PRESIDENT'S MESSAGE - North Dakota Board of Dental Examiners

ANNUAL REPORT OF THE NORTH DAKOTASTATE BOARD OF DENTAL EXAMINERSAs presented JULY 15, 2006As appointed public servants, Board members arecharged with protecting North Dakota’s consumers in avariety of ways that include ensuring that those who arelicensed by the Board meet certain minimum education andtraining criteria to safely practice in our state. Additionally,the Board must monitor all licensees to ensure compliancewith laws and rules governing the profession.New rules and regulations have been published andsent to all licensees and registrants. It is the professionalobligation of each dental professional to know these rulesand practice within all pertinent parameters. In a recentpolicy change the Board determined that all registrants andlicensees should be cognizant of the laws as they pertainto dentistry therefore all new registrants will submit asuccessful jurisprudence exam to the board as part of theregistration process.Many changes have taken place regarding the structureof the Board. An Application Review Committee has beeninstalled and is chaired by Dr. Dale Dohms. The Committeewas implemented to review license renewal applicationsand communicate with those licensees who have indicatedor ‘reported’ incidents, which the Board deems significant.As complaint numbers increase the Complaint Committeemust increase the utilization of legal counsel andinvestigative services. Conduct such as failing to providecurrent business addresses, inappropriate advertising,and other technical violations of the statutes and rules issanctioned. The Anesthesia Committee, Dr. Malaktaris,Chair, has communicated via a recent memo to all licensees,what the regulations require of those licensees who wish toutilize various levels of sedation. Although the regulationpertaining to anesthesia has remained the same, sedationmodalities being marketed to dentists have changeddramatically. Due to the changes in the way sedation isdelivered, further definition and clarification was needed.Elective cosmetic procedures being marketed to dentists areanother concern of the Board. The Board developed policypertaining to such procedures. The NDSBDE determinedthat the prescription, dispensing or administration of drugsor materials or the delivery of service by a licensed dentistfor purposes other than those required for accepted dentaltherapeutic purposes shall be considered unprofessionalconduct with the exception of those services for whichadvanced specialty training recognized and accredited bythe ADA has been acquired. This policy is applicable toall specialties of dentistry. Other transformations includean updated anesthesia application permit process, whichcan be downloaded from the Board’s web site. The Boardcontinues to look for ways to outline the scope of practicefor dentistry and implement those developments as Boardpolicy, or as future legislation. The Continuing EducationCommittee launched its first series of random audits. TheCommittee will further illuminate guidelines for proofor confirmation of CE and what is deemed acceptable tosimplify the process for licensees.In March 2006, Governor Hoeven appointed DaleBrewster, DDS from Stanley to fill the vacancy left as Dr. JohnFishpaw completed his second term with the NDSBDE. TheBoard of Dental Examiners recognizes and extends sincerePage appreciation to Dr. Fishpaw for his outstanding years ofdedicated service to the Board of Dental Examiners. In April‘06, the Board moved to accept the resignation of Dr. JamesO’Connell with appreciation for all he has contributed tothe NDSBDE. Governor Hoeven appointed Dr. Robert Lauf,Mayville to fill the vacancy.As charged, the Board will continue to focus on itsmission to protect the public while also maintaining theintegrity of the profession. The current make up of theBoard is as follows:Jay K. Taylor, DDS, President (3-15-09)FargoLinda Neppl, RDH, President-Elect (3-15-11)FargoDale Dohms, DMD, Immediate Past President (3-15-07)MinotErma Hauglie, Public Member, Secretary-Treasurer (3-15-08)BismarckRobert Lauf, DDS, Member (3-15-08)MayvilleDale Brewster, DDS, Member (3-15-11)StanleyAnthony Malaktaris, DDS, Member (3-15-10)BismarckRecent unrest within the clinical examinationcommunity has prompted many changes with morechange to come as the evolution toward acceptance of anational clinical examination continues. Licensure remainsa primary responsibility of the NDSBDE. Currently theBoard has determined that all regional clinical exams areacceptable. It remains the job of the Board to determineappropriate requirements for licensure. North Dakotacontinues to be well represented in this national clinicalexamination effort. Past NDSBDE member John