Chapter 246-817 WAC

Last Update: 12/26/18

DENTAL QUALITY ASSURANCE COMMISSION

(Formerly chapters 246-816 and 246-818 WAC)

WAC Sections

DENTISTS
246-817-001Purpose.
246-817-010Definitions.
246-817-015Adjudicative proceedings—Procedural rules for the dental quality assurance commission.
LICENSURE—APPLICATION AND ELIGIBILITY REQUIREMENTS
246-817-101Dental licenses—Types authorized.
246-817-110Dental licensure—Initial eligibility and application requirements.
246-817-120Examination content.
246-817-135Dental licensure without examination—Eligibility and application requirements.
246-817-150Licenses—Persons licensed or qualified out-of-state who are faculty at school of dentistry—Conditions.
246-817-160Graduates of nonaccredited schools.
246-817-185Temporary practice permits—Eligibility.
246-817-186Temporary practice permits—Issuance and duration.
246-817-187Temporary practice permit—Military spouse eligibility and issuance.
246-817-190Dental assistant registration.
246-817-195Licensure requirements for expanded function dental auxiliaries (EFDAs).
246-817-200Licensure without examination for expanded function dental auxiliary (EFDA).
246-817-205Dental anesthesia assistant certification requirements.
246-817-210Expired credential.
246-817-220Inactive license.
246-817-230Dentist retired active status.
GENERAL PRACTICE REQUIREMENTS AND PROHIBITIONS
246-817-301Display of licenses.
246-817-304Definitions.
246-817-305Patient record content.
246-817-310Patient record retention and accessibility requirements.
246-817-315Business records accessibility.
246-817-320Report of patient injury or mortality.
246-817-330Prescriptions.
246-817-350Recording requirement for scheduled drugs.
246-817-370Nondiscrimination.
246-817-380Patient abandonment.
246-817-390Representation of care, fees, and records.
246-817-400Disclosure of provider services.
246-817-410Disclosure of membership affiliation.
246-817-420Specialty representation.
246-817-430A rule applicable to dental technicians.
246-817-440Dentist continuing education requirements.
246-817-441Dentist suicide prevention education.
246-817-445Dental anesthesia assistant continuing education requirements.
SEXUAL MISCONDUCT
246-817-450Definitions.
246-817-460Sexual misconduct.
DELEGATIONS OF DUTIES TO PERSONS NOT LICENSED AS DENTISTS
246-817-501Purpose.
246-817-510Definitions.
246-817-520Supportive services that may be performed by registered dental assistants.
246-817-525Supportive services that may be performed by licensed expanded function dental auxiliaries (EFDAs).
246-817-530An act that may be performed by unlicensed persons outside the treatment facility.
246-817-540Acts that may not be performed by registered dental assistants.
246-817-545Acts that may not be performed by licensed expanded function dental auxiliaries (EFDAs).
246-817-550Acts that may be performed by licensed dental hygienists under general supervision.
246-817-560Acts that may be performed by licensed dental hygienists under close supervision.
246-817-570Acts that may not be performed by dental hygienists.
INFECTION CONTROL
246-817-601Purpose.
246-817-610Definitions.
246-817-620Use of barriers and sterilization techniques.
246-817-630Management of single use items.
ADMINISTRATION OF ANESTHETIC AGENTS FOR DENTAL PROCEDURES
246-817-701Administration of anesthetic agents for dental procedures.
246-817-710Definitions.
246-817-720Basic life support requirements.
246-817-722Defibrillator.
246-817-724Recordkeeping, equipment and emergency medications or drugs required in all sites where anesthetic agents of any kind are administered.
246-817-730Local anesthesia.
