Introduction to Florida’s Dental Practice Act
To understand the regulatory environment for dentistry in Florida, one must be familiar with the Florida Dental Practice Act. It serves as the legal foundation for oral and dental practices, and as such establishes the fundamental parameters in which dentists are able to operate.
The Florida Dental Practice Act sets the educational, examination, and licensing requirements for dentists and dental hygienists, initial licensure procedures, practice responsibilities, and parameters of practice. It also provides guidelines for dental corporations. For example , Dental Service Organizations (DSOs) cannot purchase, lease, or otherwise acquire the assets of a practicing dentist who is not their employee. The Florida Dental Practice Act also makes clear that although a dentist may be employed by a corporation, a dentist cannot relieve himself or herself of responsibility for "the fiduciary relationship inherent in the practice of dentistry." The Florida Dental Practice Act is written and enforced by the Department of Health, although dentists provide input. Once rules are submitted to the Department of Health, they become law unless rejected by the Legislature.
Florida’s Dental Licensure Requirements
The State of Florida imposes strict licensing requirements on all medical professionals, including dentists. Before practicing dentistry in Florida, a dentist must have obtained a valid license to practice from the Florida Board of Dentistry. The exact requirements to obtain a license are detailed below.
Examination
Potential candidates for a dental license in Florida must first pass examinations administered by the National Board Dental Examination Committee and the Florida Dental Examination Committee. The Florida Dental Examination Committee exam consists of four parts: the written examination, the proficiency examination, the clinical examination, and the CPR course. All four parts of the examination are required before full licensure.
The Florida Department of Health also requires dentists to submit proof of passing the National Board Dental Examination, which is a nationally-recognized examination that all individuals applying for a license to practice dentistry must pass. Applicants must also fulfill three different internship or training requirements.
All successful candidates for licensure may then obtain a Certificate of Qualification, which allows them to perform dental procedures on patients in the State of Florida. Applicants must also undergo a criminal background check.
Successful candidates for licensure may also apply to become licensed as a dental hygienist. In addition to a completed application, qualified applicants must submit evidence of graduation from an accredited dental hygiene school, completed examinations, and the results of the criminal background check.
Maintaining a Dental License
Once licensed, dentists in Florida must complete continuing education requirements. In order to stay in good standing, a dentist must complete either 30 credit hours of continuing education courses, or 30 credit hours of 32 Category I credits, which includes courses attached to the American Dental Association or the Academy of General Dentistry, or comparable advanced programs. Candidates with certain levels of education must complete 10 of their 30 credit hours of continuing education in topics related to medical emergency management.
The Scope of Dental Practice: What You Need to Know
The scope of practice is a key component of dental law, and for good reason. If a dentist, dental hygienist, or dental assistant exceeds the authority of their license, they are subject to disciplinary action, and their employment prospects may be forever changed. It simply is not worth the risk.
The Florida Board of Dentistry defines the scope of practice as "the procedure to be performed, pursuant to [the Professional Practice Act (Chapter 466).]" Dentists and dental hygienists, and to a limited extent dental assistants licensed by the State of Florida Board of Dentistry, have authority under the Florida Dental Practice Act to engage in the practice of dentistry.
Dentists
A "Dentist" is one who holds a license to practice dentistry issued under Chapter 466, Florida Statutes. A Florida licensed dentist may not, without the approval of the Board of Dentistry, engage in a specialty practice except as permitted by law. The following is a list of authorized procedures.
Dental Hygienists
A "Dental Hygienist" is one who holds a license to practice dental hygiene issued under Chapter 466, Florida Statutes. A dental hygienist may undertake the following procedures, under the supervision of a Florida licensed dentist.
Dental Assistants
Florida law also provides authority to dental assistants, but with very specific limitations. Only the following duties have been delegated to dental assistants, under indirect supervision of a licensed dentist, for the purpose of assisting the licensed dentist in the performance of the permitted duties. To engage in these permitted duties, the dental assistant must have completed a Board-approved training course and successfully passed an examination, as described below.
Florida Dental Continuing Education Requirements and Compliance
To ensure the highest standards of professional competence, the state of Florida has in place a progressive system where licensed dental professionals must complete continuing education requirements as mandated by the Florida Board of Dentistry. These requirements are designed to keep dentists abreast of the latest industry advancements, treatment methodologies, and legal regulations.
For dentists, the requirements for continuing education are outlined by Florida Statute 456.013. In addition to the basic requirements, additional hours are required for those dentists who hold additional certifications such as Expanded Function Dental Assistants or General Anesthesia Permits. While the exact number of required hours may change, the list of courses for specialty licenses such as orthodontics or pediatric dentistry is updated on a rotating basis to reflect current trends and practices.
Florida Licensed Dental Hygienists also must adhere to mandated continuing education credits as well as compliance monitoring. Pursuant to Section 466.0135, F.S., dentists and hygienists must complete a mandatory continuing education requirement of 30 hours every two years. If a licensee has never held a Florida license, the first renewal shall include credit hours for the period from the date of licensure to the following February 28, plus the credits required for the year in which the license is renewed.
An online renewal system is available for all licensing application services. This system is available from October 1 through February 28. All licenses expire on February 28 of each year. Anna Maria Island family dental practices are subject to the same rules and regulations as their mainland counterparts, and must complete licensure requirements in accordance with Florida law.
Safety and Infection Control in Florida Dental Practices
The safety of patients and staff is paramount in every Florida dental practice. Florida and federal laws and regulations mandate infection control standards to prevent the transmission of diseases between practitioners and patients. Following these standards is essential as insurance companies and government agencies, including the OSHA and EPA, have begun taking a more active role in monitoring compliance, according to the November 2010 issue of the Florida Dental Journal.