Fishpaw,DDS, received the honor of being elected as President-Electof the Central Regional Dental Testing Service. Althoughmuch debate remains regarding the clinical licensureprocess, North Dakota criteria and standards for licensureremain steadfast to ensure that competent and ethicallicensees provide dental care to our citizens. Members ofthe Board serving as examiners in the licensing process haveincreased due to the increase in the number of states thataccept the national exam. The North Dakota State Boardof Dental Examiners is continuing to accept candidatesfor licensure having passed any of the regional clinicalexaminations (CRDTS, NERB, SRTA, and WREB), or anystate administered clinical examination. The NDSBDE isa member of ADEX (American Board of Dental Examiners)and fully supports the effort involved in the developmentof a national examination, which will allow greater freedomof movement for hygienists and dentists with the benefit ofincreased access to care for our citizens.Continued on page 4

Annual Report Continued from page 3NDSBDE statistics for 7/15/2005 - 7/14/2006:Dental licenses issued - 16Registered dental hygienist licenses issued - 53Total DDS Licenses - 351 (one year ago - 375)RDH Licenses - 573 (one year ago - 587)Registered dental assistants - 427 (one year ago - 415)Total general anesthesia permits - 19Local anesthesia permits - 224Written Complaints2006 – 11 (through June)2005 - 292004 (not including advertising related) - 21Advertising Complaints for 2004-2006 - 13The Board maintains a website for the benefit oflicensees and the public and soon the website will beinteractive. At it’s April 06 meeting the Board unanimouslyvoted to move forward with the implementation of aproposal, which would allow online capability for licenseesand registrants. The Health Alert Network, collaborated bythe Department of Health has initiated a voluntary databaseof health care providers who can be called upon in the eventof a federal disaster. The program is administered by federalgrant money. The data system will also facilitate onlinerenewal, license verification, and certain administrativeprocesses such as change of address and CE verification.Continuing education forms, license renewal forms andapplications are currently offered via the web site. Linksto various dental related sites are also available, includingthe CDC. The North Dakota Century Code and Rules/Regulations pertaining to dentists, hygienists and assistantscan be found at the website as well. APT, an associationmanagement company with which the NDSBDE contracts,provides the custom website and database applications.Licensure verification and questions can be handled viaphone during regular business hours or by the Board’se-mail (ndsbde@aptnd.com). Office hours are Monday-Friday, 8:00 a.m. to 5:00 p.m. The website has proven tobe an excellent means of communicating with licenseesand registrants. Another vehicle of communication is theBoard’s annual newsletter, which is published in November.Minutes of all NDSBDE meetings are available by contactingthe executive director or APT.Respectfully Submitted,Rita M. Sommers, Executive DirectorNorth Dakota State Board of Dental ExaminersADHLEX Hygiene Examby Linda Neppl RDHThe Central Regional Dental Testing Service(CRDTS) was the only examination agency toadminister the American Dental Hygiene LicensureExam (ADHLEX) for the 2006 testing season. TheNorth East Regional Board (NERB) has indicatedthey will be administering the ADHLEX in the2007 testing season. CRDTS has adopted the ADEXexams as the CRDTS exam for both dental and dentalhygiene. It was a very busy exam season with theaddition of Hawaii, South Carolina, and Georgia nowparticipating with CRDTS.The new exam consists of two parts withPart 1 being an off site computer exam and Part 2being the clinical exam. Educators were invited tosit for the computer exam at no cost, which manytook advantage of. The North East Regional Board(NERB) originally developed the computer exam.With three independent examiners now grading thecandidate’s clinical exam this protocol is proving tobe very candidate friendly and more efficient for theexaminers. The major distinction in the ADHLEXexam compared to the previous CRDTS exam is theelimination of radiographs, that aspect being moreobjectively tested in the written portions of theexamination process.The scoring, content and criteria for theADHLEX will remain the same for the 2007 testingperiod, however there will be modifications possiblein 2008. This is an exciting time for our professionas we move ever closer to a standardized exam forlicensure.Continuing Education Requirements, Proof of CE GuidelinesA.G. Malaktaris, DDS, Chairman CE CommitteeIn the educational experiences to enhance