246-817-740"Minimal sedation by inhalation" (to include, but not limited to, nitrous oxide).
246-817-745"Minimal sedation."
246-817-755Moderate sedation.
246-817-760Moderate sedation with parenteral agents.
246-817-770General anesthesia and deep sedation.
246-817-771Dental anesthesia assistant.
246-817-772Requirements for anesthesia monitor.
246-817-774Permitting/renewal requirements.
246-817-776Discharge criteria for all levels of sedation/general anesthesia.
246-817-778Nondental anesthesia providers.
246-817-780Mandatory reporting of death or significant complication as a result of any dental procedure.
246-817-790Application of chapter 18.130 RCW.
SUBSTANCE ABUSE MONITORING PROGRAMS
246-817-801Intent.
246-817-810Terms used in WAC 246-817-801 through 246-817-830.
246-817-820Approval of substance abuse monitoring programs.
246-817-830Participation in approved substance abuse monitoring program.
OPIOID PRESCRIBING
Opioid PrescribingGeneral Provisions
246-817-901Intent and scope.
246-817-905Exclusions.
246-817-906Definitions.
246-817-907Patient notification, secure storage, and disposal.
246-817-908Use of alternative modalities for pain treatment.
246-817-909Continuing education requirements for opioid prescribing.
246-817-911Diagnosis identified on prescription.
Opioid PrescribingAcute Nonoperative Pain and Acute Perioperative Pain
246-817-913Treatment plan—Acute nonoperative pain and acute perioperative pain.
Opioid PrescribingSubacute Pain
246-817-915Patient evaluation and patient record.
246-817-916Treatment plan—Subacute pain.
Opioid PrescribingChronic Pain Management
246-817-919Patient evaluation and patient record.
246-817-920Treatment plan.
246-817-930Written agreement for treatment.
246-817-935Periodic review.
246-817-950Consultation—Recommendations and requirements.
246-817-955Consultation—Exemptions for exigent and special circumstances.
246-817-960Consultation—Exemptions for the dentist.
246-817-965Pain management specialist.
246-817-966Assessment of treatment plan.
246-817-967Patients with chronic pain, including those on high doses, establishing a relationship with a new dentist.
Opioid PrescribingSpecial Populations
246-817-970Special populations—Patients twenty-four years of age or under, pregnant patients, and aging populations.
246-817-971Episodic care of chronic opioid patients.
Opioid PrescribingCoprescribing
246-817-975Coprescribing of opioids with certain medications.
246-817-976Coprescribing of opioids for patients receiving medication assisted treatment.
246-817-977Coprescribing of naloxone.
Opioid PrescribingPrescribing Monitoring Program
246-817-980Prescription monitoring program—Required registration, queries, and documentation.
FEES
246-817-990Dentist fees and renewal cycle.
246-817-99005Dental assistant, dental anesthesia assistant, and expanded function dental auxiliary fees and renewal cycle.
DISPOSITION OF SECTIONS FORMERLY CODIFIED IN THIS TITLE
246-817-130Licensure without examination for dentists—Eligibility. [Statutory Authority: RCW 18.32.0365 and 18.32.215. WSR 08-23-017, § 246-817-130, filed 11/6/08, effective 12/7/08. Statutory Authority: RCW 18.32.035. WSR 95-21-041, § 246-817-130, filed 10/10/95, effective 11/10/95.] Repealed by WSR 16-16-039, filed 7/26/16, effective 8/26/16. Statutory Authority: RCW 18.32.0365 and 18.32.215.
246-817-140Licensure without examination for dentists—Licensing examination standards. [Statutory Authority: RCW 18.32.0365 and 18.32.215. WSR 08-23-017, § 246-817-140, filed 11/6/08, effective 12/7/08. Statutory Authority: RCW 18.32.035. WSR 95-21-041, § 246-817-140, filed 10/10/95, effective 11/10/95.] Repealed by WSR 16-16-039, filed 7/26/16, effective 8/26/16. Statutory Authority: RCW 18.32.0365 and 18.32.215.
