Guide to California Dental Practice Act Compliance PDF
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This guide provides a summary of the California Dental Practice Act, organized alphabetically by subject. It covers topics such as academic degrees, acupuncture, advertising, continuing education, and more.
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California Dental Association 1201 K Street, Sacramento, CA 95814...
California Dental Association 1201 K Street, Sacramento, CA 95814 800.232.7645 | cda.org Your Guide to California Dental Practice Act Compliance The California Dental Association is pleased to provide a guide that is intended for use by dentists and allied dental health professionals to assist them in complying with the California Dental Practice Act. This guide summarizes portions of the Dental Practice Act and organizes information in alphabetical order by subject. Citations are provided to the appropriate Business & Professions Code (B&P), Health & Safety Code (H&S) and to the California Code of Regulations Title 16 (CCR 16) sections. For details on license and permit requirements, educational requirements, fees, timelines, citations, license suspension or revocations, disciplinary guidelines, descriptions of disciplinary actions, appeals process and exact language of the law, please refer to the websites of the Dental Board of California (dbc.ca.gov) and the Dental Hygiene Board of California (dhcc.ca.gov/). Links to laws and regulations are found at the following sites: Business & Professions Code Health & Safety Code California Codes (statutes) California Code of Regulations, Title 16, Division 10 Dental Board of California The Dental Hygiene Board of California (DHBC) has primary responsibility for licensing dental hygienists and approving dental hygiene educational programs. The Dental Board of California is responsible for the licensing of dental assistants and approval of dental assisting educational programs in addition to the licensing of dentists and enforcement. A Dental Assisting Council (DAC) considers all matters relating to dental assistants in the state and makes recommendation to the dental board. New and revised sections of this guide are noted with an asterisk (*) in the table of contents. Copyright © 2008 - 2022 California Dental Association Guide to California Dental Practice Act Compliance | Page 2 of 50 Table of Contents Academic Degree.................................................................................................................................... 6 Acupuncture........................................................................................................................................... 6 Employment of Acupuncturist.................................................................................................................................... 6 Engaging in the Practice of Acupuncture..................................................................................................................... 6 Address Change..................................................................................................................................... 7 Adverse-Event Reporting........................................................................................................................ 7 Advertising and Marketing..................................................................................................................... 7 False, Fraudulent, Misleading or Deceptive Statements, Images or Claims...................................................................... 7 Group Advertising and Referral Services.................................................................................................................... 9 Online Advertising Services...................................................................................................................................... 9 Fee Advertising....................................................................................................................................................... 9 Academic Degree and License.................................................................................................................................. 9 Advertising Discounts............................................................................................................................................... 9 Denture Advertising............................................................................................................................................... 10 Press/Media Compensation................................................................................................................................... 10 Specialty Advertising............................................................................................................................................. 10 Continuing Education............................................................................................................................ 10 Requirements for Licensees *.................................................................................................................................. 10 What is Eligible for C.E. Credit? *.......................................................................................................................... 10 What is NOT Eligible for C.E. Credit?...................................................................................................................... 12 C.E. Certificates.................................................................................................................................................... 12 Out-of-State Courses.............................................................................................................................................. 13 Correspondence or Non-live Courses........................................................................................................................ 13 Units Required for License/Permit Renewal................................................................................................................ 13 Dentists renewing a license for the first time.............................................................................................................. 13 Moderate sedation permit...................................................................................................................................... 13 General anesthesia and deep sedation.................................................................................................................... 13 Oral conscious sedation for adult patients................................................................................................................ 13 Credit/Financing Offered to Patients..................................................................................................... 14 Criminal and Disciplinary Proceedings.................................................................................................. 15 Dental Corporations............................................................................................................................. 15 Additional Offices................................................................................................................................................. 15 Corporation Name................................................................................................................................................ 15 Estate of Deceased or Incapacitated Dentist.............................................................................................................. 15 Liability................................................................................................................................................................ 16 Ownership........................................................................................................................................................... 16 Guide to California Dental Practice Act Compliance | Page 3 of 50 Professional Responsibility...................................................................................................................................... 16 Dental Facilities.................................................................................................................................... 16 Dental Materials Fact Sheet................................................................................................................... 17 Denture Identification........................................................................................................................... 17 Disciplinary Guidelines......................................................................................................................... 17 Disciplinary Proceedings, Statute of Limitations..................................................................................... 17 Discounts.............................................................................................................................................. 18 Advertising Discounts............................................................................................................................................. 18 Discounts for Patients Without Insurance Coverage.................................................................................................... 18 Employment of Dentists, Dental Auxiliaries and Others......................................................................... 18 Estate of Deceased or Incapacitated Dentist.............................................................................................................. 19 Requirements of the Dentist Supervising/Employing a Dental Assistant......................................................................... 19 Written Orders to Dental Technicians........................................................................................................................ 20 Fictitious Name Permit.......................................................................................................................... 20 Fraud................................................................................................................................................... 20 Insurance............................................................................................................................................................. 20 Fee...................................................................................................................................................................... 20 License................................................................................................................................................................. 21 Dental Degree...................................................................................................................................................... 21 General Anesthesia and Deep Sedation Permit *................................................................................... 21 Pediatric Endorsement............................................................................................................................................ 22 Patient Monitoring................................................................................................................................................. 22 Minor Patient Written Informed Consent................................................................................................................... 23 Report of Patient Hospitalization or Death................................................................................................................ 23 Impairment, Physical or Mental............................................................................................................ 23 Infection Control................................................................................................................................... 