(H) vasopressor;

(I) corticosteroid;

(J) anticonvulsant;

(K) muscle relaxant;

(L) appropriate reversal agents;

(M) nitroglycerine;

(N) antiemetic; and

(O) Dextrose.

(4) The dentist shall maintain the following records for at least 10 years:

(A) patient's current written medical history and pre-operative assessment;

(B) drugs administered during the procedure, including route of administration, dosage, strength, time, and sequence of administration; and

(5) The sedation record shall include:

(B) procedure start and end times;

(D) status of patient upon discharge;

(E) documentation of complications or morbidity; and

(F) consent form, signed by the patient or guardian, identifying the procedure, risks and benefits, level of sedation, and date signed; and

(6) The following conditions shall be satisfied during a sedation procedure:

(A) The facility shall be staffed with at least two BLS certified auxiliaries, one of whom shall be dedicated to patient monitoring and recording sedation data throughout the sedation procedure. This Subparagraph shall not apply if the dentist permit holder is dedicated to patient care and monitoring regarding sedation throughout the sedation procedure and is not performing the surgery or other dental procedure; and

(B) If IV sedation is used, IV infusion shall be administered before the start of the procedure and maintained until the patient is ready for discharge.

(b) During an inspection or evaluation, the applicant or permit holder shall demonstrate the administration of moderate conscious sedation on a patient, including the deployment of an intravenous delivery system, while the evaluator observes. During the demonstration, the applicant or permit holder shall demonstrate competency in the following areas:

(1) monitoring blood pressure, pulse, ET CO2 if capnography is utilized, and respiration;

(2) drug dosage and administration;

(3) treatment of untoward reactions including respiratory or cardiac depression if applicable;

(4) sterile technique;

(5) use of BLS certified auxiliaries;

(6) monitoring of patient during recovery; and

(7) sufficiency of patient recovery time.

(c) During an inspection or evaluation, the applicant or permit holder shall demonstrate competency to the evaluator in the treatment of the following clinical emergencies:

(1) laryngospasm;

(2) bronchospasm;

(3) emesis and aspiration;

(4) respiratory depression and arrest;

(5) angina pectoris;

(6) myocardial infarction;

(7) hypertension and hypotension;

(8) allergic reactions;

(9) convulsions;

(10) syncope;

(11) bradycardia;

(12) hypoglycemia;

(13) cardiac arrest; and

(14) airway obstruction.

(e) A moderate conscious sedation permit holder shall evaluate a patient for health risks before starting any sedation procedure as follows:

(1) a patient who is medically stable and who is ASA I or II shall be evaluated by reviewing the patient's current medical history and medication use or;

(2) a patient who is not medically stable or who is ASA III or higher shall be evaluated by a consultation with the patient's primary care physician or consulting medical specialist regarding the potential risks posed by the procedure.

(f) Post-operative monitoring and discharge:

(1) the permit holder or a BLS certified auxiliary under his or her direct supervision shall monitor the patient's vital signs throughout the sedation procedure until the patient is recovered as defined in Subparagraph (f)(2) of this Rule and is ready for discharge from the office.

(2) recovery from moderate conscious sedation shall include documentation of the following:

(A) cardiovascular function stable;

(B) airway patency uncompromised;

(D) state of hydration within normal limits;

(E) patient can talk, if applicable;

(F) patient can sit unaided, if applicable;

(G) patient can ambulate, if applicable, with minimal assistance; and

(H) for the special needs patient or patient incapable of the usually expected responses, the pre-sedation level of responsiveness or the level as close as possible for that patient shall be achieved.

(A) oxygenation, circulation, activity, skin color, and level of consciousness are stable, and have been documented;

(B) explanation and documentation of written postoperative instructions have been provided to the patient or a person responsible for the patient at the time of discharge; and

History Note: Authority G.S. 90-28; 90-30.1; 90-48;

Eff. February 1, 1990;

Amended Eff. August 1, 2002; August 1, 2000;

Temporary Amendment Eff. December 11, 2002;

Amended Eff. June 1, 2017; November 1, 2013; July 1, 2010; July 3, 2008; August 1, 2004;

Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. January 9, 2018;

Amended Eff. February 1, 2019; August 1, 2018.

21 NCAC 16Q .0303 TEMPORARY APPROVAL PRIOR TO SITE INSPECTION

History Note: Authority G.S. 90-28; 90-30.1;

Eff. February 1, 1990;

Amended Eff. August 1, 2002; January 1, 1994;

Temporary Amendment Eff. December 11, 2002;

Amended Eff. September 1, 2014; February 1, 2009; July 3, 2008; August 1, 2004;

Repealed Eff. April 1, 2016.

21 NCAC 16Q .0304 ITINERANT (Mobile) Moderate PERMIT, EQUIPMENT AND EVALUATION

(a) A dentist who holds a moderate conscious sedation permit from the Board and who wishes to provide moderate conscious sedation or other sedation services in the office of another practitioner shall obtain a mobile moderate conscious sedation permit from the Board by completing the application requirements of this Rule and paying a one-hundred dollar ($100.00) application fee and a two-hundred seventy-five dollar ($275.00) inspection fee. No mobile permit shall be required to administer moderate conscious sedation in a hospital or credentialed surgery center.

(b) The permit holder shall maintain in good working order the equipment required by Rule .0302(a)(1) of this Section.

(c) The unexpired medications required by Rule .0302(a)(2) of this Section shall be on site and available to the permit holder.

(d) Before a mobile moderate sedation permit may be issued, a permit holder appointed by the Board shall inspect the applicant's equipment and medications to ensure that they comply with Paragraphs (b) and (c) of this Rule. The evaluation and inspection shall be conducted as set out in Rule .0306 of this Section.