246-817-155Dental resident license to full dental license—Conditions. [Statutory Authority: RCW 18.32.0365 and 18.32.040. WSR 08-23-018, § 246-817-155, filed 11/6/08, effective 12/7/08.] Repealed by WSR 18-01-106, filed 12/19/17, effective 1/19/18. Statutory Authority: RCW 18.32.002, 18.32.0365, and 18.32.040.
246-817-170Applications—Permits—Renewals for the administration of conscious sedation with multiple oral or parenteral agents or general anesthesia (including deep sedation). [Statutory Authority: RCW 18.32.035. WSR 95-21-041, § 246-817-170, filed 10/10/95, effective 11/10/95.] Repealed by WSR 09-04-042, filed 1/30/09, effective 3/2/09. Statutory Authority: RCW 18.32.640 and 18.32.0365.
246-817-175Conscious sedation with parenteral or multiple oral agents—Education and training requirements—Application. [Statutory Authority: RCW 18.32.035. WSR 95-21-041, § 246-817-175, filed 10/10/95, effective 11/10/95.] Repealed by WSR 09-04-042, filed 1/30/09, effective 3/2/09. Statutory Authority: RCW 18.32.640 and 18.32.0365.
246-817-180General anesthesia (including deep sedation)—Education and training requirements. [Statutory Authority: RCW 18.32.035. WSR 95-21-041, § 246-817-180, filed 10/10/95, effective 11/10/95.] Repealed by WSR 09-04-042, filed 1/30/09, effective 3/2/09. Statutory Authority: RCW 18.32.640 and 18.32.0365.
246-817-201Application for licensure—AIDS education requirements. [Statutory Authority: RCW 18.32.035. WSR 95-21-041, § 246-817-201, filed 10/10/95, effective 11/10/95.] Repealed by WSR 98-05-060, filed 2/13/98, effective 3/16/98. Statutory Authority: RCW 43.70.280.
246-817-340Recording requirements for all prescription drugs. [Statutory Authority: RCW 18.32.035. WSR 95-21-041, § 246-817-340, filed 10/10/95, effective 11/10/95.] Repealed by WSR 16-19-078, filed 9/20/16, effective 10/21/16. Statutory Authority: RCW 18.32.0365 and 18.32.655.
246-817-360Prescribing, dispensing or distributing drugs. [Statutory Authority: RCW 18.32.035. WSR 95-21-041, § 246-817-360, filed 10/10/95, effective 11/10/95.] Repealed by WSR 15-12-091, filed 6/2/15, effective 7/3/15. Statutory Authority: RCW 18.32.0365.
246-817-750Conscious sedation with an oral agent. [Statutory Authority: RCW 18.32.035. WSR 95-21-041, § 246-817-750, filed 10/10/95, effective 11/10/95.] Repealed by WSR 09-04-042, filed 1/30/09, effective 3/2/09. Statutory Authority: RCW 18.32.640 and 18.32.0365.
246-817-910Definitions. [Statutory Authority: RCW 18.32.785 and 18.32.0365. WSR 11-10-061, § 246-817-910, filed 5/2/11, effective 7/1/11.] Repealed by WSR 19-02-043, filed 12/26/18, effective 1/26/19. Statutory Authority: RCW 18.32.002, 18.32.0365, 18.32.800 and 2017 c 297.
246-817-925Informed consent. [Statutory Authority: RCW 18.32.785 and 18.32.0365. WSR 11-10-061, § 246-817-925, filed 5/2/11, effective 7/1/11.] Repealed by WSR 19-02-043, filed 12/26/18, effective 1/26/19. Statutory Authority: RCW 18.32.002, 18.32.0365, 18.32.800 and 2017 c 297.
246-817-940Long-acting opioids, including methadone. [Statutory Authority: RCW 18.32.785 and 18.32.0365. WSR 11-10-061, § 246-817-940, filed 5/2/11, effective 7/1/11.] Repealed by WSR 19-02-043, filed 12/26/18, effective 1/26/19. Statutory Authority: RCW 18.32.002, 18.32.0365, 18.32.800 and 2017 c 297.
246-817-945Episodic care. [Statutory Authority: RCW 18.32.785 and 18.32.0365. WSR 11-10-061, § 246-817-945, filed 5/2/11, effective 7/1/11.] Repealed by WSR 19-02-043, filed 12/26/18, effective 1/26/19. Statutory Authority: RCW 18.32.002, 18.32.0365, 18.32.800 and 2017 c 297.


