Chapter D2 – Article 10. DHA Supervision and Scope of Practice Prior to Certification

Sec. D2.10.100. Supervision of Dental Health Aides.

1. The clinical supervision of a DHA may be direct, direct via telehealth, indirect, or general, as defined in section D2.10.100(b) [supervision of DHAs; levels of supervision], provided that all the following conditions are met:
   1. The DHA will practice only under supervision of individuals who are:
      1. familiar with the community health aide program and these Standards;
      2. employed by the federal government or employed by or under contract with a tribal health organization operating a community health aide program in Alaska under the ISDEAA; and
      3. employed by the same organization in which the DHA plans to work;
   2. The DHA must be supervised at whatever level of supervision is required for the specific care being provided;
   3. A dentist, DHAT, or DHATP providing supervision may impose a higher level of supervision on the DHA than that provided in this article;
   4. With the exception of what is listed in section D2.10.100(a)(5) below, all supervision of DHAT and DHATP must be provided by a dentist; and
   5. A dental hygienist can assist with direct supervision and direct via telehealth supervision by evaluating the performance of the DHA for oral hygiene instruction, diet education, topical fluoride application, dental prophylaxis, dental radiology and sealant procedures. If the hygienist deems these supervised procedures satisfactory, they are able to sign the competency form for the DHA during preceptorship and recertification.
2. Levels of Supervision. For the purposes of this article:
   1. “Direct supervision” means a supervising dentist, DHAT or DHATP is in the facility where the procedures are taking place, personally diagnoses the condition(s) to be treated, personally authorizes the procedure(s), and before dismissal of the patient evaluates the performance of the DHA.
      1. Direct supervision hours may include chart review prior to seating patient, time the patient is being seen or procedures are being completed and reasonable time for notes and charting as determined by the supervisor.
   2. “Direct via telehealth supervision” means a supervising dentist, DHAT, or DHATP via telehealth including a video component, personally diagnoses the condition to be treated, personally authorizes the procedure, and before dismissal of the patient evaluates the performance of the PDHA I. This form of supervision is only allowed for PDHA I preceptorships.
   3. “Indirect supervision” means a supervising dentist has authorized the procedures and they are being carried out in accordance with a set of written standing orders issued to a specific DHA. A supervising dentist, DHAT or DHATP must be present in the facility where the procedures are taking place.
   4. “General supervision” means a supervising dentist has authorized the procedures and they are being carried out in accordance with a set of written standing orders issued to a specific DHA. A supervising dentist, DHAT or DHATP is not required to be in the facility where the procedures are taking place.
3. Standing orders. For the purposes of this article, standing orders are a document created to explain what procedures a DHA is authorized to perform under the different levels of supervision. The DHA and a supervising dentist must sign the standing orders. Standing orders are individualized to indicate the level of supervision required for each procedure in a DHAs full scope of practice. Standing orders must be reviewed and re-signed by a DHA and their supervising dentist every 2 years, and within 3 months if there is a change in supervisor.

Sec. D2.10.200. Scope of Practice Prior to Certification as a Dental Health Aide.

1. Minimum Requirements. A person who satisfies the requirements of subsection D2.10.200(b), below, may perform services of a certified DHA prior to being certified to the extent the services are performed under one or more of the following circumstances:
   1. as part of training required for certification;
   2. as part of a required preceptorship; or
   3. while an application for certification is pending before the Board after successful completion of all required training and preceptorship.
2. To be eligible to perform services under subsection D2.10.200(a) above, the person must be employed or sponsored by the Indian Health Service or a tribe or tribal organization operating a community health aide program in Alaska under the ISDEAA.