skills and knowledge in the area relevant to dentistry, specific criteria havebeen set forth by Administrative Rule outlining types of course work limitations and minimum number of hours that arerequired for renewal of certificate and application of license. The Continuing Education Committee recommends thatyou retain your CE records for the previous renewal cycle as well as the current renewal cycle. In the event of a randomaudit of continuing education, proof of CE should include but is not limited to:• copy of credit card receipt or other proof of payment• a course syllabus• course number if provided• any other documents showing proof of attendanceA dentist can accrue up to 10 hours of continuing education through distance learning for each renewal cycle, a hygienist5 hours and a registered dental assistant 2 hours. Distance learning means the variety of forms of organized and directedlearning experiences that occur when the instructor and the student are not in direct visual or auditory contact. Theseinclude, but are not limited to, courses delivered via the Internet, CD-ROM, satellite downlink, correspondence and homestudy. If you utilize this means of obtaining CE credits you must have proof of course completion.Page

FAQ’s - SedationIf you are currently utilizing an oral conscious sedationprotocol, you must obtain the appropriate permit from theBoard to be compliant with North Dakota law (Article 20-02-01-05. Permit for anesthesia use.). A renewal permit toutilize any form of conscious sedation or general anesthesiais required at the time of license renewal (12/07). Therehave been revisions to the initial application and renewalapplication process including the requirement of PediatricAdvanced Life Support (PALS). Don’t wait until the lastminute to review this application, which can be found onthe Board’s web site. If there is a question about sedation,please contact the Board. Some frequently asked questionsare addressed below.1) What is oral conscious sedation?Oral conscious sedation is defined as a minimallydepressed level of consciousness that retains thepatient’s ability to independently and continuouslymaintain an airway and respond appropriatelyto physical stimulation or verbal command andthat is produced by a pharmacological or nonpharmacologicalmethod or a combination thereof.In accordance with this particular definition, thedrugs and/or techniques used should carry a marginof safety wide enough to render unintended loss ofconsciousness unlikely. Patients whose only responseis reflex withdrawal from repeated painful stimuliwould not be considered to be in a state of conscioussedation.2) If I prescribe valium and use this with nitrous oxidesedation would I still need a permit?Yes, a permit would be required. Nitrous oxide/oxygen when used in combination with sedativeagents may produce anxiolysis, conscious sedationor deep sedation or general anesthesia. The clinicaleffects of titration of oral medication for the purposesof sedation are unpredictable. Repeated doses oforally administered sedative agents may alter thestate of consciousness to one deeper than intended.With recent developments in dental anesthesiaknown as “sleep dentistry” or sedation dentistry,the Anesthesia Committee is diligently stressingrequirements needed to promote public safety inlight of recent trends. While “sedation dentistry”techniques do not necessarily lead to accentuatedlevels of sedation, unintended consequences havebeen reported.3) What is “sleep dentistry”?Sleep dentistry, a phrase not endorsed by theNDSBDE, has a misleading implication whichimplies the patient is unconscious or sleepingduring definitive dental treatment. This techniqueis sometimes also referred to as “sedation dentistry”.The term “sedation dentistry” beyond a doubt, isa more accurate representation of what conscioussedation truly imparts. Many states have addressedthe use of such terminology in dental advertisingthrough statutory changes in law.4) What do I need to do to obtain a permit?Contact the NDSBDE for the permit application ordownload the application from the Board’s website; www.nddentalboard.org5) What training is required for a permit?Education and training is directly related to the typeof anesthesia permit for which the dentist applies.Different levels of sedation privileges require differentlevels of advanced education and training, as well asadditional requirements for personnel, facilities andequipment. The North Dakota State Board of DentalExaminers references the AMERICAN DENTALASSOCIATIONS GUIDELINES FOR THE USE OFCONSCIOUS SEDATION, DEEP SEDATION ANDGENERAL ANESTHESIA FOR DENTISTS foreducational requirements, training and equipmentrequirements. Further information regardingthose requirements may