(e) Prior to administering moderate conscious sedation or other sedation services at another provider's office, the mobile permit holder shall inspect the host facility within 24 business hours before each procedure and shall ensure that:

(1) the operatory's size and design permit emergency management and access of emergency equipment and personnel;

(2) there is a CPR board or dental chair without enhancements suitable for providing emergency treatment;

(3) there is lighting to permit performance of all procedures planned for the facility;

(4) there is suction equipment, including non-electrical back-up suction; and

(5) the facility shall be staffed with at least two BLS certified auxiliaries, one of whom shall be dedicated to patient monitoring and recording moderate conscious sedation or other sedation services data throughout the sedation procedure. This Subparagraph shall not apply if the dentist permit holder is dedicated to patient care and monitoring regarding sedation throughout the sedation procedure and is not performing the surgery or other dental procedure.

(f) Upon inspection, the permit holder shall document that the facility where the general anesthesia or sedation procedure will be performed was inspected and that it met the requirements of Paragraph (e) of this Rule. The permit holder shall retain the inspection and compliance record required by this Paragraph for 10 years following the procedure and provide these records to the Board upon request.

(g) The mobile moderate conscious sedation permit shall be displayed in the host facility where it is visible to patients receiving treatment.

(i) All applicants for mobile moderate conscious sedation permit shall be in good standing with the Board.

History Note: Authority G.S. 90-28; 90-30; 90-30.1; 90-39; 90-48;

Recodified from 21 NCAC 16Q .0302(e)(f), Eff. November 1, 2013;

Amended Eff. June 1, 2017;

Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. January 9, 2018;

Amended Eff. August 1, 2018.

21 NCAC 16Q .0305 ANNUAL RENEWAL of MODERATE PARENTERAL AND ENTERAL CONSCIOUS SEDATION PERMIT REQUIRED

(a) Moderate conscious sedation permits and itinerant moderate conscious sedation permits shall be renewed by the Board annually at the same time as dental licenses. For each permit to be renewed, the permit holder shall pay a one-hundred dollar ($100.00) fee and complete the renewal application requirements in this Rule. If the completed permit renewal application and renewal fee are not received before midnight on January 31 of each year, a fifty dollar ($50.00) late fee shall be charged. The renewal application shall be submitted electronically through the Board's website, www.ncdentalboard.org, and shall include the information required by Rule .0102(e) of this Subchapter and a report of compliance with the conditions for renewal in Paragraph (d) of this Rule.

(b) Any permit holder who fails to renew a moderate conscious sedation permit or itinerant moderate conscious sedation permit before March 31 of each year shall complete a reinstatement application, pay the renewal fee and late fee set out in Paragraph (a) of this Rule, and comply with all conditions for renewal set out in this Rule. Dentists whose moderate conscious sedation permits or itinerant moderate conscious sedation permits have been lapsed for more than 12 calendar months shall pass an inspection and an evaluation as part of the reinstatement process in accordance with Rules .0302 and .0306 of this Section. All applicants for reinstatement of a permit shall be in good standing. All applications for reinstatement of a permit shall be submitted on forms furnished by the Board at www.ncdentalboard.org and shall include the information required by Rule .0102(f) of this Subchapter and a report of compliance with the conditions for renewal set out in Paragraph (d) of this Rule.

(c) A dentist who administers moderate conscious sedation in violation of this Rule shall be subject to the penalties prescribed by Rule .0701 of this Subchapter.

(d) As a condition for renewal of the moderate conscious sedation permit and itinerant moderate conscious sedation permit, the permit holder shall meet the clinical and equipment requirements set out in Rule .0302 of this Section, the itinerant moderate conscious sedation permit holder shall also meet the clinical and equipment requirements set out in Rule .0304 of this Section, and the permit holder shall document the following:

(A) sedation;

(B) medical emergencies;

(D) pharmacology of drugs and agents used in IV sedation;

(E) physical evaluation, risk assessment, or behavioral management; or

(F) airway management;

(2) unexpired ACLS certification, which shall not count towards the six hours of continuing education required in Subparagraph (d)(1) of this Rule;

(3) that the permit holder and all auxiliaries involved in sedation procedures have practiced responding to dental emergencies as a team at least once every six months in the preceding year;

(4) that the permit holder and all auxiliaries involved in sedation procedures have read the practice's emergency manual in the preceding year; and

(e) Absent a Board order stating otherwise, all permit holders applying for renewal of a moderate conscious sedation permit or itinerant moderate conscious sedation permit shall be in good standing and their office shall be subject to inspection by the Board.

History Note: Authority G.S. 90-28; 90-30.1; 90-31; 90-39; 90-48;

Eff. June 1, 2017;

Amended Eff. August 1, 2021; August 1, 2018.

21 ncac 16q .0306 PROCEDURE FOR MODERATE CONSCIOUS SEDATION EVALUATION OR INSPECTION and Re-INSPECTION

(a) When an evaluation or on-site inspection is required, the Board shall designate one or more qualified persons to serve as evaluators each of whom has administered moderate conscious sedation for at least three years preceding the inspection. Training in moderate conscious sedation shall not be counted in the three years.

(d) The inspection team shall determine compliance with the requirements of the rules in this Subchapter, as applicable, by assigning a grade of "pass" or "fail."

(e) Each evaluator shall report his or her recommendation to the Board's Anesthesia and Sedation Committee, setting forth the details supporting his or her conclusion. The Committee shall not be bound by these recommendations. The Committee shall determine whether the applicant has passed the evaluation or inspection and shall notify the applicant in writing of its decision.

(f) An applicant who fails an inspection or evaluation shall not receive a permit to administer moderate conscious sedation. If a permit holder's facility fails an inspection, no further moderate sedation procedures shall be performed at the facility until it passes a re-inspection by the Board.

(g) An applicant who fails an inspection or evaluation may request a re-evaluation or re-inspection within 15 days of receiving the notice of failure. The request shall be directed to the Board in writing and shall include a statement of the grounds supporting the re-evaluation or re-inspection. Except as set forth in subsection (h) of this Rule, the Board shall require the applicant to receive additional training prior to the re-evaluation to address the areas of deficiency determined by the evaluation. The Board shall notify the applicant in writing of the need for additional training.

(i) Re-evaluations and re-inspections shall be conducted by Board-appointed evaluators not involved in the failed evaluation or inspection.

