Chapter D2 – Article 20. Dental Health Aide Prerequisites, Education, Preceptorships, Supervision, and Scope of Practice.

Sec. D2.20.100. Primary Dental Health Aide I: Education and Preceptorship.

A person meets the requirements to be a certified PDHA I upon successful completion of the requirements set forth in subsections (a) [Education] and (b) [Preceptorship] of this section.

1. Requirements include (1) below:
   1. a Board approved DHA core curriculum course that meets all the following requirements:
      1. Subject Matter. A DHA Core Curriculum course will include didactic instruction and hands-on practice in a lab or clinic setting sufficient to demonstrate understanding in all the following topics:
         1. role of community health aide certification board, and the role of a community health aide and practitioner, dental health aide and behavioral health aide and practitioner in a village;
         2. general scope of practice;
         3. medical ethics;
         4. HIPAA;
         5. malpractice coverage and FTCA;
         6. State of Alaska reporting requirements;
         7. consent for treatment;
         8. health/disease process;
         9. infection and communicable disease;
         10. introduction to body systems, and introduction to head, neck and dental anatomy;
         11. vocabulary and abbreviations;
         12. documentation, including “SOAP” (subjective, objective, assessment and plan) format and procedure codes;
         13. introduction to clinic management;
         14. scheduling;
         15. introduction to medical history taking;
         16. caries disease process;
         17. periodontal disease process;
         18. theory of oral health promotion and disease prevention;
         19. fluoride as a drug and related issues, including toxicity;
         20. topical fluoride treatments;
         21. diet counseling;
         22. oral hygiene instruction;
         23. basic infection control principles and practices, including standard precautions;
         24. introduction to clean/sterile techniques;
         25. introduction to identification of dental problems, including oral cancer, and referral;
         26. interpretation of a dental chart;
         27. introduction to dental treatment plans; and
         28. recognition of relationship between medical conditions and oral health.
      2. The training will include instruction and hands-on practice in a lab or clinic setting sufficient to demonstrate understanding of the subject matter in subsection (A) of this section. Hands-on practice must include a minimum of 12 hours.
2. A DHA must complete a preceptorship after completing the requirements in subsection (a) of this section. This preceptorship must be done under the direct supervision of a dentist, DHAT or DHATP. PDHA I’s can complete this preceptorship under direct via telehealth supervision. The preceptorship must include satisfactory performance in all the following procedures:
   1. delivery of a minimum of 20 topical fluoride treatments;
   2. delivery of a minimum of 40 oral hygiene sessions;
      1. a minimum of 10 must be with children under 6 years of age;
      2. a minimum of 10 must be with patients between ages 6 and 14; and
      3. a minimum of 10 must be with patients over age 14;
   3. delivery of a minimum of 20 diet education sessions;
      1. a minimum of 10 must be provided to the primary caregiver of children under age 6; and
      2. a minimum of 5 must be provided to an adult regarding the adult’s own diet; and
   4. an additional 40 hours of relevant work experience.

Sec. D2.20.110. Primary Dental Health Aide I: Supervision and Scope of Practice.

1. Supervision
   1. A certified PDHA I may provide services under their scope of practice following the requirements of (A), (B) or (C) below:
      1. Under the direct supervision of a dentist, DHAT or DHATP;
      2. With a signed set of standing orders, under the indirect supervision of a dentist, DHAT or DHATP; or
      3. With a signed set of standing orders, under the general supervision of a dentist.
2. Scope of Practice. Includes sections (1) and (2) below.
   1. Knowledge/Skills. A certified PDHA I must maintain an understanding of all the following:
      1. basic dental anatomy;
      2. caries disease process;
      3. periodontal disease process;
      4. infection control and standard precautions;
      5. scheduling;
      6. theory of prevention;
      7. fluoride as a drug and related issues, including toxicity;
      8. identification of potential dental problems and appropriate referrals;
      9. DHA’s general scope of practice;
      10. explanation of prevention strategies including fluoride and sealants;
      11. introduction to medical history taking;
      12. interpretation of dental charts; and
      13. recognition of relationship between medical conditions and oral health.
   2. A certified PDHA I must maintain and demonstrate competency in all the following:
      1. topical fluoride treatments;
      2. diet education; and
      3. oral hygiene instruction.