246-817-001
Purpose.

The purpose of these rules is to further clarify and define chapter 18.32 RCW, Dentistry.
[Statutory Authority: RCW 18.32.035. WSR 95-21-041, § 246-817-001, filed 10/10/95, effective 11/10/95.]



246-817-010
Definitions.

The following general terms are defined within the context used in this chapter.
"Acquired immunodeficiency syndrome" or "AIDS" means the clinical syndrome of HIV-related illness as defined by the board of health by rule.
"Clinics" are locations situated away from the School of Dentistry on the University of Washington campus, as recommended by the dean in writing and approved by the DQAC.
"CITA" means Council of Interstate Testing Agencies, a regional dental testing agency that provides clinical dental testing services.
"CRDTS" means Central Regional Dental Testing Services, a regional testing agency that provides clinical dental testing services.
"Department" means the department of health.
"DQAC" means the dental quality assurance commission as established by RCW 18.32.0351.
"Facility" is defined as the building housing the School of Dentistry on the University of Washington campus, and other buildings, designated by the dean of the dental school and approved by the DQAC.
"NERB" means the Northeast Regional Board, a regional testing agency that provides clinical dental testing services.
"Office on AIDS" means that section within the department of health or any successor department with jurisdiction over public health matters as defined in chapter 70.24 RCW.
"Secretary" means the secretary of the department of health or the secretary's designee.
"SRTA" means the Southern Regional Testing Agency, a regional testing agency that provides clinical dental testing services.
"WREB" means the Western Regional Examining Board, a national testing agency that provides clinical dental testing services.
[Statutory Authority: RCW 18.32.0365 and 18.32.040. WSR 08-23-019, § 246-817-010, filed 11/6/08, effective 12/7/08. Statutory Authority: RCW 18.32.035. WSR 95-21-041, § 246-817-010, filed 10/10/95, effective 11/10/95.]



246-817-015
Adjudicative proceedings—Procedural rules for the dental quality assurance commission.

The DQAC adopts the model procedural rules for adjudicative proceedings as adopted by the department of health and contained in chapter 246-11 WAC, including subsequent amendments.
[Statutory Authority: RCW 18.32.035. WSR 95-21-041, § 246-817-015, filed 10/10/95, effective 11/10/95.]



246-817-101
Dental licenses—Types authorized.

The DQAC is granted the authority to issue the following types of dental licenses or permits:
(1) Licensure by examination standard. (RCW 18.32.040)
(2) Licensure without examination—Licensed in another state. (RCW 18.32.215)
(3) Faculty licensure. (RCW 18.32.195)
(4) Dental resident licensure. (RCW 18.32.195)
(5) Conscious sedation permits. (RCW 18.32.640)
(6) Anesthesia permits. (RCW 18.32.640)
(7) Temporary practice permits. (RCW 18.130.075)
[Statutory Authority: RCW 18.32.035. WSR 95-21-041, § 246-817-101, filed 10/10/95, effective 11/10/95.]



246-817-110
Dental licensureInitial eligibility and application requirements.