(j) An applicant must complete all the requirements of Rule .0302, including passing the written examination, evaluation and inspection, within 12 months of submitting the application to the Board.

History Note: Authority G.S. 90‑30.1; 90-39; 90-48;

Eff. April 1, 2016;

Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. January 9, 2018;

Amended Eff. February 1, 2019; August 1, 2018.

section .0400 - PEDIATRIC MODERATE conscious sedation

21 NCAC 16Q .0401 MINIMAL CONSCIOUS SEDATION CREDENTIALS, EVALUATION AND PERMIT (Recodified to 21 NCAC 16Q .0504 Eff. November 9, 2020)

21 NCAC 16Q .0402 MINIMAL CONSCIOUS SEDATION PERMIT REQUIREMENTS, CLINICAL PROVISIONS AND EQUIPMENT (Recodified to 21 NCAC 16Q .0505 Eff. November 9, 2020)

21 NCAC 16Q .0403 TEMPORARY APPROVAL PRIOR TO SITE INSPECTION

History Note: Authority G.S. 90-28; 90-30.1.

Temporary Adoption Eff. March 13, 2003; December 11, 2002;

Eff. August 1, 2004;

Amended Eff. February 1, 2009; July 3, 2008;

Repealed Eff. April 1, 2016.

21 NCAC 16Q .0404 CREDENTIALS AND PERMITS FOR MODERATE PEDIATRIC CONSCIOUS SEDATION

(a) Before a dentist licensed to practice in North Carolina may administer moderate pediatric conscious sedation, the dentist shall obtain a general anesthesia or moderate pediatric conscious sedation permit from the Board by completing the application requirements of this Rule and paying a fee of three hundred seventy-five dollars ($375.00) that includes the one-hundred dollar ($100.00) application fee and the two-hundred seventy-five dollar ($275.00) inspection fee. The permit shall be renewed annually and shall be displayed with the current renewal at all times in the permit holder's facility where it is visible to patients receiving treatment.

(b) A dentist applying for a permit to administer moderate pediatric conscious sedation shall hold an unexpired PALS certification and meet at least one of the following criteria:

(1) completion of a postgraduate program that included pediatric intravenous conscious sedation training;

(2) completion of a Commission On Dental Accreditation (CODA) approved pediatric residency that included intravenous conscious sedation training; or

(3) completion of a pediatric degree or pediatric residency at a CODA approved institution that includes training in the use and placement of IVs or intraosseous vascular access. A list of CODA approved institutions that is hereby incorporated by reference, including subsequent amendments and editions, appears at www.ada.org/coda and is available at no cost.

(c) All applicants for moderate pediatric conscious sedation permits shall have completed the training required by Paragraph (b) of this Rule within the last two years or show evidence of moderate pediatric conscious sedation practice within the last two years in another state or U.S. Territory.

(d) All applicants for moderate pediatric conscious sedation permits shall be in good standing with the Board.

(e) Prior to issuance of a moderate pediatric conscious sedation permit, the applicant shall pass an evaluation and a facility inspection. The applicant shall be responsible for passing the evaluation and inspection of his or her facility.

(f) A moderate pediatric conscious sedation permit holder may provide moderate pediatric conscious sedation at the office of another licensed dentist, regardless of the permit, if any held, by the hosting dentist. The permit holder shall ensure that the facility where the moderate pediatric conscious sedation is administered has been inspected and complies with the requirements set out in Rule .0405 of this Section. The permit holder shall also obtain an itinerant moderate pediatric conscious sedation permit and comply with the requirements of Rule .0406 of this Section.

History Note: Authority G.S. 90-30.1; 90-39; 90-48;

Eff. June 1, 2017;

Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. January 9, 2018;

Amended Eff. February 1, 2019; August 1, 2018.

21 NCAC 16Q .0405 MODERATE PEDIATRIC CONSCIOUS SEDATION CLINICAL REQUIREMENTS AND EQUIPMENT

(a) A dentist administering moderate pediatric conscious sedation shall ensure that the facility where the sedation is administered meets the following requirements:

(1) The facility shall be equipped with the following:

(A) an operatory of size and design to permit access of emergency equipment and personnel and to permit emergency management;

(B) a CPR board or a dental chair without enhancements, suitable for providing emergency treatment;

(D) suction equipment as necessary for specific procedures, including non-electrical back-up suction;

(E) positive pressure oxygen delivery system, including full face masks for small, medium, and large patients and back-up E-cylinder portable oxygen tank apart from the central system;

(F) small, medium, and large oral and nasal airways;

(G) blood pressure monitoring device;

(H) EKG monitor;

(I) pulse oximeter;

(J) automatic external defibrillator (AED);

(K) precordial stethoscope or capnograph;

(L) thermometer;

(M) vascular access set-up as necessary for specific procedures, including hardware and fluids;

(N) laryngoscope with working batteries;

(O) intubation forceps and advanced airway devices;

(P) tonsillar suction with back‑up suction;

(Q) syringes as necessary for specific procedures; and

(R) tourniquet and tape.

(2) The following unexpired drugs shall be maintained in the facility and with access from the operatory and recovery rooms:

(A) Epinephrine;

(B) Atropine;

(D) antihistamine;

(E) antihypertensive;

(F) bronchodilator;

(G) antihypoglycemic agent;

(H) vasopressor;

(I) corticosteroid;

(J) anticonvulsant;

(K) muscle relaxant;

(L) appropriate reversal agents;

(M) nitroglycerine;

(N) antiemetic; and

(O) Dextrose.

(4) The following records are maintained for at least 10 years:

(A) patient's current written medical history and pre-operative assessment;

(B) drugs administered during the procedure, including route of administration, dosage, strength, time, and sequence of administration;

(D) a consent form, signed by the patient or a guardian, identifying the procedure, risks and benefits, level of sedation, and date signed;

(5) The sedation record shall include:

(B) procedure start and end times;

(D) status of patient upon discharge; and

(E) documentation of complications or morbidity; and

(6) The following conditions shall be satisfied during a sedation procedure:

(A) the facility shall be staffed with at least two BLS certified auxiliaries, one of whom shall be dedicated to patient monitoring and recording sedation data throughout the sedation procedure. This Subparagraph shall not apply if the dentist permit holder is dedicated to patient care and monitoring regarding sedation throughout the sedation procedure and is not performing the surgery or other dental procedure; and

(B) when IV sedation is used, IV infusion shall be administered before the commencement of the procedure and maintained until the patient is ready for discharge.