24 Informed Consent................................................................................................................................. 24 Judgments and Settlements, Reporting................................................................................................. 24 Licenses................................................................................................................................................ 25 Inactive Licenses and Reactivation............................................................................................................................ 25 Retired License...................................................................................................................................................... 26 Disabled Dentist.................................................................................................................................................... 26 Military/National Guard Service *.......................................................................................................................... 26 Military Spouse or Partner, Temporary License.......................................................................................................... 26 Expired License..................................................................................................................................................... 27 Mental or Physical Illness *..................................................................................................................................... 27 Patient Notification of License and Academic Degree................................................................................................ 27 Health Care Practitioner Information........................................................................................................................ 27 Temporary State License for Health Care Volunteers.................................................................................................. 28 Guide to California Dental Practice Act Compliance | Page 4 of 50 Tribal Health Programs........................................................................................................................................... 28 Reservists............................................................................................................................................................. 28 Prohibitions.......................................................................................................................................................... 28 Mobile Dental Clinics............................................................................................................................ 29 Moderate Sedation Permit *.................................................................................................................. 29 Pediatric Endorsement............................................................................................................................................ 30 Patient Monitoring................................................................................................................................................. 30 Name Change...................................................................................................................................... 31 Name Tags........................................................................................................................................... 31 Nitrous Oxide *.................................................................................................................................... 32 Nonprofit Organization Practicing Dentistry.......................................................................................... 32 Notice of Licensure............................................................................................................................... 33 Oral Conscious Sedation for Adult Patients Permit *.............................................................................. 33 Oral Surgery Permit............................................................................................................................. 34 Ownership of a Dental Practice............................................................................................................. 34 Patient Records.................................................................................................................................... 34 Dental Board Request............................................................................................................................................ 34 Electronic Records.................................................................................................................................................. 34 Estate of Deceased or Incapacitated Dentist............................................................................................................... 34 Patient Access to Records........................................................................................................................................ 35 Record Retention................................................................................................................................................... 35 Treatment Entries................................................................................................................................................... 35 Patients................................................................................................................................................ 36 Communication of Disciplinary Action...................................................................................................................... 36 Death or Incapacitation of a Dentist......................................................................................................................... 36 Diagnosis, Prescription and Treatment...................................................................................................................... 36 Discrimination....................................................................................................................................................... 36 Illness or Death of a Patient.................................................................................................................................... 36 Informed Consent.................................................................................................................................................. 37 Patient Abandonment............................................................................................................................................. 37 Patient of Record................................................................................................................................................... 37 Sexual Abuse and Misconduct................................................................................................................................. 38 Threats or Harassment........................................................................................................................................... 38 Pediatric Minimal Sedation Permit *...................................................................................................... 38 Place of Practice................................................................................................................................... 38 Portable Dental Units............................................................................................................................ 39 Prescriptions, Controlled Substances and Other Drugs........................................................................... 39 Agent of Prescriber................................................................................................................................................ 39 Authority and Scope of Prescription.......................................................................................................................... 39 Guide to California Dental Practice Act Compliance | Page 5 of 50 Controlled Substances and CURES *....................................................................................................................... 39 Controlled Substance Prescriptions and Minor Patients............................................................................................... 40 Excessive Prescribing or Administering of Drugs........................................................................................................ 40 Fraud................................................................................................................................................................... 40 Impairment/Convictions......................................................................................................................................... 41 Naloxone............................................................................................................................................................. 41 Prescriber Dispensing............................................................................................................................................. 41 Samples............................................................................................................................................................... 42 Prescription (Written Authorization) to a Dental Lab.............................................................................. 42 Quality of Care..................................................................................................................................... 42 Radiation Safety................................................................................................................................... 42 Rebates and Refunds............................................................................................................................ 43 Compensation or Inducement for Referrals................................................................................................................ 43 Refund of Duplicate Payment.................................................................................................................................. 43 Referrals and Referral Services............................................................................................................. 44 Referral Services................................................................................................................................................... 44 Referrals to Other Organizations............................................................................................................................. 44 Scope of Practice.................................................................................................................................. 45 Dentistry............................................................................................................................................................... 45 Oral and Maxillofacial Surgery............................................................................................................................... 46 Cosmetic Procedures *........................................................................................................................................... 46 Sleep Apnea *...................................................................................................................................................... 46 Venipuncture *..................................................................................................................................................... 46 Dental Assisting..................................................................................................................................................... 