Florida Board of Dentistry Rule 64B5-17.002 sets out certain minimum requirements for the safe operation of a dental practice. They include:
· Acceptable infection control and sanitation protocols
· A written emergency and disaster plan
· An emergency kit containing the supplies for the most common medical emergencies related to dentistry
· A plan for disposal of medical waste
· A documented location, by street address and map coordinates, of the practice
As to infection control and sanitation, the Board rules provide:
Establishing an infection control and sanitation protocol requires knowledge of current disease transmission and prevention through handwashing, barrier usage and personal protective equipment; instrument processing and sterilization/cleaning; surface disinfection; and management of blood, body fluids, and needles and sharp instruments.
Infection Control (Universal Precautions). Dental healthcare workers shall observe the following general requirements in managing the infection hazard:
(a) Cover all cuts, abrasions and other breaks on the skin with a waterproof bandage when working with blood or body fluids that might contain HIV infected fluids .
(b) Restore deficient mechanical barriers by gloves, gowns or other appropriate means.
(c) Avoid recapping or otherwise handling needles by hand after use.
(d) Keep the work area free of unnecessary items and clutter and use desks, chairs and other nonsurfaces for storage.
Personal Protective Equipment (PPE). Personal protective equipment, such as utility gloves, clinical examination gloves, masks, protective eyewear and gowns shall be worn in a manner that prevents clothing, skin and mucous membranes from contacting potentially infectious materials and as indicated for the task in order to prevent physical contact to the extent feasible.
Clinical Examination and Utility Gloves. Clinical examination and utility gloves shall be used when:
(a) There is hand contact with blood, blood containing bodily fluids, tissue surfaces or a moist continuous dressing.
(b) Performing phlebotomy or finger or heel sticks.
(c) Using chemical agents or alkaline solutions or when contact may be made with caustic solutions and noxious substances.
(d) Handling, and using, transfer forceps or scalpels when passing items back or forth, such as scalpel blades or needles.
(e) Processing instruments, dental laboratory work, handling soiled materials, transporting specimens, cleaning treatment room surfaces, handling amounts of chemicals and observed as necessary according to prevailing professional practice.
PPE used in the practice of dentistry must meet or exceed the standards set by the American National Standard Institute, including the individual’s requirements for fit and wearability. It is the responsibility of the dentist to provide FDA-approved PPE appropriate to the task being performed.
Ethical and Legal Obligations in Florida
In addition to the regulatory framework, ethical obligations also guide Florida dental practices. The Florida Dental Association (FDA) and the American Dental Association (ADA) have put forth a Code of Ethics that sets the standard for professional conduct and patient-care responsibilities. The six fundamental principles include Patient Autonomy, Nonmaleficence, Beneficence, Justice, Veracity, and Confidentiality. The Code explains how to apply these principles to actual practice in a manner that benefits patients.
Perhaps the most important aspect of these ethical guidelines is the concept of informed consent. Dentists are required to explain treatment options, risks, and benefits to patients who are then expected to make their own decisions about their dental care. The Florida Board of Dentistry’s rule 64B5-17.0055 for Informed Consent articulates the legal requirements for informed consent in a manner that generally dovetails with the ethical and moral expectations underscored by the FDA and ADA.
When these rules and standards conflict, ethical guidelines provide a clear means to approach the situation in a professional and responsible manner. If faced with disciplinary action or even criminal prosecution, a dentist will have the opportunity to establish that he or she was acting in a manner that is consistent with the prevailing ethical and legal standards of the profession. Simply doing one’s job in accordance with the law is the clearest, most efficient means of defending oneself.
Of course ethical considerations can go far beyond the scope of the law. For example, Florida Dentists must align their practice with the requirements of Section 499.01212 of the Florida Statutes dealing with "tissue banking." Tissue banking is not required; dental professionals may simply keep tissues removed from a patient at the time of surgery for later use. If the tissue is to be stored or shared with another dental professional, however, proper records must be maintained (including but not limited to the patient’s medical history and written authorization), and the facility in which such tissue is stored must be "..in compliance with all applicable federal, state, and local laws and regulations." A failure to keep such records or ensure compliance with applicable laws and regulations could lead to significant fines, loss of the ability to practice, or even criminal prosecution.
Recent Changes to Florida Dental Laws and Regulations
Recently, Florida has seen some significant updates to dental laws that have implications for practicing dentists. As of October 1, 2016, the Florida legislature passed several acts that affect the operation and supervision of dental practices. Among them were the following:
1. HB 1149 – Dental Service Organizations ("DSOs") Exemption
This provision provides an exemption from previous DSOs rules, including certain management service organizations, such as those that lease practice spaces.
2. HB 199 – Dental Associations
By amending Section 466.028, Florida Statutes , this act removed the provision allowing a dentist who organized as a corporation to use the word "dentistry" in the name of the corporation. Other organizations that may be affected going forward are those organized as partnerships and limited liability corporations.
3. HB 723 – Licensure by Credential for Dentists
This act updates the licensure law for dentists for practice in Florida for dentists licensed in another state for 5 years or more. It also adds requirements for those organizations with unlicensed dentists practicing with the state.
4. SB 686 – Licensure by Endorsement for Dental Hygienists
This act facilitates licensure and permits dental hygienist licensure for applicants who have been lawfully engaged in practice for two (2) years or more and holds a current license. It also permits the licensing and practice of dental hygiene through the use of telehealth services and mandates that a supervising dentist be in a nearby facility.
These recent, significant changes and shifts in Florida laws for dentists and their practices may affect your Florida dental practice in some way. If you need assistance in understanding how these changes may impact your practice, consult an experienced professional.