(b) During an inspection or evaluation, applicants and permit holders who use intravenous sedation shall demonstrate the administration of moderate pediatric conscious sedation on a live patient, including the deployment of an intravenous delivery system, while the evaluator observes. Applicants and permit holders who do not use IV sedation shall describe the proper deployment of an intravascular delivery system to the evaluator and shall demonstrate the administration of moderate pediatric conscious sedation on a live patient while the evaluator observes.

(1) monitoring blood pressure, pulse, and respiration;

(2) drug dosage and administration;

(3) treatment of untoward reactions including respiratory or cardiac depression if applicable;

(4) sterile technique;

(5) use of BLS certified auxiliaries;

(6) monitoring of patient during recovery; and

(7) sufficiency of patient recovery time.

(d) During an inspection or evaluation, the applicant or permit holder shall demonstrate competency in the treatment of the following clinical emergencies:

(1) laryngospasm;

(2) bronchospasm;

(3) emesis and aspiration;

(4) respiratory depression and arrest;

(5) angina pectoris;

(6) myocardial infarction;

(7) hypertension and hypotension;

(8) allergic reactions;

(9) convulsions;

(10) syncope;

(11) bradycardia;

(12) hypoglycemia;

(13) cardiac arrest; and

(14) airway obstruction.

(e) During the evaluation, the permit applicant shall take a written examination on the topics set forth in Paragraphs (c) and (d) of this Rule. The permit applicant must obtain a passing score on the written examination by answering 80 percent of the examination questions correctly. If the permit applicant fails to obtain a passing score on the written examination that is administered during the evaluation, he or she may be re-examined in accordance with Rule .0408(h) of this Section.

(f) A moderate pediatric conscious sedation permit holder shall evaluate patients for health risks before starting any sedation procedure as follows:

(1) a patient who is medically stable and who is ASA I or II shall be evaluated by reviewing the patient's current medical history and medication use; or

(g) Patient monitoring:

(1) Patients who have been administered moderate pediatric conscious sedation shall be monitored for alertness, responsiveness, breathing, and skin coloration during waiting periods before operative procedures.

(2) The permit holder or a BLS certified auxiliary under his or her direct supervision shall monitor the patient's vital signs throughout the sedation procedure until the patient is recovered as defined in Subparagraph (g)(3) of this Rule and is ready for discharge from the office.

(3) Recovery from moderate pediatric conscious sedation shall include documentation of the following:

(A) cardiovascular function stable;

(B) airway patency uncompromised;

(D) state of hydration within normal limits;

(E) patient can talk, if applicable;

(F) patient can sit unaided, if applicable;

(G) patient can ambulate, if applicable, with minimal assistance; and

(4) Before allowing the patient to leave the office, the dentist shall determine that the patient has met the recovery criteria set out in Subparagraph (g)(3) of this Rule and the following discharge criteria:

(A) oxygenation, circulation, activity, skin color, and level of consciousness are stable, and have been documented;

(B) explanation and documentation of written postoperative instructions have been provided to a person responsible for the patient at time of discharge; and

(C) a person responsible for the patient is available to transport the patient after discharge, and for the patient for whom a motor vehicle restraint system is required, an additional responsible individual is available to attend to the patient.

History Note: Authority G.S. 90-28; 90-30.1; 90-48;

Eff. June 1, 2017;

Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. January 9, 2018;

Amended Eff. February 1, 2019; August 1, 2018.

21 NCAC 16Q .0406 ITINERANT (Mobile) Moderate PEDIATRIC CONSCIOUS SEDATION PERMITS

(a) A dentist who holds a moderate pediatric conscious sedation permit from the Board and who wishes to provide moderate pediatric conscious sedation or other sedation services in the office of another practitioner shall obtain a mobile moderate pediatric conscious sedation permit from the Board by completing the application requirements of this Rule and paying a one hundred dollar ($100.00) application fee and a two-hundred seventy-five dollar ($275.00) inspection fee. No mobile permit shall be required to administer moderate pediatric conscious sedation in a hospital or credentialed surgery center.

(b) The permit holder shall maintain in good working order the equipment required by Rule .0405(a)(1) of this Section.

(c) The unexpired medications required by Rule .0405(a)(2) of this Section shall be on site and available to the permit holder.

(d) Before a mobile moderate pediatric sedation permit may be issued, a permit holder appointed by the Board shall inspect the applicant's equipment and medications to ensure that they comply with Paragraphs (b) and (c) of this Rule. The evaluation and on-site inspection shall be conducted as set out in Rule .0405 of this Section.

(e) Prior to administering moderate pediatric conscious sedation or other sedation services at another provider's office, the mobile permit holder shall inspect the host facility within 24 business hours before each procedure and shall ensure that:

(1) the operatory's size and design permit emergency management and access of emergency equipment and personnel;

(2) there is a CPR board or dental chair without enhancements suitable for providing emergency treatment;

(3) there is lighting to permit performance of all procedures planned for the facility;

(4) there is suction equipment, including non-electrical back-up suction; and

(5) the facility shall be staffed with at least two BLS certified auxiliaries, one of whom shall be dedicated to patient monitoring and recording moderate pediatric conscious sedation or other sedation services data throughout the sedation procedure. This Subparagraph shall not apply if the dentist permit holder is dedicated to patient care and monitoring regarding sedation throughout the sedation procedure and is not performing the surgery or other dental procedure.

(f) Upon inspection, the permit holder shall document that the facility where the sedation procedure will be performed was inspected and that it met the requirements of Paragraph (e) of this Rule. The permit holder shall retain the inspection and compliance record required by this Paragraph for 10 years following the procedure and provide these records to the Board upon request.