46 Dental Hygiene *.................................................................................................................................................. 47 Supervision of Dental Auxiliaries and Posting of Dental Auxiliary Duties....................................................................... 49 Telehealth *.......................................................................................................................................... 50 Guide to California Dental Practice Act Compliance | Page 6 of 50 Academic Degree See also Licenses and Name Tags Every dental licensee must communicate to a patient their name, license type and highest level of academic degree by one or both of the following methods: (1) In writing at the patient’s initial office visit. (2) In a prominent display in an area visible to patients in their place of practice. If method #No. 1 is chosen, the required information must be presented in 24-point type in the following format: Health Care Practitioner Information (1) Name and license type. (2) Highest level of academic degree. (3) Board certification, where applicable. This same information must also be prominently displayed on a website that is directly controlled or administered by the licensee or their staff. This law does not apply to a person working in a facility licensed under Section 1250 of the Health and Safety Code (includes hospitals and skilled nursing facilities) (B&P 680.5). Comply with the requirement to notify patients of clinical staff names, licenses and academic degrees by following these three actions: (1) Clinical staff wear name tags or have license or certificate posted. (2) Prominently post the name, license type and highest level of academic degree of each licensed individual or provide the information in writing in 24-point type to the patient at the initial visit. (3) Prominently display the name, license type and highest level of academic degree of each licensed individual on the practice website. Acupuncture Employment of Acupuncturist A licensed dentist, group of dentists or dental corporation shall not share in any fee charged by a person for performing acupuncture or receive anything of value from or on behalf of such acupuncturist for any referral or diagnosis. A licensed dentist shall not employ more than one person to perform acupuncture services. A group of dentists or a dental corporation shall not employ more than one person to perform acupuncture services for every 20 dentists in such group or corporation (B&P 1626.5). Directing or supervising the performance of acupuncture or performing acupuncture except as licensed pursuant to the Acupuncture Licensure Act is unprofessional conduct (B&P 730.5). Engaging in the Practice of Acupuncture A dentist who has successfully completed a course of instruction that complies with the requirements of California Code of Regulations Title 16 §1064 may engage in the practice of acupuncture only as part of the practice of dentistry. Guide to California Dental Practice Act Compliance | Page 7 of 50 Address Change All licensees must notify the dental board within 30 days of any new place of practice (B&P 136). Adverse-Event Reporting A licensee must report the following to the dental board, or DHBC if applicable, within seven days of: The death of their patient during the performance of any dental or dental hygiene procedure. The discovery of the death of a patient whose death is related to a dental or dental hygiene procedure performed by the dentist, dental hygienist, dental hygienist in extended functions or dental hygienist in alternative practice. Except for scheduled hospitalization, the removal to a hospital or emergency center for medical treatment exceeding 24 hours of any patient to whom oral conscious sedation, conscious sedation or general anesthesia was administered or any patient as a result of dental or dental hygiene treatment. With the exception of patients to whom oral conscious sedation, conscious sedation or general anesthesia was administered, removal to a hospital or emergency center that is the normal or expected treatment for the underlying dental condition is not required to be reported. A dentist must report to the dental board, using a form provided by the board, all deaths occurring in their practice. A dentist must send a copy of the report to the DHBC if the death was the result of treatment by a registered dental hygienist, registered dental hygienist in alternative practice or registered dental hygienist in extended functions. A registered dental hygienist, registered dental hygienist in alternative practice or registered dental hygienist in extended functions must report to the DHBC all deaths occurring as the result of dental hygiene treatment and a copy of the notification sent to the dental board. The dental board may conduct an inspection upon receipt of the report. The requirement to report an adverse event in a dental facility also is applicable to a physician anesthesiologist (B&P 1680(z)). Advertising and Marketing “Advertising” or “advertisement” is defined as any written or printed communication for the purpose of soliciting, describing or promoting a dentist’s licensed activities; any directory listing caused or permitted by a dentist that indicates their licensed activity; any radio, television or airwave or electronic transmission that solicits or promotes the dentist’s practice; or any printing or writing on novelty objects or dental care products. It does NOT include the following: any printing or writing used on buildings or uniforms where the purpose of the writing is for identification or any printing or writing on memoranda or other communications used in the ordinary course of business other than for solicitation or promotion of the dentist’s practice (CCR 16 Section 1054.3). Advertising by a licensee may include the following: (1) A statement of the name of the practitioner. (2) A statement of addresses and telephone numbers of the offices maintained by the practitioner. (3) A statement of office hours regularly maintained by the practitioner. (4) A statement of languages, other than English, fluently spoken by the practitioner or a person in the practitioner’s office. (5) A statement that the practitioner is certified by a private or public board or agency or a statement that the practitioner limits their practice to specific fields. (B&P 651(h)) False, Fraudulent, Misleading or Deceptive Statements, Images or Claims It is unlawful for any licensee to disseminate or cause to be disseminated any form of public communication containing a false, fraudulent, misleading or deceptive statement, claim or image for the purpose of or likely to induce, directly or indirectly, the Guide to California Dental Practice Act Compliance | Page 8 of 50 rendering of professional services or furnishing of products in connection with the professional practice. “Public communication” includes, but is not limited to, communication by means of mail, television, radio, motion picture, newspaper, book, list or directory of healing arts practitioners, internet or other electronic communication (B&P 651). A false, fraudulent, misleading; or deceptive statement, claim or image includes a statement or claim that does any of the following: (1) Contains a misrepresentation of fact. (2) Is likely to mislead or deceive because of a failure to disclose material facts. (3) Is intended or is likely to create false or unjustified expectations of favorable results, including the use of any photograph or other image that does not accurately depict the results of the procedure being advertised or that has been altered in any manner from the image of the actual subject depicted in the photograph or image. (4) Uses any photograph or other image of a model (that is, anyone other than an actual patient of the advertising dentist) without clearly stating in a prominent location in easily readable type the fact that the photograph or image is of a model. (5) Uses any photograph or other image of an actual patient that depicts or purports to depict the results of any procedure, or presents “before” and “after” views of a patient, without specifying in a prominent location in easily readable type size what procedures were performed on that patient. Any “before” and “after” views shall be comparable in presentation so that the results are not distorted by favorable poses, lighting or other features of presentation and shall contain a statement that the same “before” and “after” results may not occur for all patients. (6) Relates to fees, other than a standard consultation fee or a range of fees for specific types of services, without fully and specifically disclosing all variables and other material factors. (7) Contains other representations or implications that in reasonable probability will cause an ordinarily prudent person to misunderstand or be deceived. (8) Makes a claim either of professional superiority or of performing services in a superior manner, unless that claim is relevant to the service being performed and can be substantiated with objective scientific evidence (also see B&P 1680(i)). (9) Makes a scientific claim that cannot be substantiated by reliable, peer-reviewed, published scientific studies. (10) Includes any statement, endorsement; or testimonial that is likely to mislead or deceive because of a failure to disclose material facts. (B&P 651(b)) A licensee may not use any professional card, professional announcement card, office sign, letterhead, telephone directory listing, medical list, medical directory listing or a similar professional notice or device if it includes a statement or claim that is false, fraudulent, misleading or deceptive (B&P 651(e)). The use of any false, assumed or fictitious name, or any name other than the name under which a dentist is licensed to practice or has a valid permit for, in advertising is considered unprofessional conduct (B&P 1680(f)). The use of any advertising statements of character tending to deceive or mislead the public is unprofessional conduct (B&P 1680(h)) It is unprofessional conduct to advertise a guarantee that any dental service or dental operation will be performed painlessly (B&P 1680(l)). Guide to California Dental Practice Act Compliance | Page 9 of 50 Group Advertising and Referral Services It is unprofessional conduct to participate in group advertising and referral services that violate the law. See section on Referral Services and Referrals (B&P 1680 (aa)). Online Advertising Services It is not considered a referral of patients when a licensee offers or sells services through a third-party advertiser that does not itself recommend, endorse or otherwise select a licensee on behalf of a consumer. This provision allows dental practices to advertise through Groupon and other similar services. The law requires that the fee paid to the third-party advertiser be commensurate with the service provided by the advertiser. The licensee must disclose in the advertisement that a consultation is required and that the purchaser will receive a refund if they are not eligible to receive the service. In any advertisement offering a discount price for a service, the licensee must also disclose the regular, nondiscounted price for that service. If the licensee determines, after consultation with the purchaser of the service, that the service is not appropriate for the purchaser or if the purchaser elects not to receive the service for any reason and requests a refund, the purchaser shall receive a refund of the full purchase price as determined by the terms of the advertising service agreement between the advertiser and the licensee. The third-party advertiser must be able to show that the licensee consented in writing to the requirements described here and must make available to prospective purchasers advertisements for services of all licensees advertising with the advertiser in the applicable geographic region. This provision is not applicable to advertisements of “basic health care services” or “essential health benefits,” such