Sec. D2.20.200. Primary Dental Health Aide II: Education, Preceptorship and Skillsets.

A person meets the requirements to be a certified PDHA II upon successful completion of the requirements set forth in subsections (a) [Education], (b) [Preceptorship] and (c) [Skillsets] of this section.

1. Requirements include (1) and (2) below:
   1. a Board approved DHA Core Curriculum course that meets all of the requirements listed in D2.20.100 (a)(1); and
   2. a Board approved DHA Advanced Dental Procedures course that meets all of the following requirements:
      1. Subject Matter. A DHA Advanced Dental Procedures course must address all the following topics:
         1. dental anatomy;
         2. dental instruments and equipment;
         3. handling and sterilization of instruments; and
         4. disinfection of operatory; and
      2. The training will include instruction and hands-on practice in a lab or clinic setting sufficient to demonstrate understanding of the subject matter in subsection (A) of this section. Hands-on practice must include a minimum of 7 hours.
2. Preceptorship. Requirements include (1) below:
   1. Successful completion of the PDHA I preceptorship listed in D2.20.100(b).
3. Skillsets.
   1. A certified PDHA II must meet the requirements of one or more of the following skillsets:
      1. 30.200 [sealants];
      2. 30.300 [dental prophylaxis];
      3. 30.400 [dental radiology]; or
      4. 30.500 [atraumatic restorative treatment (ART)].

Sec. D2.20.210. Primary Dental Health Aide II: Supervision and Scope of Practice.

1. Supervision.
   1. A certified PDHA II may provide services under their scope of practice listed in D2.20.210(b)(1) and (2) following the requirements of (A), (B), or (C) below:
      1. under the direct supervision of a dentist, DHAT or DHATP;
      2. with a signed set of standing orders, under the indirect supervision of a dentist, DHAT or DHATP; or
      3. with a signed set of standing orders, under the general supervision of a dentist; and
   2. Skillsets come with their own supervision requirements, and those must be followed for procedures performed from that skillset.
2. Scope of Practice. Includes (1), (2) and (3) below:
   1. The scope of practice of a PDHA I listed in D2.20.110(b);
   2. Knowledge/Skills. Must maintain an understanding of all the following:
      1. dental anatomy;
      2. identification and knowledge of dental instruments and equipment;
      3. proper handling and sterilization of instruments; and
      4. disinfection of the operatory; and
   3. The scope of practice listed in skillsets for which they are certified.

Sec. D2.20.300. Dental Health Aide Hygienist: Prerequisites, Education, Preceptorship and Skillsets.

A person meets the requirements to be a certified DHAH upon successful completion of (a) [Prerequisites], (b) [Education] and (c) [Preceptorship]. A DHAH has the option of adding on one or more of the skillsets listed in (d) [Skillsets].