be found on the Board’sweb site; www.nddentalboard.org by clicking onLICENSURE and then scrolling down to theADA Guidelines.6) What is the active period of a conscious sedationpermit?Sedation permits for general anesthesia, parenteralanesthesia, or any form of conscious sedation mustbe renewed by application and payment of a fee,concurrently with renewal of a certificate of license.7) Can my hygienist administer nitrous oxide?No. A dental hygienist or a dental assistant maynot initiate the administration of nitrous oxide to apatient. The Administrative Rule states that a dentistmay delegate the monitoring tasks to a licenseddental hygienist or a registered dental assistantutilizing direct supervision only after the patienthas been stabilized at the desired level of conscioussedation or relative analgesia by the action of thedentist. The licensed dental hygienist or registereddental assistant who is assigned the monitoring taskshall remain in the treatment room with the patientat all times.Oral conscious sedation is a treatment modality thatcan reduce the trepidation some patients experienceduring dental treatment. The Board welcomes inputfrom North Dakota’s dental community as it continuesto monitor the use of oral conscious sedation practicesin the state. Questions or concerns may be directed tothe Board via e-mail,Reportdental@aol.comorNDSBDE, Anesthesia CommitteePO Box 7246Bismarck, ND 58507-7246Page

The North DakotaState Board of DentalExaminers is pleased tointroduce…The North Dakota StateBoard of Dental Examinersalso introduces…North Dakota native DaleBrewster, DDS graduated fromBowbells High School in 1966 andreceived his Bachelors of Sciencedegree from Minot State College.He taught school in the Minotpublic system for three years beforeembarking on a new career at theUniversity of Minnesota School ofDentistry, where in 1979 he earnedhis degree. After graduation Dr.Brewster was employed by agraduate adult special prosthodonticprogram through the University ofMinnesota, enriching his educational experience.Dr. Brewster established a private practice in Crosby, ND in 1980and moved to Stanley, North Dakota a short time later where he hasmaintained his private general practice for the past 24 years. Thislocation has allowed him to continue his lifetime farming interest andlove of the outdoors. The Brewster’s also love to travel, especiallywhere hunting and fishing are involved although Debbie has beenknown to say, “He hunts too much!” Dr. Brewster further extendshis service to the people of North Dakota through the Minne-ToheHealth Center serving the members of the Three Affiliated Tribes(the Mandan, Arikara and Hidatsa peoples) where he has contractedwith the Indian Health Services for the past five years.Dr. Brewster and his wife Debbie, a Minot native, have shared29 years as husband and wife, and have raised three children.Andrea, age 26, is enrolled in dental school at the Arizona School ofDentistry in Mesa, Arizona. Leah, age 24, is a registered nurse andlives in Grand Forks, North Dakota. Jacob, age 20, is a student at theUniversity of North Dakota.When asked about his appointment to the Board, Dr. Brewstercommented “Working with the Board of Dental Examiners is anexciting and challenging position. I hope to serve the public and thedental profession fairly.”Robert Lauf, DDS was raised andeducated in North Dakota. Afterreceiving his Bachelors of Sciencedegree from North Dakota StateUniversity he went on to study atthe University of Nebraska receivinghis DDS degree in 1989. In 1990 Dr.Lauf became established with GooseRiver Dental Associates in Mayville,ND where he resides today with hiswife Kimberly and their two children,Savannah, 15 and Robert III, 14.In a relatively short time Dr.Lauf’s passion for dentistry hasbecome apparent through his dedicated service to patients as wellas his fellow dental professionals holding various responsibilitieswith the ADA and it’s component and constituent organizations.Dr. Lauf has been a supporter of dental education, participating inthe ADA Dental Education Summit and is an ardent supporter ofthe dental needs of the elderly population through his service onthe Older Adult Access to Oral Health Care Advisory Committeewith the ADA Health Foundation and Glaxo Smith Kline. DrLauf has also served on the ADA Elder Care Task Force. TheSeptember/October 2006 issue of the AGD General Dentistryfeatured an article co-authored by Dr. Lauf, “Assessment of DentalCare Access and Utilization Among the Older Adult Population inthe United States”. In addition, Dr. Lauf is credited with servingthe dental community as a consultant for the ADA’s Council onAccess, Prevention and Interprofessional Relations (CAPIR) and haschaired the Committee on Access