as pediatric oral health care, as defined by law (B&P 650 (g)). Fee Advertising Any fee advertisement shall be exact, without the use of phrases, including, but not limited to, “as low as,” “and up,” “lowest prices” or words or phrases of similar import. Any advertisement that refers to services or costs for services and that uses words of comparison shall be based on verifiable data substantiating the comparison. Any advertising shall be prepared to provide information sufficient to establish the accuracy of that comparison. Fee advertising shall not be fraudulent, deceitful or misleading, including statements or advertisements of bait, discount, premiums, gifts or any statements of a similar nature. In connection with fee advertising, the fee for each product or service shall be clearly identifiable. The fee advertised for products shall include charges for any related professional services, including dispensing and fitting services, unless the advertisement specifically and clearly indicates otherwise. Fee advertising for a dental service must fully disclose all services customarily included by the dental profession as part of the advertised service, including but not limited to necessary diagnosis, radiographs, restorative treatment, drugs, local anesthesia or analgesia, materials, laboratory fees and postoperative care. The advertisement must also disclose any additional services that are not part of the procedure but for which the patient will be charged, together with the fees for such services (B&P 651(c) and CCR 16 Section 1050). Academic Degree and License A dental practice website that is directly controlled or administered by the licensee or their staff must have displayed prominently on the website the name, license type, highest level of academic degree and board certifications, where applicable, of all who work at the practice (B&P 680.5). Advertising Discounts The advertisement of a discount must: List the dollar amount of the nondiscounted fee for the service. List either the dollar amount of the discount fee or the percentage of the discount for the specific service. Inform the public of the length of time the discount will be honored. List verifiable fees. Identify specific groups that qualify for the discount or any other terms, conditions or restrictions for qualifying for the discount. (CCR 16 Section 1051) Guide to California Dental Practice Act Compliance | Page 10 of 50 Denture Advertising Advertising of dentures must include whether the dentures are preformed or custom made and, in the case of “immediate dentures,” details of (including charges for) later relines or other necessary procedures. Advertising may include fees for various grades of dentures, providing that potentially misleading descriptive phrases are not used and the advertising discloses the variables (CCR 16 Section 1053). Press/Media Compensation A licensee shall not compensate or give anything of value to a representative of the press, radio, television or other communication medium in anticipation of, or in return for, professional publicity unless the fact of compensation is made known in that publicity (B&P 651(d)). Specialty Advertising Limitations on specialty advertising were removed with the passage of legislation in 2011. However, other advertising rules still apply to specialty advertising. Violations of Business & Professions Code Section 651 on advertising can be charged as misdemeanors and may subject the licensee to disciplinary action. Continuing Education Requirements for Licensees * For each licensure period of two years, licensees must take 2 units of a dental board-approved course in the California Dental Practice Act, 2 units of a dental board-approved course on infection control and a basic life support course that meets the requirements of the dental board. The requirement for mandatory courses also applies to unlicensed dental assistants who renew a specialty permit in orthodontics or sedation. Starting Jan. 1, 2023, dentists must complete in each licensure renewal period a board-approved 2-unit course in the responsibilities and requirements of prescribing Schedule II opioid drugs. The employer of a dental assistant is responsible for ensuring that the dental assistant maintains certification in basic life support (B&P 1750(d)). What is Eligible for C.E. Credit? * Courses of study for which continuing education credit may be earned include: Courses in preventive services, diagnostic protocols and procedures (including physical evaluation, radiography, dental photography) and comprehensive treatment planning, charting of the oral conditions, informed consent protocols and record-keeping. Courses dealing primarily with nutrition and nutrition counseling of the patient. Courses in esthetic, corrective and restorative oral health diagnosis and treatment. Courses in dentistry’s role in individual and community health emergencies, disasters and disaster recovery. Courses that pertain to the legal requirement governing the licensee in the areas of auxiliary employment and delegation of responsibilities; the Health Insurance Portability and Accountability Act (HIPAA) and actual delivery of care. Courses pertaining to federal, state and local regulations, guidelines or statutes regarding workplace safety, fire and emergency, environmental safety, waste disposal and management, general office safety, sexual harassment prevention and all training requirements set forth by the California Division of Occupational Safety and Health (Cal-/DOSH) including the Bloodborne Pathogens Standard. Courses pertaining to the administration of general anesthesia, conscious sedation, oral conscious sedation or medical emergencies. Guide to California Dental Practice Act Compliance | Page 11 of 50 Courses pertaining to the evaluation, selection, use and care of dental instruments, sterilization equipment, operatory equipment and personal protective attire. Courses in dependency issues and substance abuse such as alcohol and drug use as it relates to patient safety, professional misconduct, ethical considerations or malpractice. Courses in behavioral sciences, behavior guidance and patient management in the delivery of care to all populations including special needs, pediatric and sedation patients when oriented specifically to the clinical care of the patient. Courses in the selection, incorporation and use of current and emerging technologies. Courses in cultural competencies such as bilingual dental terminology, cross-cultural communication, provision of public health dentistry and the dental professional’s role in provision of care in nontraditional settings when oriented specifically to the needs of the dental patient and will serve to enhance the patient experience. Courses in dentistry’s role in individual and community health programs. Courses pertaining to the legal and ethical aspects of the insurance industry, to include management of third-party payer issues, dental billing practices, patient and provider appeals of payment disputes and patient management of billing matters. Continuing education credit may be earned up to a maximum of 20 percent of the total units required for license renewal for courses in the following areas considered to be primarily of benefit to the licensee: Courses to improve recall and scheduling systems, production flow, communication systems and data management. Courses in organization and management of the dental practice including business planning and operations, office computerization and design, ergonomics and the improvement of practice administration and office operations. Courses in leadership development and team development. Coursework in teaching methodology and curricula development. Coursework in peer evaluation and case studies that include reviewing clinical evaluation procedures, reviewing diagnostic methods, studying radiographic data, study models and treatment planning procedures. Courses in human resource management and employee benefits. Only courses offered by dental board-approved continuing education providers, ADA CERP providers and AGD PACE providers may be eligible for continuing education credit as long as the courses comply with the dental board’s regulations. Requirements of dental board-approved continuing education providers can be found in CCR 16 Section 1016. The dental board will consider, upon petition, courses offered by other providers for continuing education credit. Current and active licensees enrolled in a full-time dental educational program, including a dental school program, residency program, postdoctoral specialty program, dental hygiene school program, dental hygiene in alternative practice program or registered dental assisting in extended functions program approved by the dental board or the ADA Commission on Dental Accreditation, can earn continuing education credits for completed curriculum during that renewal period. Current and active dental sedation assistant and orthodontic assistant permit holders enrolled in a full-time dental hygiene school program, dental assisting program or registered dental assisting in extended functions program approved by the dental board or the ADA Commission on Dental Accreditation can earn continuing education credits for completed curriculum during that renewal period. In the event of audit, both licensees and assisting permit holders must provide school transcripts to the committee or dental board as evidence of enrollment and course completion. Continuing education credit may be earned, up to a maximum of 20 percent of the total units required for license renewal, for participation in certain dental board activities. The dental board will issue to participants a certificate that contains the date, Guide to California Dental Practice Act Compliance | Page 12 of 50 time, location, authorizing signature, 11-digit course registration number and the number of units conferred for each activity consistent with all certificate requirements. Credit may be earned for: Participation in any Dental Board of California or Western Regional Examination Board (WREB) administered examination including attendance at calibration training, examiner orientation sessions and examinations. Participation in any site visit or evaluation relating to issuance and maintenance of a general anesthesia, conscious sedation or oral conscious sedation permit. Participation in any calibration training and site evaluation training session relating to general anesthesia, conscious sedation or oral conscious sedation permits. Participation in any site visit or evaluation of an approved dental auxiliary program or dental auxiliary course. Starting Jan. 1, 2023, up to 3 units of continuing education credit may be earned by licensees who provide direct patient care as an unpaid volunteer at a free public health care event or non-profit community health clinic. One unit of credit is issued per hour of volunteer services and can be issued in half hour increments. What is NOT Eligible for C.E. Credit? Continuing education credit will not be allowed for: Courses in money management, the licensee’s personal finances or personal business matters, such as financial planning, estate planning and personal investments. Courses in general physical fitness, weight management or the licensee’s personal health. Presentations by political or public figures or other persons that do not deal primarily with dental practice or issues impacting the dental profession. Courses designed to make the licensee a better business person or designed to improve licensee personal profitability, including motivation and marketing. Courses pertaining to the purchase or sale of a dental practice, business or office; courses in transfer of practice ownership, acquisition of partners and associates, practice valuation, practice transitions or retirement. Courses pertaining to the provision of elective facial cosmetic surgery as defined by the Dental Practice Act, unless the licensee has a special permit obtained from the dental board to perform such procedures. Additionally, the