(g) The mobile moderate pediatric conscious sedation permit shall be displayed in the host facility where it is visible to patients receiving treatment.

(h) All applicants for a mobile moderate pediatric conscious sedation permit shall be in good standing with the Board.

History Note: Authority G.S. 90-28; 90-30.1; 90-48;

Eff. June 1, 2017;

Amended Eff. August 1, 2018.

21 NCAC 16Q .0407 ANNUAL RENEWAL OF MODERATE PEDIATRIC CONSCIOUS SEDATION PERMIT REQUIRED

(a) Moderate pediatric conscious sedation permits and itinerant moderate pediatric conscious sedation permits shall be renewed by the Board annually at the same time as dental licenses. For each permit to be renewed, the permit holder shall pay a one-hundred dollar ($100.00) fee and complete the renewal application requirements in this Rule. If the completed renewal application and renewal fee are not received before midnight on January 31 of each year, a fifty dollar ($50.00) late fee shall be charged. The renewal application shall be submitted electronically through the Board's website, www.ncdentalboard.org, and shall include the information required by Rule .0102(e) of this Subchapter and a report of compliance with the conditions for renewal in Paragraph (d) of this Rule.

(b) Any permit holder who fails to renew a moderate pediatric conscious sedation permit or itinerant moderate pediatric conscious sedation permit before March 31 of each year shall complete a reinstatement application, pay the renewal fee and late fee set out in Paragraph (a) of this Rule, and comply with all conditions for renewal set out in Paragraphs (d) and (e) of this Rule. Dentists whose moderate pediatric conscious sedation permits or itinerant moderate pediatric conscious sedation permits have been lapsed for more than 12 calendar months shall pass an inspection and an evaluation as part of the reinstatement process in accordance with Rules .0405 and .0408 of this Section. All applicants for reinstatement of a permit shall be in good standing. All applications for reinstatement of a permit shall be submitted on forms furnished by the Board at www.ncdentalboard.org and shall include the information required by Rule .0102(f) of this Subchapter and a report of compliance with the conditions for renewal set out in Paragraph (d) of this Rule.

(c) A dentist who administers moderate pediatric conscious sedation in violation of this Rule shall be subject to the penalties prescribed by Rule .0701 of this Subchapter.

(d) As a condition for renewal of the moderate pediatric conscious sedation permit and itinerant moderate pediatric conscious sedation permit, the permit holder shall meet the clinical and equipment requirements of Rule .0405 of this Section, the itinerant moderate pediatric conscious sedation permit holder shall also meet the clinical and equipment requirements of Rule .0406 of this Section, and the permit holder shall document the following:

(A) sedation;

(B) medical emergencies;

(D) pharmacology of drugs and agents used in IV sedation;

(E) physical evaluation, risk assessment, or behavioral management; or

(F) airway management;

(2) unexpired PALS certification, which shall not count towards the six hours of continuing education required in Subparagraph (d)(1) of this Rule;

(3) that the permit holder and all auxiliaries involved in sedation procedures have practiced responding to dental emergencies as a team at least once every six months in the preceding year;

(4) that the permit holder and all auxiliaries involved in sedation procedures have read the practice's emergency manual in the preceding year; and

(e) Absent a Board order stating otherwise, all permit holders applying for renewal of a moderate pediatric conscious sedation permit or itinerant moderate pediatric conscious sedation permit shall be in good standing and their office shall be subject to inspection by the Board.

History Note: Authority G.S. 90-28; 90-30.1; 90-31; 90-39; 90-48;

Eff. June 1, 2017;

Amended Eff. August 1, 2021; August 1, 2018.

21 ncac 16q .0408 PROCEDURE FOR MODERATE PEDIATRIC SEDATION EVALUATION OR INSPECTION and RE-INSPECTION

(a) When an evaluation or on-site inspection is required, the Board shall designate one or more qualified persons to serve as evaluators, each of whom has administered moderate pediatric sedation for at least three years preceding the evaluation or inspection. Training in moderate pediatric sedation shall not count toward the three years.

(d) The inspection team shall determine compliance with the requirements of the rules in this Subchapter, as applicable, by assigning a grade of "pass" or "fail."

(e) Each evaluator shall report his or her recommendation to the Board's Anesthesia and Sedation Committee, setting forth the details supporting his or her conclusion. The Committee shall not be bound by these recommendations. The Committee shall determine whether the applicant has passed the evaluation or inspection and shall notify the applicant in writing of its decision.

(f) An applicant who fails an inspection or evaluation shall not receive a permit to administer moderate pediatric sedation. If a permit holder's facility fails an inspection, no further moderate pediatric sedation procedures shall be performed at the facility until it passes a re-inspection by the Board.

(g) An applicant who fails an inspection or evaluation may request a re-evaluation or re-inspection within 15 days of receiving the notice of failure. The request shall be directed to the Board in writing and include a statement of the grounds supporting the re-evaluation or re-inspection. Except as set forth in subsection (h) of this Rule, the Board shall require the applicant to receive additional training prior to the re-evaluation to address the areas of deficiency determined by the evaluation. The Board shall notify the applicant in writing of the need for additional training.

(i) Re-evaluations and re-inspections shall be conducted by Board-appointed evaluators not involved in the failed evaluation or inspection.

(j) An applicant must complete all the requirements of Rule. 0405, including passing the written examination, evaluation and inspection, within 12 months of submitting the application to the Board.

History Note: Authority G.S. 90‑30.1; 90-39; 90-48;

Eff. April 1, 2016;

Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. January 9, 2018;

Amended Eff. February 1, 2019; August 1, 2018.

SECTION .0500 - Enteral Minimal Conscious Sedation

21 NCAC 16Q .0501 ANNUAL RENEWAL REQUIRED

History Note: Authority G.S. 90-28; 90-30.1; 90-48;

Eff. February 1, 1990;

Amended Eff. August 1, 2002;

Transferred and Recodified from 16Q .0401 to 16Q .0501;

Temporary Amendment Eff. December 11, 2002;

Amended Eff. November 1, 2013; July 3, 2008; August 1, 2004;

Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. January 9, 2018;

Amended Eff. August 1, 2018;

Repealed Eff. February 1, 2019.