1. Prerequisites. A DHA may be certified under this section provided the DHA has satisfied (1) below:
   1. Has a current dental hygiene license in one of the states or territories of the United States.
2. Education. The DHA must meet the requirements of (1) and (2):
   1. A board approved DHA Core Curriculum course that meets all the requirements listed in D2.20.100(a)(1); and
   2. Local Anesthesia Training that meets the requirements of at least one of the following:
      1. Has resulted in local anesthesia being added to the hygienist’s current dental hygiene license; and
      2. A local anesthesia course approved by the Board that must provide instruction and clinical training equivalent to that required for accreditation by the Commission on Dental Accreditation of the American Dental Association.
         1. Subject Matter. A course in local anesthetic administration must address the following topics:
            1. medical history evaluation procedures;
            2. anatomy of the head, neck and oral cavity as it relates to administering local anesthetic agents;
            3. pharmacology of local anesthetic agents, vasoconstrictors and preservatives, including physiologic actions, types of anesthetics, and maximum dose per weight;
            4. systemic conditions which influence selection and administration of anesthetic agents;
            5. signs and symptoms of reactions to local anesthetic agents, including monitoring of vital signs;
            6. management of reactions to, or complications associated with, the administration of local anesthetic agents;
            7. selection and preparation of the instruments, supplies and equipment for administering various local anesthetic agents; and
            8. methods of administering local anesthetic agents with emphasis on technique, aspiration, slow injection; and minimum effective dosage.
         2. Training. The training will include instruction and hands-on practice in a lab or clinic setting sufficient to demonstrate competency of the subject matter in subsection (i) of this section; hands-on practice must include clinical experience sufficient to establish the DHA’s ability to adequately anesthetize the entire dentition and supporting structure in a clinical setting, and a minimum of 16 hours of clinical encounters.
      3. offered by an accredited school of higher education; or
      4. offered or approved by IHS;
3. Preceptorship. A DHAH must complete a preceptorship after completing the requirements in subsection (b) of this section. Supervision of this preceptorship can be done under the direct supervision of a dentist, DHAT, or DHATP. The preceptorship must include satisfactory performance of the following:
   1. Administration of 5 intra-alveolar nerve block injections;
   2. Administration of 5 infiltration injections;
   3. Administration of 5 greater palatine injections;
   4. Administration of 5 nasopalatine injections; and
   5. Administration of 5 mental nerve block injections;
4. Skillsets. A certified DHAH has the option to meet the requirements of one or more below:
   1. 30.500 [atraumatic restorative treatment (ART)]; or
   2. 30.700 [stainless steel crown placement on primary teeth].

Sec. D2.20.310. Dental Health Aide Hygienist: Supervision and Scope of Practice.

1. Supervision.
   1. A certified DHAH may provide services under their Scope of Practice listed in D2.20.210(b)(1) and (2) following the requirements of (A) or (B) below:
      1. under the direct supervision of a dentist; or
      2. with a signed set of standing orders, under the indirect or general supervision of a dentist; and
   2. Skillsets come with their own supervision requirements, and those must be followed for procedures performed from that skillset.
2. Scope of Practice. In addition to the skills they are licensed to perform with their state hygiene license, a DHAH scope of practice includes (1), (2), and (3) below:
   1. Knowledge/Skills. A certified DHAH must maintain an understanding of:
      1. The requirements identified in the Scope of Practice sections for D2.20.110(b), [PDHA I], D2.20.210(b) [PDHA II], D2.30.200 [sealants], D2.30.300 [dental prophylaxis], and D2.30.400 [dental radiology];
      2. removing calculus deposits, accretions and stains from the surfaces of teeth by scaling and polishing techniques;
      3. non-surgical periodontal therapy;
      4. placing sulcular medicinal or therapeutic materials;
      5. periodontal probing; and
      6. identification and responding to the side effects of local anesthetics;
   2. Competencies a certified DHAH must maintain and demonstrate competency in the following:
      1. Administration of local anesthetics; and
   3. The scope of practice listed in any skillsets that the DHAH has been certified in.

Sec. D2.20.400. Expanded Function Dental Health Aide I: Prerequisites, Education and Skillsets.

A person meets requirements to be a certified EFDHA I upon successful completion of the requirements in subsections (a) [Prerequisites], (b) [Education] and (c) [Skillsets] of this section.

1. Prerequisites. A DHA may be certified under this section provided the DHA satisfies (1) below:
   1. Must be a certified dental assistant or have at least one year of dental assisting experience;
2. Education. A person meets the education requirements to be a certified EFDHA I upon successful completion of (1) below:
   1. A board approved DHA Core Curriculum course that meets all the requirements listed in D2.20.100(a)(1); and
3. Skillsets.
   1. A certified EFDHA I must meet the requirements of (A) and/or (B) below
      1. 30.300 [dental prophylaxis]; and/or
      2. 30.600 [basic restorative];
   2. A certified EFDHA I has the option to meet the requirements of one or more of the additional skillsets listed below:
      1. 30.200 [sealants];
      2. 30.400 [dental radiology];
      3. 30.500 [atraumatic restorative treatment (ART)]; or
      4. 30.700 [stainless steel crown placement on primary teeth].

Sec. D2.20.410. Expanded Function Dental Health Aide I: Supervision and Scope of Practice.