maximum number of units that can be earned in a day is eight (8), even if a licensee is able to attend courses for more than eight hours in a day. C.E. Certificates To renew a license, a licensee provides a summary of C.E. units earned on a dental board-approved form. Each licensee must retain C.E. certificates for at least three renewal periods. If requested by the board, the licensee shall submit the certificates to the board. Individual licensees are responsible for obtaining C.E. certificates from course providers when original certificates are lost. Course providers may issue duplicate certificates only to licensees whose names appear on the provider’s roster of course attendees. The certification shall be clearly marked “duplicate” and shall contain the licensee’s name, as well as the provider’s name, course registration number, dates attended and units earned. Any licensee who furnishes false or misleading information to the board regarding his continuing education units shall be subject to disciplinary action. The board will audit licensee records as it deems necessary to assure that the continuing education requirements are met (CCR 16 Section 1017(f)). Guide to California Dental Practice Act Compliance | Page 13 of 50 Out-of-State Courses A licensee who attends a course or program that meets all requirements for continuing education courses but was administered outside California by an unregistered provider may request continuing education credit by submitting information on course content and duration to the board and furnishing evidence from the course provider that the licensee was in attendance. In the case of a scientific meeting or convention, such evidence shall indicate that the licensee attended the specific lecture for the credit requested. When the necessary requirements have been fulfilled, the board may issue a written certification that the licensee may then use for documentation of continuing education credits. Correspondence or Non-live Courses Credit for tape-recorded courses, home study materials, video courses and computer courses offered by registered continuing education providers are acceptable for no more than one-half of the units required for license renewal. Full credit is allowed for interactive instruction courses such as live lectures, live telephone conferencing, live video conferencing or live classroom study offered by registered providers. Units Required for License/Permit Renewal Dentists Dentist – 50 units Disabled Dentist – 0 units during the renewal period he or she is disabled. A disabled dentist is one who has not practiced in the state for more than one year because of the disability. Retired/Inactive Dentist – 0 units Retired/Active Dentist – 30 units as of Jan. 1, 2023 A retired dentist qualifies for a reduced license renewal fee and is a dentist who Has practiced dentistry in California for 20 years or more. Has reached the age of retirement under the federal Social Security Act. A retired active dentist provides clinical services free of charge or for a nominal amount as required by the board. Dentists renewing a license for the first time are exempt from continuing education requirements. Dentists holding certain permits are required to meet specific continuing education requirements. These specified hours may be included in the total number of units required for license renewal. Moderate sedation permit renewal requires completion of 15 hours of courses related to the administration of conscious sedation and to medical emergencies. If the permit holder has a pediatric endorsement, additional requirements must be met for permit renewal. General anesthesia and deep sedation permit renewal requires completion of 24 hours of courses related to general anesthesia or deep sedation. If the permit holder has a pediatric endorsement, continued competency requirements must be met for permit renewal. Oral conscious sedation for adult patients permit renewal requires completion of seven (7) hours of approved courses related to oral conscious sedation of adult patients. Dental Auxiliaries Registered Dental Assistant, RDA – 25 units -- As of Jan. 1, 2006, must provide evidence of successful completion of board-approved courses in radiation safety and coronal polishing (B&P 1645.1). Guide to California Dental Practice Act Compliance | Page 14 of 50 Registered Dental Assistant in Extended Functions, RDAEF – 25 units Unlicensed Dental Assistant With a Dental Sedation Permit – 25 units Unlicensed Dental Assistant With an Orthodontic Permit – 25 units Registered Dental Hygienist, RDH – 25 units Registered Dental Hygienists in Extended Functions, RDHEF – 25 units Registered Dental Hygienists in Alternative Practice, RDHAP – 35 units (CCR 16 Sections 1016 and 1017) A licensee who holds another dental license or a dental assistant specialty permit is not required to maintain separate continuing education credits for renewal of each license or permit. In other words, the continuing education credits earned during a license renewal period can apply to renewal of both license and/or permit. Renewal of a license or permit requires payment of separate renewal fees. For example, a registered dental assistant with a sedation permit would pay the two separate fees. The DBC and DHBC are required to conduct random audits of at least 5 percent of the licensee population each year to ensure compliance of the continuing education requirement. Credit/Financing Offered to Patients Prior to arranging for or establishing a commercial credit card, line of credit or loan for a patient in the dental office (the law does not apply to credit established by patients on their own, outside the dental office or to financing arrangements made directly between the dental office and the patient without involving a commercial third party): (1) The dentist must provide patient with a written treatment plan which details each anticipated service to be provided and the estimated cost of each service. If a patient is covered by a private or government dental benefit plan or dental insurance from which the dentist takes assignment of benefits, the treatment plan shall indicate the patient’s private or government-estimated share of cost for each service. If the dentist does not take assignment of benefits from a patient’s dental benefit plan or insurance, the treatment plan shall indicate that the treatment may or may not be covered by a patient’s dental benefit or insurance plan and that the patient has the right to confirm dental benefit or insurance information from the patient’s plan, insurer or employer before beginning treatment. (2) The dentist, or their staff, must obtain the patient’s signature on a specified written disclosure notice. A sample of the required notice is included in a zip file, California Commercial Credit Law, available on cda.org/practicesupport. The required notice must be offered in the primary language in which the dentist or staff members are communicating with the patient (limited to the following languages – English, Chinese, Hmong, Russian, Spanish and Vietnamese). The notice explains in detail the nature of the credit product being offered and the patient’s rights and responsibilities with regard to that product. The notice, which may be printed on office letterhead, must appear on one page in at least 14-point type. Credit companies offering these products may make this sample form available to the dental office as well. (3) The dental office may only apply charges to a credit card or line of credit established in the office before the dentist has rendered or incurred the costs of the treatment being charged if the patient is first provided a specific list of services being paid for in advance and their estimated costs. This requirement can be met by providing the patient with a ledger statement or other form of receipt that includes these details. (4) The dental office may not arrange for or establish any of these credit products for a patient who has been administered or is under the influence of general anesthesia, conscious sedation or nitrous oxide. (5) The dentist must refund to the lender within 15 business days of a patient’s request any payment made through such a credit arrangement that was received for treatment not rendered or costs that have not been incurred. (B&P 654.3 and H&S 1395.7) Guide to California Dental Practice Act Compliance | Page 15 of 50 Criminal and Disciplinary Proceedings It is unprofessional conduct for a licensee to fail to report to the dental board within 30 days any of the following: (1) The bringing of an indictment or information charging a felony against the licensee. (2) The conviction of the licensee, including any verdict of guilty or pleas of guilty or no contest, of any felony or misdemeanor. (3) Any disciplinary action taken by another professional licensing entity or authority of this state or of another state or an agency of the federal government or the United States military. For the purposes of this section, “conviction” means a plea or verdict of guilty or a conviction following a plea of nolo contendere or “no contest” and any conviction that has been set aside or deferred pursuant to Sections 1000 or 1203.4 of the Penal Code, including infractions, misdemeanors and felonies. “Conviction” does not include traffic infractions with a fine of less than ($1,000) unless the infraction involved alcohol or controlled substances (CCR 1018.05). Dental Corporations A dental corporation is defined in Business & Professions Code Section 1800 as: “... a corporation that is authorized to render professional services, as defined in Sections 13401 and 13401.5 of the Corporations Code, if that corporation, its shareholders, officers, directors, and employees rendering professional services who are dentists, physicians and surgeons, dental assistants, registered dental assistants, registered dental assistants in extended functions, registered dental hygienists, registered dental hygienists in extended functions, or registered dental hygienists in alternative practice are in compliance with the Moscone-Knox Professional Corporation Act (Part 4 (commencing with Section 13400) of Division 3 of Title 1 of the Corporations Code), this article, and other statutes, rules, and regulations applicable to a dental corporation and the conduct of its affairs. Subject to all applicable statutes, rules, and regulations, a dental corporation is entitled to practice dentistry. With respect to a dental corporation, the governmental agency referred to in the Moscone-Knox Professional Corporation Act is the Dental Board of California.” Additional Offices A dental corporation is subject to the additional office requirements of Business & Professions Code Sections 1658 – 1658.8. A dental corporation that desires to have more than one place of practice shall, prior to opening any additional office, apply for and receive permission in writing from the board (CCR 16 Section 1057). Corporation Name Business & Profession Code Section 1804 states that: “Notwithstanding subdivision (i) of Section 1680 and subdivision (g) of Section 1701, the name of a dental corporation and any name or names under which it may be rendering professional services shall contain and be restricted (emphasis added) to the name or the last name of one or more of the present, prospective, or former shareholders and shall include the words ‘dental corporation’ or wording or abbreviations denoting corporate existence, unless otherwise authorized by a valid permit issued pursuant to Section 1701.5.” Estate of Deceased or Incapacitated Dentist Upon the death or incapacity of a dentist, an executor or administrator of the dentist’s estate, a legal guardian, conservator or authorized representative of the dentist or a trustee or successor trustee of a trust that owns a share of the deceased or incapacitated dentist’s dental corporation may employ licensed dentists and dental assistants and charge for their professional services for a period not to exceed 12 months from the date of death or incapacity of the dentist. The