21 NCAC 16Q .0502 PAYMENT OF FEES

History Note: Authority G.S. 90‑28; 90‑30.1;

Eff. February 1, 1990;

Transferred and Recodified from 16Q .0402 to .0502;

Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. January 9, 2018;

Repealed Eff. August 1, 2018.

21 NCAC 16Q .0503 INSPECTION AUTHORIZED (Recodified to 21 NCAC 16Q .0704 Eff. November 9, 2020)

21 NCAC 16Q .0504 MINIMAL CONSCIOUS SEDATION CREDENTIALS AND PERMIT

(a) Before a dentist licensed to practice in North Carolina may administer or supervise a CRNA employed to administer or an RN employed to deliver minimal conscious sedation, the dentist shall obtain a Board-issued permit for minimal conscious sedation, moderate pediatric conscious sedation, moderate conscious sedation, or general anesthesia. A dentist may obtain a minimal conscious sedation permit from the Board by completing the application requirements of this Rule and paying a fee of three-hundred seventy-five dollars ($375.00) that includes the one-hundred dollar ($100.00) application fee and the two-hundred seventy-five dollar ($275.00) inspection fee. The permit shall be renewed annually and shall be displayed with the current renewal at all times in the facility of the permit holder where it is visible to patients receiving treatment.

(b) The minimal conscious sedation permit holder shall ensure the level of the sedation administered does not exceed minimal conscious sedation as defined in Rule .0101(27) of this Subchapter.

(1) a completed application form provided by the Board at www.ncdentalboard.org that includes the information and materials required by Rule .0102(b) and (c) of this Subchapter;

(2) a copy of an unexpired ACLS certification; and

(3) documentation showing completion of one of the following:

(A) an 18-hour minimal conscious sedation course from the list, available on the Board's website, of sedation courses reviewed at any public Board meeting and approved by a majority of the Board based on its collective experience; or

(B) a post-doctoral program accredited by the Commission on Dental Accreditation (CODA) that provides training in administering and managing minimal conscious sedation. A list of CODA-accredited programs is available at no cost at www.ada.org/coda and is incorporated by reference, including subsequent amendments and editions.

(d) Prior to issuance of a minimal conscious sedation permit, the applicant shall pass an evaluation and facility inspection in accordance with Rules .0505 and .0507 of this Section.

(e) An applicant shall submit the fee set out in Paragraph (a) and satisfy all requirements in Paragraphs (c) and (d) of this Rule for the application to be complete. Applications that are not completed within one year of being submitted to the Board shall be disregarded without a refund of the fee.

(f) A dentist who administers minimal conscious sedation in violation of this Rule shall be subject to the penalties prescribed by Rule .0701 of this Subchapter.

History Note: Authority G.S. 90-28; 90-30.1; 90-39;

Temporary Adoption Eff. March 13, 2003; December 11, 2002;

Eff. August 1, 2004;

Amended Eff. July 3, 2008;

Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. January 9, 2018;

Amended Eff. February 1, 2019;

Recodified from 21 NCAC 16Q .0401 Eff. November 9, 2020;

Amended Eff. August 1, 2021.

21 NCAC 16Q .0505 MINIMAL CONSCIOUS SEDATION CLINICAL REQUIREMENTS AND EQUIPMENT

(a) A permit holder administering minimal conscious sedation or supervising a CRNA employed to administer or RN employed to deliver minimal conscious sedation shall ensure that the facility where the sedation is administered meets the following requirements:

(1) The facility shall be equipped with the following:

(A) an operatory of size and design to permit access of emergency equipment and personnel and to permit emergency management;

(B) a CPR board or a dental chair without enhancements, suitable for providing emergency treatment;

(D) suction equipment as necessary for specific procedures, including non-electrical back-up suction;

(E) positive pressure oxygen delivery system, including full face masks for small, medium, and large patients and back-up E-cylinder portable oxygen tank apart from the central system;

(F) small, medium, and large oral and nasal airways;

(G) blood pressure monitoring device;

(H) pulse oximeter;

(I) automatic external defibrillator (AED);

(J) thermometer;

(K) tonsillar suction with back-up suction; and

(L) syringes as necessary for specific procedures.

(2) The following unexpired drugs shall be maintained in the facility and with access from the operatory and recovery rooms:

(A) epinephrine;

(B) oral antihistamine;

(D) antihypoglycemic agent;

(E) appropriate reversal agents; and

(F) nitroglycerine.

(4) The permit holder shall maintain the following records for at least 10 years:

(A) patient's current written medical history and pre-operative assessment;

(B) drugs administered during the procedure, including route of administration, dosage, strength, time, and sequence of administration; and

(5) The sedation record shall include:

(A) base line vital signs, blood pressure (unless patient behavior prevents recording), oxygen saturation, pulse and respiration rates of the patient recorded in real time at 15-minute intervals;

(B) procedure start and end times;

(D) documentation of complications or morbidity; and

(E) a consent form, signed by the patient or guardian, identifying the procedure, risks and benefits, level of sedation, and date signed.

(6) During a sedation procedure, the facility shall be staffed with at least two BLS certified auxiliaries, one of whom shall be involved in patient monitoring. This Subparagraph shall not apply if the permit holder is dedicated to patient care and monitoring regarding sedation throughout the sedation procedure and is not performing the surgery or other dental procedure.

(b) During an inspection or evaluation, the applicant or permit holder shall demonstrate the administration of minimal sedation on a patient while the evaluator observes. During the demonstration, the applicant or permit holder shall demonstrate competency in the following areas:

(1) monitoring blood pressure, pulse, pulse oximetry, and respiration;

(2) drug dosage and administration;

(3) treatment of untoward reactions, including respiratory or cardiac depression if applicable;

(4) sterile technique;

(5) use of BLS certified auxiliaries;

(6) monitoring of patient during recovery; and

(7) sufficiency of patient recovery time.