To be eligible for Washington state dental licensure, the applicant must provide:
(1) A completed application and fee. The applicant must submit a signed application and required fee as defined in WAC 246-817-990;
(2) Proof of graduation from a dental school approved by the DQAC:
(a) DQAC recognizes only those applicants who are students or graduates of dental schools in the United States or Canada, approved, conditionally or provisionally, by the Commission on Dental Accreditation of the American Dental Association. The applicant must have received, or will receive, a Doctor of Dental Surgery (DDS) or Doctor of Dental Medicine (DMD) degree from that school;
(b) Other dental schools which apply for DQAC approval and which meet these adopted standards to the DQAC's satisfaction may be approved, but it is the responsibility of a school to apply for approval and of a student to ascertain whether or not a school has been approved;
(3) Proof of successful completion of the National Board Dental Examination Parts I and II, or the Canadian National Dental Examining Board Examination. An original scorecard or a certified copy of the scorecard shall be accepted. Exception: Dentists who obtained initial licensure in a state prior to that state's requirement for successful completion of the national boards, may be licensed in Washington, provided that the applicant provide proof that their original state of licensure did not require passage of the national boards at the time they were initially licensed. Applicants need to meet all other requirements for licensure;
(4) Proof of graduation from an approved dental school. The only acceptable proof is an official, posted transcript sent directly from such school, or in the case of recent graduates, a verified list of graduating students submitted directly from the dean of the dental school. Graduates of nonaccredited dental schools must also meet the requirements outlined in WAC 246-817-160;
(5) A complete listing of professional education and experience including college or university (predental), and a complete chronology of practice history from the date of dental school graduation to present, whether or not engaged in activities related to dentistry;
(6) Proof of completion of seven clock hours of AIDS education as required in chapter 246-12 WAC, Part 8;
(7) Proof of malpractice insurance if available, including dates of coverage and any claims history;
(8) Written certification of any licenses held, submitted directly from another licensing entity, and including license number, issue date, expiration date and whether applicant has been the subject of final or pending disciplinary action;
(9) Proof of successful completion of:
(a) An approved practical/clinical examination under WAC 246-817-120; or
(b) A qualifying residency program under RCW 18.32.040 (3)(c);
(10) Proof of successful completion of an approved written jurisprudence examination;
(11) A recent 2" x 2" photograph, signed, dated, and attached to the application;
(12) Authorization for background inquiries to other sources may be conducted as determined by the DQAC, including but not limited to the national practitioner data bank and drug enforcement agency. Applicants are responsible for any fees incurred in obtaining verification of requirements;
(13) Any other information for each license type as determined by the DQAC.
[Statutory Authority: RCW 18.32.002, 18.32.0365, and 18.32.040. WSR 18-01-106, § 246-817-110, filed 12/19/17, effective 1/19/18. Statutory Authority: RCW 18.32.0365 and 18.32.100 as amended by 2015 c 72. WSR 16-05-083, § 246-817-110, filed 2/16/16, effective 3/18/16. Statutory Authority: RCW 18.32.0365 and 18.32.040. WSR 08-23-019, § 246-817-110, filed 11/6/08, effective 12/7/08. Statutory Authority: RCW 43.70.280. WSR 98-05-060, § 246-817-110, filed 2/13/98, effective 3/16/98. Statutory Authority: RCW 18.32.035. WSR 95-21-041, § 246-817-110, filed 10/10/95, effective 11/10/95.]



246-817-120
Examination content.

(1) An applicant seeking dentist licensure in Washington by examination, must successfully pass a written and practical examination approved by the Dental Quality Assurance Commission (commission).
The examination will consist of:
(a) A written examination. The National Board Dental Examination Parts I and II, or the Canadian National Dental Examining Board examination will be accepted, except as provided in subsection (4) of this section.
(b) A practical examination containing at least the following sections:
(i) Restorative;
(ii) Endodontic;
(iii) Periodontal;
(iv) Prosthodontic; and
(v) Comprehensive treatment planning or diagnostic skills.
(2)(a) The commission accepts the following practical examinations provided the testing agency offers at least the sections listed in subsection (1)(b) of this section:
(i) The Western Regional Examining Board's (WREB) clinical examination;
(ii) The Central Regional Dental Testing Services (CRDTS) clinical examination;
(iii) The Commission on Dental Competency Assessments (CDCA) formally known as Northeast Regional Board (NERB) clinical examination;
(iv) The Southern Regional Testing Agency (SRTA) clinical examination;
(v) The Council of Interstate Testing Agency's (CITA) clinical examination;
(vi) U.S. state or territory with an individual state board clinical examination; or
(b) The commission will accept the complete National Dental Examining Board (NDEB) of Canada clinical examination as meeting its standards if the applicant is a graduate of an approved dental school defined in WAC 246-817-110 (2)(a).
(3) The applicant must pass all sections listed in subsection (1)(b) of this section of the practical examination with the same testing agency.
(4) The commission will only accept results of approved practical examinations taken within the preceding five years from the date of an application for licensure.
(5) The commission may, at its discretion, give or require an examination in any other subject under subsection (1)(a) and (b) of this section, whether in written or practical form or both written and practical.
[Statutory Authority: RCW 18.32.002, 18.32.0365, and 18.32.040. WSR 17-22-035, § 246-817-120, filed 10/24/17, effective 11/24/17. Statutory Authority: RCW 18.32.0365 and 18.32.040. WSR 16-14-067, § 246-817-120, filed 6/30/16, effective 7/31/16; WSR 08-23-019, § 246-817-120, filed 11/6/08, effective 12/7/08. Statutory Authority: RCW 18.32.035. WSR 95-21-041, § 246-817-120, filed 10/10/95, effective 11/10/95.]