employment of licensed dentists and dental assistants shall not be deemed the practice of dentistry within the meaning of Business & Professions Code Section 1625 provided that all of the requirements of Section 1625.4 of the Business & Professions Code Guide to California Dental Practice Act Compliance | Page 16 of 50 are met. If the non-dentist dental corporation owner is employing licensed persons and dental assistants, the shares of the deceased or incapacitated dentist shall be transferred as provided by law no later than 12 months from the date of death or incapacity of the dentist (Corporations Code 13407). Liability When a dental corporation provides security by means of insurance for claims against it by its patients, the security shall consist of a policy or policies of insurance insuring either the corporation or all the employed licensed persons rendering such dental services against liability imposed by law for damages arising out of the rendering of or failure to render dental services by the corporation in an amount for each claim of at least $50,000 multiplied by the number of employed licensed persons rendering such dental services and an aggregate maximum limit of liability per policy year of at least $150,000 multiplied by the number of such employees, provided that the maximum coverage shall not be required to exceed $150,000 for each claim and $450,000 for all claims during the policy year and that the deductible portion of such insurance shall not exceed $5,000 multiplied by the number of such employees. All shareholders of the corporation shall be jointly and severally liable for all claims established against the corporation by its patients arising out of the rendering of or failure to render dental services up to the minimum amounts specified for insurance except during periods of time when either the corporation or all the employed licensed persons rendering dental services provide and maintain insurance for claims by its patients arising out of the rendering of or failure to render dental services. Said insurance when provided shall meet the minimum standards established above (CCR 16 Section 1059). Ownership The shares of a dental corporation may be owned only by a dental corporation or by licensed dentists, hereinafter referred to as eligible shareholders, provided, however, that no issuance or transfer of shares may be made that violates the provisions of Business & Professions Code Sections 1658 –1658.7. Where there are two or more shareholders in a dental corporation and one of the shareholders: (1) Dies; (2) Ceases to be an eligible shareholder; or (3) Becomes a disqualified person as defined in Section 13401(d) of the Corporations Code for a period exceeding 90 days Their shares shall be sold and transferred to the corporation, its shareholders or other eligible persons on such terms as are agreed upon. Such sale or transfer shall not be later than six months after any such death and not later than 90 days after the date he or she ceases to be an eligible shareholder or 90 days after the date he becomes a disqualified person. See California Code of Regulations Title 16 Section 1060 for additional requirements. Professional Responsibility Nothing in the laws or rules relating to dental corporations alters the dentist’s duties and responsibilities to and professional relationships with their patients. Nor do such laws or rules in any way impair the disciplinary powers of the board over its licensees or impair any other law or rule pertaining to the standards of professional conduct of dentists (CCR 16 Section 1055). Dental Facilities See these sections: Address Change Dental Corporations Fictitious Name Permit Guide to California Dental Practice Act Compliance | Page 17 of 50 General Anesthesia and Deep Sedation Permit Mobile Dental Clinics Moderate Sedation Permit Name Tags Oral Conscious Sedation for Adult Patients Permit Ownership Pediatric Minimal Sedation Permit Place of Practice Dental Materials Fact Sheet A dentist is required to provide a dental board-approved dental materials fact sheet to new patients and at least once to a patient before performing a restorative procedure. The dentist should obtain patient’s acknowledgement of receipt of the fact sheet and place the acknowledgement in the patient record. The current fact sheet is dated 2004. The fact sheet may not be altered but dentists may provide patients with supplemental information (B&P 1648.10-1648.20). Denture Identification Every complete upper or lower denture fabricated by a licensed dentist or fabricated pursuant to the dentist’s work order shall be marked with the patient’s name, unless the patient objects. The initials of the patient may be shown alone if use of the name of the patient is not practical. The markings shall be done during fabrication and shall be permanent, legible and cosmetically acceptable. The exact location of the markings and the methods used to implant or apply them shall be determined by the dentist or dental laboratory fabricating the denture. The dentist shall inform the patient that the markings are to be used for identification only and that the patient shall have the option to decide whether or not the dentures shall be marked. The dentist shall retain the records of those marked dentures and shall not release the records to any person except to enforcement officers in the event of an emergency requiring personal identification by means of dental records or to anyone authorized by the patient (B&P 1706). Disciplinary Guidelines The dental board has recommended guidelines for disciplinary orders and conditions of probation for violations of the DPA. The guidelines are intended for use by administrative law judges, attorneys and any licensee involved in settlement of disciplinary actions or statement of issues proceedings. The dental board seeks to ensure that the totality of facts and circumstances in each case is considered, with public safety being paramount, and to the extent not inconsistent with public protection, disciplinary actions shall be calculated to aid in the rehabilitation of the licensee. The disciplinary guidelines can be found online at http://www.dbc.ca.gov/formspubs/pub_dgml.pdf. Disciplinary Proceedings, Statute of Limitations The dental board can initiate a disciplinary proceeding within three years after the board discovers the act or omission alleged as the ground for disciplinary action or within seven years after the act or omission is alleged to have occurred, whichever occurs first. The exceptions to this limitation period are: a) An accusation alleging fraud or willful misrepresentation. Guide to California Dental Practice Act Compliance | Page 18 of 50 b) An accusation alleging unprofessional conduct based on incompetence, gross negligence or repeated negligent acts of the licensee, which includes proof that the licensee intentionally concealed from discovery their incompetence, gross negligence or repeated acts of negligence. c) An accusation that involves an alleged act of sexual abuse, misconduct or relations committed on a minor patient (statute of limitations does not apply until the minor reaches the age of majority). d) An accusation that involves an alleged act of sexual abuse, misconduct or relations committed on a patient who is not a minor. The dental board can act within three years after discovering the act or omission or within 10 years after the act or omission is alleged to have occurred, whichever occurs first. This paragraph only applies to complaints received by the dental board on or after Jan. 1, 2005. The limitations period does not apply during the period in which material evidence necessary for prosecuting or determining whether a disciplinary action would be appropriate is unavailable to the dental board due to an ongoing criminal investigation. (B&P 1670.2) Discounts Advertising Discounts The advertisement of a discount must: List the dollar amount of the nondiscounted fee for the service. List either the dollar amount of the discount fee or the percentage of the discount for the specific service. Inform the public of the length of time the discount will be honored. List verifiable fees. Identify specific groups that qualify for the discount or any other terms, conditions or restrictions for qualifying for the discount (CCR 16 Section 1051). Discounts for Patients Without Insurance Coverage State law authorizes a health care provider to grant discounts for health care to any patient the provider has reasonable cause to believe is not eligible for or is not entitled to insurance reimbursement, coverage under the Medi-Cal program or coverage by a health care service plan for the health care provided. Any discounted fee granted pursuant to this law shall not be deemed to be the provider’s usual, customary or reasonable fee for any other purposes including, but not limited to, any health care service plan contract or insurance contract (B&P 657(c)). For additional information on providing discounts to patients, refer to the CDA Legal Reference Guide, Chapter 6 - Collections and Dental Benefit Plans. Employment of Dentists, Dental Auxiliaries and Others For information on employing acupuncturists, see the section on Acupuncture. Any of the following entities may employ dentists and dental auxiliaries and charge for their services and shall not be deemed as practicing dentistry: A licensed primary care clinic. A primary care clinic exempt from licensure pursuant to the Health & Safety Code. A clinic owned or operated by a public hospital or health system. A clinic owned and operated by a hospital that maintains the primary contract with a county government to fill the county’s obligation under the Welfare & Institutions Code. A nonprofit corporation under the conditions described in B&P 1625.2. Guide to California Dental Practice Act Compliance | Page 19 of 50 These entities shall not interfere with or otherwise direct the professional judgment of a dentist or licensed dental auxiliary acting within their scope of practice (B&P 1625.1). It is unprofessional conduct to employ directly or indirectly any student or suspended or unlicensed dentist to practice dentistry (B&P 1680(b)). Employment of use of solicitors is unprofessional conduct (B&P 1680(j)). Discharging an employee primarily based on the employee’s attempt to comply with the Dental Practice Act is unprofessional conduct. Also, using threats or harassment against a licensee for providing evidence in any possible or actual disciplinary action or other action is unprofessional conduct (B&P 1680(q)). A dentist may not utilize any person to perform the functions of a licensed dental auxiliary unless the person possesses a current, valid license to perform those functions (B&P 1680(ae)). All dentists utilizing the services of dental auxiliaries shall post in a common area of the office a notice that delineates duties and functions deemed by the board as delegable within stipulated settings and/or circumstances (CCR 16 Section 1068). A dentist may simultaneously utilize in a practice no more than three registered dental assistants in extended functions or registered dental hygienists in extended functions. (Law changed allowance from two to three as of Jan. 1, 2010.) (B&P 1753.7) The names of every person employed in the practice of dentistry must be posted in a conspicuous place (B&P 1700 (c)). The dental board includes licensed dental auxiliaries as “practicing dentistry.” If demanded by the dental board, a list of the individuals practicing dentistry in the facility with names and addresses must be provided within 10 days (B&P 1700(d)). See also Academic Degree, Name Tags and Telehealth. Estate of Deceased or Incapacitated Dentist An executor or administrator of a dentist’s estate, a legal guardian, conservator or authorized representative of a dentist who is deceased or incapacitated or a trustee or successor trustee of a trust that owns a deceased or incapacitated dentist’s dental practice may employ one or more licensed dentists and dental auxiliaries and charge for professional services