for the ADA. Dr. Lauf has beenactive closer to home serving two consecutive terms as Presidentfor the North Dakota Dental Association in 2001 and 2002.Fortunately for the dental consumers of North Dakota,participation in dentistry does not end in the private dental operatoryfor Dr. Dale Brewster and Dr. Robert Lauf. Welcome Aboard!Board to participate in the stateHealth Care Professionals Emergency Credential SystemEarlier this year the ND Department of Health, Division of Emergency Preparedness and Response, contacted the North Dakota StateBoard of Dental Examiners to discuss the Board’s participation in a voluntary emergency response system for health care professionals.Federal bioterrorism grant dollars are available to each state to implement a Health Care Professionals Emergency CredentialingSystem which includes a Health Alert Network (HAN). The HAN is a real-time, or near real-time database of health care professional’slicensing status information shared by state licensing boards and is used to verify and credential volunteers willing to practice in a nonemployerfacility in the event of an emergency. The North Dakota Department of Health administers the grant and maintains the HANdatabase of licensed health care professionals in ND and in the event of an emergency, will activate the HAN to contact volunteers.Currently, the licensing boards for the physicians, nurses, pharmacists and social workers in North Dakota are participating in theHAN and in 2006 four other health care professions were identified by the Department of Health including dentists, registered dentalhygienists, registered dental assistants, respiratory therapists, psychologists and veterinarians.Beginning in 2007 for the 2008 license renewal year, the State Board of Dental Examiners will recruit for the volunteer emergencyresponse system as part of our license renewal process. Participation is voluntary and not required to renew your license. Should youchoose to volunteer to participate in the Emergency Response System, you will be provided additional information from the NorthDakota Department of Health, Division of Emergency Preparedness & Response.Participation in the HAN requires additional database technologies paid for by the federal grant and will allow the Board of Dental Examinersto implement an online license renewal system as well as online license and continuing education verification for consumers and licensees.Page

Dental Assistants - Registered?Certified? Do you know the difference?The North Dakota Board of Dental Examiners is the governing body as to what a dental assistant may or maynot be delegable to perform in our state. In the state of North Dakota, a dental assistant must be registered withthe NDBODE in order to perform expanded duties delegated by a dentist. If an assistant is a certified dentalassistant, they too must be registered in the state in order to utilize expanded duties.To be registered by the NDSBDE, a dental assistant must register annually, must be compliant with the continuingeducation requirements set forth by the board of dental examiners, CPR certified, and pay an annual fee.The following definitions of dental assistants have been set forth by the board of dental examiners:“Registered dental assistant” is a dental assistant who is a graduate of a dental assistant program approved orprovisionally approved by the commission on dental accreditation (CODA) of the American dental association;or who has received three thousand two hundred hours of dental assisting instruction including on-the-jobtraining as a dental assistant and has completed dental assistant national boards; or who has completed a coursein dental assisting which is approved by the North Dakota board of dental examiners, and who is registered bythe North Dakota board of dental examiners.“Certified dental assistant” means a dental assistant who meets the education and/or experienceprerequisites established by the Dental Assisting National Board (DANB) and passes DANB’s Certified DentalAssistant (CDA) examination (including Radiation Health and Safety (RSH), Infection Control (ICE) and GeneralChairside (GC) components), is currently CPR certified and continues to maintain the credential by meetingDANB requirements.