246-817-135
Dental licensure without examinationEligibility and application requirements.

For individuals holding a dentist credential in another U.S. state or territory, to be eligible for Washington state dental license without examination, the applicant must provide:
(1) A completed application on forms provided by the secretary;
(2) Applicable fees under WAC 246-817-990;
(3) A verification by a U.S. state or territory board of dentistry (or equivalent authority) of an active credential to practice dentistry, without restrictions, and whether the applicant has been the subject of final or pending disciplinary action;
(4) Proof of graduation from an approved dental school under WAC 246-817-110 (2)(a):
(a) The only acceptable proof is an official, posted transcript sent directly from such school;
(b) Graduates of nonapproved dental schools must meet the requirements under RCW 18.32.215 (1)(b).
(5) Proof that the applicant is currently engaged in the practice of dentistry:
(a) Dentists serving in the United States federal services as described in RCW 18.32.030(2) must provide documentation from their commanding officer regarding length of service, duties and responsibilities, and any adverse actions or restrictions;
(b) Dentists employed by a dental school approved under WAC 246-817-110 (2)(a) must provide documentation from the dean or appropriate administrator of the institution regarding the length and terms of employment, duties and responsibilities, and any adverse actions or restrictions;
(c) Dentists in a dental residency program must provide documentation from the director or appropriate administrator of the residency program regarding length of residency, duties and responsibilities, and any adverse actions or restrictions; or
(d) Dentists practicing dentistry for a minimum of twenty hours per week for the four consecutive years preceding application, in another U.S. state or territory must provide:
(i) Address of practice location(s);
(ii) Length of time at the location(s);
(iii) A letter from all malpractice insurance carrier(s) defining years when insured and any claims history;
(iv) Federal or state tax numbers; and
(v) DEA numbers if any.
(6) Proof of seven clock hours of AIDS education and training as required by chapter 246-12 WAC, Part 8;
(7) Proof of successful completion of a commission approved written jurisprudence examination;
(8) A recent 2" x 2" photograph, signed, dated, and attached to the application; and
(9) Authorization for background inquiries to other sources may include, but are not limited to, the national practitioner data bank and drug enforcement agency.
[Statutory Authority: RCW 18.32.0365 and 18.32.215. WSR 16-16-039, § 246-817-135, filed 7/26/16, effective 8/26/16; WSR 08-23-017, § 246-817-135, filed 11/6/08, effective 12/7/08. Statutory Authority: RCW 18.32.035. WSR 95-21-041, § 246-817-135, filed 10/10/95, effective 11/10/95.]



246-817-150
LicensesPersons licensed or qualified out-of-state who are faculty at school of dentistryConditions.

(1) The department shall provide an application for faculty licensure upon receipt of a written request from the dean of the University of Washington, School of Dentistry.
(2) Applicants for faculty licensure shall submit a signed application, including applicable fees, and other documentation as required by the DQAC.
(3) The dean of the University of Washington, School of Dentistry, or his designee, shall notify the department of health of any changes in employment status of any person holding a faculty license.
[Statutory Authority: RCW 18.32.0365 and RCW 18.32.100 as amended by 2015 c 72. WSR 16-05-083, § 246-817-150, filed 2/16/16, effective 3/18/16. Statutory Authority: RCW 18.32.0365 and 18.32.195. WSR 11-11-073, § 246-817-150, filed 5/17/11, effective 6/17/11. Statutory Authority: RCW 43.70.280. WSR 98-05-060, § 246-817-150, filed 2/13/98, effective 3/16/98. Statutory Authority: RCW 18.32.035. WSR 95-21-041, § 246-817-150, filed 10/10/95, effective 11/10/95.]



246-817-160
Graduates of nonaccredited schools.