1. Supervision.
   1. A certified EFDHA I may provide services under their scope of practice listed in D2.20.410(b)(1) following the requirements of (A), (B) or (C) below:
      1. under the direct supervision of a dentist, DHAT or DHATP;
      2. with a signed set of standing orders, under the indirect supervision of a dentist, DHAT, or DHATP; or
      3. with a signed set of standing orders, under the general supervision of a dentist;
   2. Skillsets come with their own supervision requirements, and those must be followed for procedures performed from that skillset.
2. Scope of Practice. Includes (1) and (2) below:
   1. The scope of practice of a PDHA I stated in section D2.20.110(b); and
   2. The scope of practice listed in any skillset(s) that the EFDHA I has been certified in.

Sec. D2.20.500. Expanded Function Dental Health Aide II: Prerequisites and Skillsets.

1. Prerequisites. A DHA may be certified under this section provided the DHA has met all the certification requirements below:
   1. 20.400 [EFDHA I] with the basic restorative skillset.
2. Skillsets. An EFDHA II must meet the requirements below:
   1. 30.800 [advanced restorative].

Sec. D2.20.510. Expanded Function Dental Health Aide II: Supervision and Scope of Practice.

1. Supervision.
   1. A certified EFDHA II may provide services under their Scope of Practice listed in D2.20.510(b)(1) following the requirements of (A), (B) or (C) below:
      1. under the direct supervision of a dentist, DHAT or DHATP;
      2. with a signed set of standing orders, under the indirect supervision of a dentist, DHAT, or DHATP; or
      3. with a signed set of standing orders, under the general supervision of a dentist.
   2. Skillsets come with their own supervision requirements, and those must be followed for procedures performed from that skillset.
2. Scope of Practice. Includes (1) and (2) below:
   1. The scope of practice of a PDHA I stated in section D2.20.110(b).
   2. The scope of practice listed in any skillset(s) that the EFDHA II has been certified in.

Sec. D2.20.600. Dental Health Aide Therapist: Education and Preceptorship.

A person meets the training and education requirements to be a certified DHAT upon successful completion of subsections (a) [Education] and (b) [Preceptorship] below:

1. Education. Must complete (1), (2) and (3):
   1. A board approved DHA Core Curriculum course that meets all the requirements listed in D2.20.100(a)(1);
   2. a board approved DHA village-based dental practice course that meets all the requirements listed in D2.30.100 (b)(1); and
   3. a board approved DHAT Educational Program that meets the requirements of (A) and/or (B) below:
      1. is a Commission on Dental Accreditation (CODA) accredited Dental Therapy educational program or the Alaska Dental Therapy Educational Program (ADTEP); and/or
      2. Meets CODA Dental Therapy Accreditation Standards.
2. Preceptorship. Must complete a clinical preceptorship under the direct supervision of a dentist for a minimum of three months or 400 hours, whichever is longer. The preceptorship should encompass all requirements of a DHAT scope of practice outlined in section D2.20.610(b) and show that the DHAT has demonstrated competency at least once in all the procedures listed under the DHAT competencies in section D2.20.610(b)(2).

Sec. D2.20.610. Dental Health Aide Therapist: Supervision and Scope of Practice.