(c) During an inspection or evaluation, the applicant or permit holder shall demonstrate competency to the evaluator in the treatment of the following clinical emergencies:

(1) laryngospasm;

(2) bronchospasm;

(3) emesis and aspiration;

(4) respiratory depression and arrest;

(5) angina pectoris;

(6) myocardial infarction;

(7) hypertension and hypotension;

(8) allergic reactions;

(9) convulsions;

(10) syncope;

(11) bradycardia;

(12) hypoglycemia;

(13) cardiac arrest; and

(14) airway obstruction.

(d) During the evaluation, the applicant shall take a written examination on the topics set forth in Paragraphs (b) and (c) of this Rule. The applicant must obtain a passing score on the written examination by answering 80 percent of the examination questions correctly. If the applicant fails to obtain a passing score on the written examination that is administered during the evaluation, he or she may be reexamined in accordance with Rule .0507(h) of this Section.

(e) A minimal conscious sedation permit holder shall evaluate each patient for health risks before starting any sedation procedure as follows:

(1) The permit holder shall review the patient's current medical history and medication use and, if the permit holder considers it clinically necessary, the permit holder shall consult with the patient's treating medical provider.

(2) A patient who is not medically stable or who is ASA III or higher shall be evaluated further by the permit holder's consultation with the patient's treating primary care physician or medical specialist regarding the potential risks posed by the procedure the permit holder plans to perform.

(f) Post-operative monitoring and discharge:

(1) The permit holder or a BLS certified auxiliary under his or her direct supervision shall monitor the patient's vital signs throughout the sedation procedure until the patient is recovered as defined in Subparagraph (f)(2) of this Rule and is ready for discharge from the office.

(2) Recovery from minimal conscious sedation shall include documentation of the following:

(A) cardiovascular function stable;

(B) airway patency uncompromised;

(D) state of hydration within normal limits;

(E) patient can talk, if applicable;

(F) patient can sit unaided, if applicable;

(G) patient can ambulate, if applicable, with minimal assistance; and

(3) Prior to allowing the patient to leave the office, the permit holder shall determine that the patient has met the recovery criteria set out in Subparagraph (f)(2) of this Rule and the following discharge criteria:

(A) oxygenation, circulation, activity, skin color, and level of consciousness are stable and have been documented;

(B) explanation and documentation of written postoperative instructions have been provided to the patient or a person responsible for the patient at the time of discharge; and

History Note: Authority G.S. 90-28; 90-30.1;

Temporary Adoption Eff. December 11, 2002;

Eff. August 1, 2004;

Amended Eff. July 3, 2008;

Readopted Eff. February 1, 2019;

Recodified from 21 NCAC 16Q .0402 Eff. November 9, 2020;

Amended Eff. August 1, 2021.

21 NCAC 16Q .0506 ANNUAL RENEWAL of MINIMAL CONSCIOUS SEDATION PERMIT REQUIRED

(a) Minimal conscious sedation permits shall be renewed by the Board annually at the same time as dental licenses by the permit holder paying a renewal fee of one hundred dollars ($100.00) and completing the renewal application requirements of this Rule. If the completed permit renewal application and renewal fee are not received in the Board's office before midnight on January 31 of each year, a fifty dollar ($50.00) late fee shall be charged. The renewal application shall be submitted electronically through the Board's website, www.ncdentalboard.org, and shall include the information required by Rule .0102(e) of this Subchapter and a report of compliance with the conditions for renewal in Paragraph (d) of this Rule.

(b) Any permit holder who fails to renew a minimal conscious sedation permit before midnight on March 31 of each year shall complete a reinstatement application, pay the renewal fee and late fee set out in Paragraph (a), and comply with all conditions for renewal set out this Rule. Dentists whose sedation permits have been lapsed for more than 12 calendar months shall pass an inspection and an evaluation as part of the reinstatement process in accordance with Rules .0505 and .0507 of this Section. All applicants for reinstatement of a permit shall be in good standing. All applications for reinstatement of a permit shall be submitted on forms furnished by the Board at www.ncdentalboard.org and shall include the information required by Rule .0102(f) of this Subchapter and a report of compliance with the conditions for renewal set out in Paragraph (d) of this Rule.

(c) A dentist who administers minimal conscious sedation in violation of this Rule shall be subject to the penalties prescribed by Rule .0701 of this Subchapter.

(d) As a condition for renewal of the minimal conscious sedation permit, the permit holder shall meet the clinical and equipment requirements of Rule .0505 of this Section and shall document the following:

(1) three hours of continuing education each year in one or more of the following areas, which shall be counted toward fulfillment of the continuing education required each calendar year for license renewal:

(A) sedation;

(B) medical emergencies;

(D) pharmacology of drugs and agents used in sedation;

(E) physical evaluation, risk assessment, or behavioral management; or

(F) airway management;

(2) unexpired ACLS certification, which shall not count towards the three hours of continuing education required in Subparagraph (d)(1) of this Rule;

(3) that the permit holder and all auxiliaries involved in sedation procedures have read the practice's emergency manual in the preceding year; and

(4) that all auxiliaries involved in sedation procedures have completed BLS certification and, within the past two years, completed three hours of continuing education in any of the areas set forth in Subparagraph (d)(1) of this Rule.

(e) Absent a Board order stating otherwise, all permit holders applying for renewal of a minimal conscious sedation permit shall be in good standing and their office shall be subject to inspection as set out in Rule .0507 of this Section.

History Note: Authority G.S. 90-30.1; 90-31; 90-39;

Eff. August 1, 2021.

21 ncac 16q .0507 PROCEDURE FOR MINIMAL CONSCIOUS SEDATION EVALUATION OR INSPECTION and Re-INSPECTION

(a) When an evaluation or on-site inspection is required, the Board shall designate one or more persons to serve as evaluators, each of whom has administered sedation or general anesthesia in accordance with this Subchapter for at least three years preceding the inspection. Training in minimal conscious sedation or other levels of sedation shall not be counted in the three years.

(b) The inspection fee set out in Rule .0504(a) of this Section shall be paid no later than 10 days after the applicant or permit holder receives notice of the inspection for each additional location at which the applicant or permit holder administers minimal conscious sedation.