(1) An applicant for Washington state dental licensure, who is a graduate of a dental school or college not accredited by the Commission on Dental Accreditation shall provide to the Dental Quality Assurance Commission (commission):
(a) Materials listed in WAC 246-817-110 (1), (3), (5) through (8), and (10) through (13);
(b) Official school transcript or diploma with dental degree listed transcribed to English if necessary;
(c) Evidence of successful completion of at least two additional predoctoral or postdoctoral academic years of dental education.
(i) Additional predoctoral or postdoctoral dental education completed prior to July 1, 2018, must be obtained at a dental school in the United States or Canada, approved, conditionally or provisionally, by the Commission on Dental Accreditation.
(ii) Additional predoctoral or postdoctoral dental education completed after July 1, 2018, must be obtained in a dental program in the United States or Canada, approved, conditionally or provisionally, by the Commission on Dental Accreditation and include clinical training; and
(d) An applicant for Washington state dental licensure must provide proof of successful completion of:
(i) An approved practical/clinical examination under WAC 246-817-120; or
(ii) A qualifying residency program under RCW 18.32.040 (3)(c).
(2) Upon completion of the requirements in subsection (1)(a) through (c) of this section, an applicant may be eligible to take the practical examination as approved in WAC 246-817-120 (2) through (4).
(a) The commission may issue examination approval up to six months before an applicant has completed the two additional predoctoral or postdoctoral academic years of dental education.
(b) An applicant must provide a letter from the school where the two additional predoctoral or postdoctoral academic years is being obtained indicating expected date of education completion.
[Statutory Authority: RCW 18.32.002, 18.32.0365, and 18.32.040. WSR 18-01-106, § 246-817-160, filed 12/19/17, effective 1/19/18. Statutory Authority: RCW 18.32.002 and 18.32.0365. WSR 16-17-104, § 246-817-160, filed 8/19/16, effective 9/19/16. Statutory Authority: RCW 18.32.0365, 18.32.002, 18.32.040, and 18.32.222. WSR 14-20-064, § 246-817-160, filed 9/26/14, effective 10/27/14. Statutory Authority: RCW 18.32.035. WSR 95-21-041, § 246-817-160, filed 10/10/95, effective 11/10/95.]



246-817-185
Temporary practice permits—Eligibility.

Fingerprint-based national background checks may cause a delay in credentialing. Individuals who satisfy all other licensing requirements and qualifications may receive a temporary practice permit while the national background check is completed.
(1) A temporary practice permit, as defined in RCW 18.130.075, shall be issued at the written request of an applicant for dentists, expanded function dental auxiliaries, dental anesthesia assistants, and dental assistants. The applicant must be credentialed in another state, with credentialing standards substantially equivalent to Washington.
(2) The conditions of WAC 246-817-160 must be met for applicants who are graduates of dental schools or colleges not accredited by the American Dental Association Commission on Dental Accreditation.
[Statutory Authority: Chapter 18.350 RCW, RCW 18.32.0365, 18.32.640, 18.130.050(14), and 18.260.120. WSR 13-15-144, § 246-817-185, filed 7/23/13, effective 8/23/13. Statutory Authority: RCW 18.130.064, 18.130.075, and 18.32.0365. WSR 10-07-026, § 246-817-185, filed 3/8/10, effective 4/8/10. Statutory Authority: RCW 18.32.035. WSR 95-21-041, § 246-817-185, filed 10/10/95, effective 11/10/95.]



246-817-186
Temporary practice permits—Issuance and duration.

(1) Unless there is a basis for denial of the credential or for issuance of a conditional credential, the applicant shall be issued a temporary practice permit when DQAC receives:
(a) A completed application form, all other documentation required to complete the credential application, completed fingerprint card, and fees for the credential;
(b) A written request for a temporary practice permit;
(c) Written verification of all credentials, whether active or not, attesting that the applicant has a credential in good standing and is not the subject of any disciplinary action for unprofessional conduct or impairment; and
(d) Results of disciplinary national practitioner data bank reports.
(2) The temporary practice permit shall expire when one of the following occurs:
(a) A full, unrestricted credential is granted;
(b) A notice of decision is mailed;
(c) One hundred eighty days after the temporary practice permit is issued.
(3) A temporary practice permit shall not be renewed, reissued or extended.
(4) A temporary practice permit grants the individual the full scope of practice for the profession.
[Statutory Authority: RCW 18.130.064, 18.130.075, and 18.32.0365. WSR 10-07-026, § 246-817-186, filed 3/8/10, effective 4/8/10. Statutory Authority: RCW 18.32.035. WSR 95-21-041, § 246-817-186, filed 10/10/95, effective 11/10/95.]