1. Supervision.
   1. A certified DHAT may provide services under their scope of practice following the requirements of (A) or (B):
      1. under the direct supervision of a dentist; or
      2. with a signed set of standing orders, under the indirect or general supervision of a dentist:
         1. Pulpal therapy (not including pulpotomies on deciduous teeth) or extraction of adult teeth can be performed by a DHAT only after consultation with a licensed dentist who determines that the procedure is a medical emergency that cannot be resolved with palliative treatment.
         2. DHATs are strictly prohibited from performing all other oral or jaw surgeries, subject to the condition that uncomplicated extractions shall not be considered oral surgery under this section.
2. Scope of Practice. Includes (1) and (2) below:
   1. Knowledge/Skills. A certified DHAT must maintain an understanding of:
      1. taking medical and dental history;
      2. infection control and standard precautions;
      3. proper handling and sterilization of instruments;
      4. basic management of medical emergencies in the dental office;
      5. identifying oral and systemic conditions requiring evaluation and/or treatment by dentists, physicians or other healthcare providers, and manage referrals;
      6. post-extraction complications;
      7. basic management of dental emergencies;
      8. caries diagnosis;
      9. periodontal diagnosis;
      10. patient management;
      11. local anesthesia;
      12. community and preventive dentistry;
      13. applying desensitizing medication or resin;
      14. fabrication and delivery of athletic mouthguards;
      15. emergency palliative treatment of dental pain, excluding gross pulpal debridement of permanent teeth;
      16. fabrication and placement of single tooth temporary crowns;
      17. management of post extraction complications;
      18. indirect and direct pulp capping on permanent teeth;
      19. indirect pulp capping on primary teeth;
      20. minor adjustments and repairs on removable prostheses;
      21. removal of space maintainers; and
      22. dispensing, counseling and/or administering medications as prescribed by a licensed healthcare provider from the list of approved medications in the CHAM under the dental tab.
   2. Competencies. A certified DHAT must maintain and demonstrate competency in:
      1. topical fluoride treatments;
      2. diet education;
      3. oral hygiene instruction;
      4. intraoral and extraoral photographs;
      5. sealant placement;
      6. child dental prophylaxis;
      7. adult dental prophylaxis with coronal or clinically visible calculus;
      8. charting of the oral cavity;
      9. comprehensive exam including diagnosis and treatment planning;
      10. taking radiographic images;
      11. atraumatic restorative treatment (ART);
      12. administration of local anesthetics;
      13. preparation and placement of direct restorations including:
          1. Class I;
          2. Class II;
          3. Cuspal coverage Class II;
          4. Class III;
          5. Class IV;
          6. Class V;
      14. preparation and placement of stainless steel crowns on primary teeth;
      15. pulpotomy on primary teeth;
      16. extraction of primary teeth;
      17. uncomplicated extraction of permanent teeth, only after consultation with a licensed dentist who determines the procedure is a medical emergency that cannot be resolved with palliative treatment;
      18. pulp vitality testing;
      19. suture placement and removal; and
      20. intraoral and extraoral photographs.

Sec. D2.20.700. Dental Health Aide Therapist Practitioner: Prerequisites and Credentialing.

1. Prerequisites. A person meets the requirements to be a certified DHATP upon successful completion of:
   1. three consecutive certifications as a DHAT.
2. Credentialing. If seeking a DHATP credential, no less often than once every six years, the individual must submit all of the following to the Alaska Dental Therapy Educational Program:
   1. Procedure log with de-identified patient information showing satisfactory performance, under direct supervision of an appropriate supervisor as defined in D2.10.100 [supervision of DHAs], of (A) or (B) below:
      1. 80 hours of direct supervision and demonstration of competence at least once in each procedure listed in the “Competencies” sections for which they are seeking certification; or
      2. demonstrate competence 8 times for each procedure listed in the “Competencies” sections in which they are seeking certification;
   2. Letter of recommendation signed by the applicant’s supervising dentist and dental director;
   3. CHAPCB certificates showing three consecutive certifications as a DHAT or DHATP;
   4. Current Standing Orders in accordance with employer’s policy;
   5. Dental therapy diploma; and
   6. Current BLS certification.

Sec. D2.20.710. Dental Health Aide Therapist Practitioner: Supervision and Scope of Practice.

1. Supervision. A certified DHATP has the same supervision requirements as a DHAT. D2.20.610(a):
   1. A certified DHATP may provide services under their Scope of Practice following the requirements of (A) or (B) below:
      1. under the direct supervision of a dentist; or
      2. with a signed set of standing orders under the indirect or general supervision of a dentist:
         1. Pulpal therapy (not including pulpotomies on deciduous teeth) or extraction of adult teeth can be performed by a DHATP only after consultation with a licensed dentist who determines that the procedure is a medical emergency that cannot be resolved with palliative treatment.
         2. DHATs are strictly prohibited from performing all other oral or jaw surgeries, subject to the condition that uncomplicated extractions shall not be considered oral surgery under this section.
2. Scope of Practice. A certified DHATP has the same scope of practice as a DHAT. The DHAT scope of practice can be found in section D2.20.610(b).