for not longer than 12 months after the dentist’s death or incapacity. The non-dentist owner of the practice shall not interfere with, control or otherwise direct the professional judgment of a licensed dental professional or dental assistant acting within respective scopes of practice. The non-dentist owner of the practice shall notify the dental board and provide required information or face immediate termination of the dental practice and be subject to a civil penalty (B&P 1625.3 & 1625.4). Requirements of the Dentist Supervising/Employing a Dental Assistant The supervising licensed dentist is responsible for determining the competency of an unlicensed dental assistant to perform basic supportive dental procedures. An employer is responsible for ensuring that the dental assistant, who has been in continuous employment for 120 days or more, has already successfully completed, or successfully completes, all of the following within a year of the date of employment: A board-approved course in the Dental Practice Act. An 8-hour board-approved course in infection control. A course in basic life support offered by an instructor approved by the American Red Cross or the AHA or any other course approved by the board as equivalent and that provides the student the opportunity to engage in hands-on simulated clinical scenarios. The employer must ensure that the dental assistant maintains certification in basic life support. Guide to California Dental Practice Act Compliance | Page 20 of 50 The dental assistant needs only to take the DPA and 8-hour infection control course once in the course of a career as long as the assistant can provide documentation of successfully completing the courses (B&P 1750). Written Orders to Dental Technicians A written authorization for the construction, making, verification of shade taking, alteration or repairing of bridges, crowns, dentures or other prosthetic appliances or orthodontic appliances, when the casts or impressions for this work have been made or taken by the licensed dentist, must be provided by a licensed dentist or the work shall be performed in the office of the licensed dentist under their supervision (B&P 1626(e)). Any written authorization issued by a licensed dentist shall include the following: (a) The date of its issuance. (b) A description of the work authorized by the dentist to be done by the technician. (c) The signature of the dentist issuing the written authorization. (d) The license number of the dentist issuing the written authorization.(CCR 16 Section 1063) Fictitious Name Permit A dentist may not practice under any false, assumed or fictitious name, either as an individual, firm, corporation or otherwise, or any name other than the name under which he or she is licensed, except with a permit from the dental board (B&P 1701(g)). Any association or partnership or corporation or group of three or more dentists may practice under a fictitious name if, and only if, the entity holds an outstanding, unexpired, unsuspended and unrevoked permit issued by the dental board. Requirements for the permit can be found on the dental board’s website (B&P 1701.5). Separate from the Dental Practice Act, the state also requires all for-profit businesses that use a fictitious business name to file a fictitious business name statement with the clerk of the county where the business is located. Such statement shall be filed no more than 40 days from the time the business starts transactions. Specific information is required in the statement, and the statement must be published in a general circulation newspaper within 30 days of filing the fictitious business name statement. The statement must be published once a week for four consecutive weeks or as otherwise allowed in Government Code Section 6064. An affidavit showing publication of statement must be filed with the county clerk within 30 days after the fourth publication of the statement. A fictitious name statement typically expires five years from the date it was filed. Other requirements on filing a fictitious name statement can be found in Business & Professions Code Sections 17900 -17930. A dentist considering the use of a fictitious name is advised to research the availability of names using the Department of Consumer Affairs license database at www.breeze.ca.gov as well as their county database. Fraud Insurance It is unprofessional conduct to do any of the following in connection with professional activities: Knowingly present or cause to be presented any false or fraudulent claim for the payment of a loss under an insurance contract. Knowingly prepare any writing with intent to present or allow it to be presented in support of any false or fraudulent claim. (B&P 810) Fee It is unprofessional conduct to obtain any fee by fraud or misrepresentation (B&P 1680(a)). Guide to California Dental Practice Act Compliance | Page 21 of 50 License It is unprofessional conduct to procure a license through use of fraud (B&P 1680(w)). Aiding or abetting any unlicensed person to practice dentistry and aiding or abetting any licensed person to practice dentistry unlawfully is unprofessional conduct (B&P 1680(c), (d)). The purchase or receipt of a fraudulent, forged or counterfeited license knowing that it is fraudulent, forged or counterfeited can be charged as a misdemeanor. “Fraudulent” means containing any misrepresentation of fact (B&P 119). Practicing dentistry or offering to practice dentistry without a license or when a license is suspended or revoked is a crime (B&P 1701(f) and 1701.1). A dentist may not practice under any false, assumed or fictitious name, either as an individual, firm, corporation or otherwise, or any name other than the name under which he licensed, except with a permit from the dental board (B&P 1701(g) and 1701.5). Dental Degree A licensee may not conspire with an unlicensed individual to violate any provision of the Business & Professions Code or intend to aid or assist that person in violating those provisions by either allowing their license to be used by the unlicensed individual or by acting as the unlicensed individual’s agent or partner (B&P 125). An individual may not append the letters DDS, DMD or DDSc to their name or assume the use of a dental degree that has not been conferred upon the individual by a recognized dental school. However, any person who holds a valid dental license may append the letters DDS to their name regardless of the degree conferred upon the individual (B&P 1700(a), 1700.5). An individual who sells, barters or offers to sell or barter any dental degree, license or dental school transcript may be charged with a misdemeanor or a felony. Purchasers or procurers of these items will have the activity used in evidence of the holder’s qualification to practice dentistry (B&P 1701 (a) and (b)). An individual who makes or attempts to make counterfeits of or alters in a material regard with fraudulent intent any diploma, certificate or transcript may be charged with a misdemeanor. An individual who knowingly uses the fraudulent documents may be charged with a misdemeanor (B&P 1701 (c) and (d)). General Anesthesia and Deep Sedation Permit * See also Moderate Sedation Permit, Oral Conscious Sedation for Adult Patients Permit and Pediatric Minimal Sedation Permit. (B&P 1646-1646.13) New laws in this area became effective Jan. 1, 2022. A dentist is required to have a general anesthesia permit before administering or ordering the administration of deep sedation or general anesthesia on an outpatient basis. The dentist must be physically within the dental office at the time of administration. A pediatric endorsement is required in order to administer or order the administration of deep sedation or general anesthesia to patients under seven years of age. A permit is not necessary, however, if the deep sedation or general anesthesia is directly administered by another licensed dentist or physician and surgeon who possesses a general anesthesia permit from the dental board (CCR 16 Section 1043.1). General anesthesia permit requirements for a dentist include: Successful completion of a minimum of one year of advanced training in anesthesiology and related academic subject or equivalent training or experience approved by the dental board. Guide to California Dental Practice Act Compliance | Page 22 of 50 Documentation that required equipment and drugs are at the dental office. Maintenance of medical history, physical evaluation and general anesthesia records. On-site inspection and evaluation at the discretion of the dental board. Requirements for the on-site inspection and evaluation are detailed in CCR 16 Sections 1043.3 and 1043.4. Renewal of a permit requires: Completion of 24 hours of approved courses of study related to deep sedation or general anesthesia. On-site inspection and evaluation every five years; it may be done at each permit renewal at the discretion of the dental board. Pediatric Endorsement A pediatric endorsement requires proof of successful completion of all of the following: A Commission on Dental Accreditation-accredited or equivalent residency training program that provides competency in the administration of deep sedation and general anesthesia on pediatric patients. At least 20 cases of deep sedation or general anesthesia to patients under seven years of age in the 24-month period directly preceding application for the pediatric endorsement. If an applicant for a pediatric endorsement lacks sufficient cases of deep sedation or general anesthesia, the applicant may administer deep sedation or general anesthesia to patients under seven years of age under the direct supervision of a general anesthesia permit holder with a pediatric endorsement. These cases may count toward the 20 required in order to qualify for the endorsement. Current certification in ACLS and pediatric advanced life support (PALS) or other board-approved training in pediatric life support and airway management. Renewal of a pediatric endorsement requires documentation of at least 20 cases of deep sedation or general anesthesia to patient under seven years of age in the 24-month period directly preceding renewal deadline. Documentation must be maintained for up to three permit renewal periods. A dentist is not authorized to administer or directly supervise the administration of general anesthesia or deep sedation for reasons other than dental treatment. A licensed physician or surgeon may administer general anesthesia in the office of any licensed dentist, with or without a general anesthesia permit, if the physician or surgeon holds a valid general anesthesia permit issued by the dental board (B&P 1646 – 1646.9). A violation of the laws regarding general anesthesia is unprofessional conduct (B&P 1646 – 1646.9, 1682). Patient Monitoring In offices where deep sedation or general anesthesia is administered, a dentist may not perform dental procedures on more than one patient undergoing deep sedation or general anesthesia on an outpatient basis unless each patient is being continuously monitored on a 1-to-1 ratio while sedated by either the dentist or another licensed health professional authorized to administer general anesthesia. Patients recovering from deep sedation or general anesthesia must be closely monitored by licensed health professionals experienced in the care and resuscitation of patients recovering from deep sedation or general anesthesia. If one licensed professional is responsible for the recovery care of more than one patient at a time, all of the patients shall be physically in the same room to allow continuous visual contact with all patients and patient-to-recovery-staff ratio should not exceed 3-to-1. Guide to California Dental Practice Act Compliance | Page 23 of 50 Patients undergoing deep sedation or general anesthesia must be continuously monitored during the dental procedure with a pulse oximeter or similar or superior monitoring equipment and ventilation continuously monitored using these two methods: (1) Auscultation of breath sounds using a precordial stethoscope. (2) Monitoring for the