(d) Each evaluator shall determine compliance with the requirements of the rules in this Subchapter, as applicable, by assigning a recommended grade of "pass" or "fail."

(e) Each evaluator shall report his or her recommendation to the Board through the Board member serving as the Chair of the Board's Anesthesia and Sedation Committee, setting forth the details supporting his or her conclusion. The Committee Chair shall not be bound by these recommendations. The Committee Chair shall determine whether the applicant or permit holder has passed the evaluation or inspection and shall notify the applicant or permit holder in writing of its decision.

(f) An applicant who fails an inspection or evaluation shall not receive a permit to administer minimal conscious sedation. If a permit holder's facility fails an inspection, no further minimal conscious sedation procedures shall be performed at the facility until it passes a re-inspection by the Board.

(g) An applicant or permit holder who fails an inspection or evaluation may request a re-evaluation or re-inspection within 15 days of receiving the notice of failure. The request shall be directed to the Board in writing and shall include a statement of the grounds supporting the re-evaluation or re-inspection. Except as set forth in Paragraph (h) of this Rule, the Board shall require the applicant or permit holder to receive additional training prior to the re-evaluation to address the areas of deficiency determined by the evaluation. The Board shall notify the applicant in writing of the need for additional training.

(h) An applicant who failed the written examination portion of the evaluation but passed all other aspects of the evaluation and inspection may retake the written examination two additional times at the Board office. The applicant must wait a minimum of 72 hours before attempting to retake a written examination. Any applicant who failed the written portion of the examination three times shall complete an additional Board-approved course of study in the areas of deficiency and provide the Board evidence of the additional study before written reexamination.

(i) Re-evaluations and re-inspections shall be conducted by Board-appointed evaluators not involved in the failed evaluation or inspection.

(j) An applicant must satisfy all the requirements of Rule .0505 of this Section, including passing the written examination, evaluation, and inspection, within 12 months of submitting the application to the Board.

History Note: Authority G.S. 90‑30.1; 90-39;

Eff. August 1, 2021.

section .0600 - REPORTING AND PENALTIES

21 NCAC 16Q .0601 REPORTS OF ADVERSE OCCURRENCES

21 ncac 16q .0602 FAILURE TO REPORT

History Note: Authority G.S. 90-28; 90-30.1; 90-41;

Eff. February 1, 1990;

Transferred and Recodified from 16Q .0501 to 16Q .0601;

Transferred and Recodified from 16Q .0502 to 16Q .0602;

Temporary Amendment Eff. December 11, 2002;

Amended Eff. August 1, 2004;

Repealed Eff. April 1, 2016.

SECTION .0700 – COMPLIANCE AND REPORTING

21 NCAC 16Q .0701 FAILURE TO COMPLY

Failure to comply with the provisions of this Subchapter may result in suspension or revocation of the permit and/or the dentist's license to practice dentistry in accordance with G.S. 90‑41.

History Note: Authority G.S. 90‑28; 90‑30.1; 90‑41;

Eff. February 1, 1990;

Transferred and Recodified from 16Q .0601 to 16Q .0701;

Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. January 9, 2018.

21 NCAC 16Q .0703 REPORTS OF ADVERSE OCCURRENCES

(a) A dentist who holds a permit to administer general anesthesia or sedation shall report to the Board within 72 hours after each adverse occurrence related to the administration of general anesthesia or sedation that results in the death of a patient within 24 hours of the procedure. Sedation permit holders shall cease administration of sedation until the Board has investigated the death and approved resumption of permit privileges. General anesthesia permit holders shall cease administration of general anesthesia and sedation until the Board has reviewed the incident report and approved resumption of permit privileges.

(b) A dentist who holds a permit to administer general anesthesia or sedation shall report to the Board within 30 days after each adverse occurrence related to the administration of general anesthesia or sedation that results in permanent organic brain dysfunction of a patient occurring within 24 hours of the procedure or that results in physical injury or severe medical emergencies, causing hospitalization of a patient occurring within 24 hours of the procedure.

(1) dentist's name, license number and permit number;

(2) date and time of the occurrence;

(3) facility where the occurrence took place;

(4) name and address of the patient;

(5) surgical procedure involved;

(6) type and dosage of sedation or anesthesia utilized in the procedure;

(7) circumstances involved in the occurrence; and

(8) anesthesia records.

(d) Upon receipt of any such report, the Board shall investigate and shall take disciplinary action if the evidence demonstrates that a licensee has violated the Dental Practice Act set forth in Article 2 of G.S. 90 or the Board's rules of this Chapter.

History Note: Authority G.S. 90‑28; 90‑30.1; 90‑41; 90-48;

Eff. April 1, 2016;

Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. January 9, 2018.

21 ncac 16q .0704 INSPECTION AUTHORIZED

Incident to the renewal of an anesthesia or sedation permit or any itinerant permit, or incident to an investigation pursuant to 21 NCAC 16U, the Board may require an on-site inspection of the dentist's facility, equipment, personnel, and procedures. The inspection shall be conducted in accordance with the rules and requirements of this Subchapter applicable to the type of permit.

History Note: Authority G.S. 90-28; 90-30.1;

Eff. February 1, 1990;

Amended Eff. January 1, 1994;

Transferred and Recodified from 16Q .0403 to 16Q .0503;

Temporary Amendment Eff. December 11, 2002;

Amended Eff. August 1, 2004;

Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. January 9, 2018;

Amended Eff. August 1, 2018;

Recodified from 21 NCAC 16Q .0503 Eff. November 9, 2020;

Amended Eff. July 1, 2022.

subchapter 16r – ANNUAL RENEWAL OF LICENSE AND CONTINUING EDUCATION REQUIREMENTS: DENTIST

SECTION .0100 - RENEWAL OF LICENSE

21 NCAC 16R .0101 APPLICATIONS

(a) A renewal application for a dental license shall be submitted electronically before midnight on January 31 of each year through the Board's website: www.ncdentalboard.org. The renewal application shall include:

(1) dental license number;

(2) full name;

(3) mailing address;