“Qualified dental assistant” means a dental assistant who has received on-the-job training or instructiontotaling six hundred fifty hours and has completed a board-approved infection control seminar and passed the x-ray and infection control portions of the DANB examination, and has applied to the board and paid the certificatefee determined by the board.Dental Assistants may perform sealants with the following criteria:1. The assistant is currently certified by the dental assisting national board (DANB), registered withthe North Dakota state board of dental examiners and has provided documented proof of a boardapprovedsealant class or course offered at an accredited school; or2. The assistant is a graduate within the past two years of an accredited school recognized by thecommission on dental accreditation of the American dental association (CODA), or if not a graduateof a CODA accredited school within two years, if the assistant successfully completes a boardapproved sealant class or course offered at an accredited school.Dental assistants may monitor nitrous oxide with the following criteria:1. A dentist may delegate the monitoring of nitrous oxide to a registered dental assistant utilizingdirect supervision only after the patient has been stabilized at the desired level of conscious sedationor relative analgesia by the action of the dentist. A registered dental assistant who is assigned themonitoring task shall remain in the treatment room with the patient at all times.2. The dentist must provide and document training for the registered dental assistant in the properand safe operation of the analgesia machine being used, including the emergency procedures to beemployed if required.A dentist may delegate to a dental assistant under direct, indirect or general supervision, procedures overwhich the dentist exercises full responsibility as permitted by rules adopted by the board of dental examiners.The delegable expanded duties for dental assistants are listed under Article 20-03 in the North Dakota Rules andRegulations.Carla Schneider, CDA, RDANDDAA, LiaisonPage

MEMBER DIRECTORYBOARD MEMBERSPresidentJay K. Taylor, DDSFargo, NDTerm Expires: March 2009President-ElectLinda Neppl, RDHFargo, NDTerm Expires: March 2011Immediate Past PresidentDale Dohms, DMDMinot, NDTerm Expires: March 2012Secretary/TreasurerErma Hauglie, Consumer MemberBismarck, NDTerm Expires: March 2008Robert Lauf, DDSMayville, NDTerm Expires: March 2008Anthony Malaktaris, DDSBismarck, NDTerm Expires: March 2010Dale Brewster, DDSStanley, NDTerm Expires: March 2011EXECUTIVE STAFFExecutive DirectorRita Sommers, RDH, BAND State Board of Dental ExaminersPO Box 7246Bismarck, ND 58507-7246Tel: (701) 258-8600Fax: (701) 224-9824Ritamichel@aol.comLegal CounselJerome Kettleson, Esq.Pearce & Durick Law FirmPO Box 400Bismarck, ND 58502Board Office StaffJacinda SimmonsTel: (701) 258-8600Fax: (701) 224-9824ndsbde@aptnd.comNorth Dakota State Boardof Dental Examiners web site:nddentalboard.orgFishpaw Honored forTen years of serviceThe North Dakota State Board of Dental Examiners at its SeptemberExaminers Breakfast presented Dr. John Fishpaw with a plaque in honorof his ten years (two consecutive terms) of dedicated service to the NorthDakota State Board of Dental Examiners. Dr. Fishpaw, a practicing generaldentist in Minot, North Dakota began his journey with the Board in 1996 andserved the Board in numerous capacities completing his latest term in March2006. In the examination community Dr. Fishpaw is highly respected and waselected in March 2006 by his examining colleagues to serve as President Electfor the Central Regional Dental Testing Service (CRDTS). His commitment toserve has been exemplary. He advocates for fairness to the candidates withinthe ongoing journey toward independent third party testing, while alwaysremaining mindful of maintaining public protection. The NDSBDE extendsits most sincere appreciation and gratitude for Dr. Fishpaw’s many hoursof generous dedication to maintaining standards that ensure the quality ofdentistry for the citizens of North Dakota.MISSION STATEMENTThe Mission of the North Dakota State Board of Dental Examiners isto protect the dental health of the citizens of North Dakota by regulatingthe practice of dentistry and dental hygiene through the enforcementof laws, rules and policies. The board requires competency and ethicalbehavior in all areas of the practice of dentistry.CHANGE OF ADDRESSPursuant to North Dakota Century Code and Administrative Rule,licensed and registered dentists, hygienists and registered dentalassistants shall notify the Executive Director of the Board withinthirty days of a new address. Such licensed and registered dentist orhygienist may not practice dentistry in the state for more than thirtywithout giving such notice. A dentist must provide a new businessaddress. A registered dental hygienists or a registered dental assistant isrequired to provide a new mailing address as well. Failure to providethis information to the board can result in loss of registration of licenseor penalty. You may send all correspondence to:North Dakota State Board of Dental ExaminersPO Box 7246Bismarck, ND 58507-7246NEXT BOARD MEETINGJanuary 12th, 2007 9:00 a.m.Bismarck, NDPage