presence of exhaled carbon dioxide with capnography Any dental office personnel directly involved with the care of patients who are undergoing deep sedation or general anesthesia must hold current certification in basic cardiac life support. (B&P 1682) With patients under 13 years old, the operating dentist and at least two additional personnel must be present throughout the procedure. (1) If the operating dentist is the permitted anesthesia provider, then the operating dentist and at least one of the additional personnel must maintain current certification in PALS or other board-approved training in pediatric life support and airway management. The PALS-certified personnel must be solely dedicated to monitoring the patient. The PALS-certified personnel must be trained to read and respond to monitoring equipment including but not limited to pulse oximeter, cardiac monitor, and blood pressure. The operating dentist is responsible for initiating and administering any necessary emergency response. (2) If the operating dentist is not the anesthesia provider, then at least two of the three required personnel must maintain current certification in PALS. The anesthesia provider is responsible for initiating and administering any necessary emergency response and the operating dentist, or other trained and designated personnel, shall assist the anesthesia provider in emergency response. Minor Patient Written Informed Consent Prior to administering deep sedation or general anesthesia, a dentist must obtain written informed consent of a patient or, if the patient is a minor, the patient’s parent or guardian. The written informed consent for general anesthesia, in the case of a minor, shall include, but not be limited to, the following information: “The administration and monitoring of deep sedation or general anesthesia may vary depending on the type of procedure, the type of practitioner, the age and health of the patient, and the setting in which anesthesia is provided. Risks may vary with each specific situation. You are encouraged to explore all the options available for your child’s anesthesia for their dental treatment, and consult with your dentist, family physician, or pediatrician as needed.” (B&P 1682). Report of Patient Hospitalization or Death A dentist must report in writing within seven days of any patient being medically treated in a hospital or emergency center, except for scheduled hospitalization, following the administration of general anesthesia, deep sedation, moderate sedation, oral conscious sedation or pediatric minimal sedation. A dentist may provide the required information by completing and submitting the Courtesy Hospitalization Form found on the board’s website under the Forms and Publications tab. (B&P 1680) Impairment, Physical or Mental Whenever it appears a licensee may be unable to practice their profession safely because their ability to practice is impaired due to mental and/or physical illness affecting competency, the dental board may order the licensee to be examined by an appropriate professional. Examination procedures are outlined in statute and regulation (B&P 820-828). Guide to California Dental Practice Act Compliance | Page 24 of 50 The dental board has established a diversion program with the intent to rehabilitate licensees whose competency may be impaired due to abuse of dangerous drugs or alcohol and return them to the practice of dentistry in a manner that will not endanger the public health and safety. A licensee who is not a subject of a current investigation may self-refer to the dental board’s diversion program. A licensee under investigation may request entry into the diversion program (B&P 1695, 1695.5). Engaging in the practice of dentistry while under the influence of alcohol or a controlled substance can be charged as a misdemeanor (B&P 1700(e)). The parameters of the dental board’s Impaired Licentiates Program can be found in CCR 16 Section 1020.1 to 1020.8. Infection Control Having unsanitary or unsafe office conditions, as determined by the customary practice and standards of the profession, is considered unprofessional conduct (B&P 1680(t)). Failure to follow the dental board infection control regulation is unprofessional conduct (B&P 1680(ad)). The infection control regulation can be found in the California Code of Regulations Title 16 Section 1005. A copy of the regulation must be conspicuously posted in the office. Failure to irrigate using sterile water or other irrigation method that contains recognized disinfecting or antibacterial properties when performing dental procedures on exposed dental pulp is considered unprofessional conduct (B&P 1680 (ag)) Informed Consent A dentist must obtain written informed consent of a patient or, if patient is a minor, the patient’s parent or guardian prior to administering general anesthesia, deep sedation or moderate sedation (B&P 1682(e)). Additionally, in the case of a minor receiving general anesthesia services, informed consent shall include, but not be limited to, the following statement: “The administration and monitoring of general anesthesia may vary depending on the type of procedure, the type of practitioner, the age and health of the patient, and the setting in which anesthesia is provided. Risks may vary with each specific situation. You are encouraged to explore all the options available for your child’s anesthesia for their dental treatment, and consult with your dentist or pediatrician as needed.” (B&P 1682) Judgments and Settlements, Reporting Liability insurance companies are required to report to the dental board settlement or arbitration awards greater than $10,000 for any claim that injury or death was caused by the licensee’s negligence, error or omission in practice or by rendering unauthorized professional services. Reporting must be done within 30 days of generating the written settlement or award (B&P 801). A complete report of any settlement, judgment or arbitration award over $3,000 of a claim or action for damages for death or personal injury caused by negligence, error or omission in practice, or by the unauthorized rendering of professional services, shall be reported by the licensee to the dental board within a prescribed time period (B&P 802). Certain judgments, settlements and decisions, including those resulting from CDA’s Peer Review and Judicial Council, must be reported to the National Practitioners Data Bank. For information, refer to the online NPDB guidebook at npdb-hipdb.hrsa.gov/npdbguidebook.html. Guide to California Dental Practice Act Compliance | Page 25 of 50 Licenses See also Continuing Education All licensees and permit holders are required to; Notify the dental board or, if a dental hygienist, the DHBC within 30 days of an address change. Complete 2 units of California law, 2 units of infection control and a basic life support course offered by a board- approved provider as part of continuing education requirements (B&P 1640). Notify the dental board or, if a dental hygienist, the DHBC within 10 days of a name change. Notify the dental board or, if a dental hygienist, the DHBC upon initial licensure or licensure renewal of employment or practice status. Renew license every two years. All licensed dentists are required to report to the dental board upon initial licensure or licensure renewal completion of any advanced educational program accredited by the Commission on Dental Accreditation in an ADA-recognized specialty (B&P 1715.5). The dental board and DHBC must collect and disseminate information on licensees’ cultural background and foreign language proficiency. Licensees are asked for the information as part of the application and renewal processes, but reporting information regarding cultural background and foreign language proficiency is optional (B&P 1715.5). The dental board and DHBC may require a licensee to submit digital fingerprints as a part of licensure renewal if the fingerprints are not already on file. Dental licenses must be prominently displayed at the facility, unless each licensee wears a name tag that discloses their name and license in at least 18-point type (B&P 680). Any person who holds a valid dental license may append the letters DDS to their name regardless of the actual degree conferred upon the individual (B&P 1700.5). The use of fraud to obtain a license is unprofessional conduct (B&P 1680(w)). Suspension or revocation of a license issued or discipline imposed by another state or territory on grounds that would be the basis of discipline in California (B&P 1680(r)). Engaging in the practice of dentistry with an expired license is unprofessional conduct (B&P 1680(ac)). Confirm license status on BreEZe. Inactive Licenses and Reactivation Individuals with inactive licenses shall not engage in any activity for which an active license or certificate is required (B&P 702). Continuing education units are not required of inactive licensees, but payment of full license renewal fees is required (B&P 703). A disabled dentist may apply for an inactive license and for a reduction in license renewal fee (B&P 1716.1). To restore a license to active status, a licensee must: Pay the license renewal fee; the fee may be waived if reactivation is for the sole purpose of providing voluntary, unpaid service to a public agency, not-for-profit agency, institution or corporation that provides services to indigent patients in underserved areas of the state. Complete required continuing education units. (B&P 704) Guide to California Dental Practice Act Compliance | Page 26 of 50 Retired License Dentists who meet the following criteria may apply for retired status and are eligible for a reduced license renewal fee: Practiced dentistry in California for 20-plus years, and Reached the age of retirement as defined in the federal Social Security Act. Renewal fees from these retired dentists shall not be less than one-half the regular renewal fee (B&P 1716.1(a)). If a dentist qualifies for the reduced fee, the dentist can choose to be either (1) retired active or (2) retired inactive. Retired active dentists may continue to provide dental services but it must be free of charge or for a nominal fee. In no event shall the aggregate of these charges in any single calendar year be in an amount that would render the dentist ineligible for full Social Security benefits. Retired active dentists are required to complete 30 continuing education units for license renewal as of Jan. 1, 2023. Retired inactive dentists no longer provide dental services and are no longer required to take continuing education units. (B&P 1716.1). Disabled Dentist A 50 percent waiver of renewal fees may be granted to a disabled dentist upon application to the dental board. The dentist may not practice dentistry until the licensee establishes that the disability no longer exists or no longer affects their ability to practice and they pay the current renewal fee (B&P 1716.1 (b)). Military/National Guard Service * A licensee whose license expired while on active duty with the U.S. Armed Forces or with the California National Guard may renew the license upon meeting all of the following requirements: The license was valid at the time the licensee entered the California National Guard or the U.S. Armed Forces. The reinstatement application is made while serving in the California National Guard or the U.S. Armed Forces or not later than one year from the date of discharge from active service or return to inactive military status. Time spent by a licensee in receiving treatment or hospitalization in any veterans’ facility during which they are prevented from practicing their profession is excluded from being counted as part of the one-year period. The reinstatement application is accompanied by an affidavit showing the date of entrance into the service and whether the licensee is still in the service or their date of discharge, and the renewal fee is paid for the current renewal period in which the application is filed. If the application is filed more than one year after discharge or return to inactive status, the licensi