246-817-187
Temporary practice permitMilitary spouse eligibility and issuance.

A military spouse or state registered domestic partner of a military person may receive a temporary practice permit while completing any specific additional requirements that are not related to training or practice standards for the profession. This section applies to dentists licensed in chapter 18.32 RCW, expanded function dental auxiliaries licensed and dental assistants registered in chapter 18.260 RCW, and dental anesthesia assistants certified in chapter 18.350 RCW.
(1) A temporary practice permit may be issued to an applicant who is a military spouse or state registered domestic partner of a military person and:
(a) Is moving to Washington as a result of the military person's transfer to Washington;
(b) Left employment in another state to accompany the military person to Washington;
(c) Holds an unrestricted, active credential in another state that has substantially equivalent credentialing standards for the same profession to those in Washington; and
(d) Is not subject to any pending investigation, charges, or disciplinary action by the regulatory body of the other state or states.
(2) A temporary practice permit grants the individual the full scope of practice for the profession.
(3) A temporary practice permit expires when any one of the following occurs:
(a) The credential is granted;
(b) A notice of decision on the application is mailed to the applicant, unless the notice of decision on the application specifically extends the duration of the temporary practice permit; or
(c) One hundred eighty days after the temporary practice permit is issued.
(4) To receive a temporary practice permit, the applicant must:
(a) Submit the necessary application, fee(s), fingerprint card if required, and documentation for the credential;
(b) Attest on the application that the applicant left employment in another state to accompany the military person;
(c) Meet all requirements and qualifications for the credential that are specific to the training, education, and practice standards for the profession;
(d) Provide verification of having an active unrestricted credential in the same profession from another state that has substantially equivalent credentialing standards for the profession in Washington;
(e) Submit a copy of the military person's orders and a copy of:
(i) The military-issued identification card showing the military person's information and the applicant's relationship to the military person;
(ii) A marriage license; or
(iii) A state registered domestic partnership; and
(f) Submit a written request for a temporary practice permit.
(5) For the purposes of this section:
(a) "Military person" means a person serving in the United States armed forces, the United States public health service commissioned corps, or the merchant marine of the United States.
(b) "Military spouse" means the husband, wife, or registered domestic partner of a military person.
[Statutory Authority: RCW 18.32.0365, 18.340.020, and chapter 18.340 RCW. WSR 15-11-005, § 246-817-187, filed 5/7/15, effective 6/7/15.]



246-817-190
Dental assistant registration.

To be eligible for registration as a dental assistant you must:
(1) Provide a completed application on forms provided by the secretary;
(2) Pay applicable fees as defined in WAC 246-817-99005;
(3) Provide evidence of completion of seven clock hours of AIDS education and training as required by chapter 246-12 WAC Part 8; and
(4) Provide any other information determined by the secretary.
[Statutory Authority: RCW 18.260.120 and 18.32.0365. WSR 08-14-010, § 246-817-190, filed 6/19/08, effective 7/1/08.]



246-817-195
Licensure requirements for expanded function dental auxiliaries (EFDAs).

To be eligible for licensure as an EFDA in Washington an applicant must:
(1) Provide a completed application on forms provided by the secretary;
(2) Pay applicable fees as defined in WAC 246-817-99005;
(3) Provide evidence of:
(a) Completion of a dental assisting education program accredited by the Commission on Dental Accreditation (CODA); or
(b) Obtain the Dental Assisting National Board (DANB) certified dental assistant credential, earned through pathway II, which includes:
(i) A minimum of three thousand five hundred hours of experience as a dental assistant within a continuous twenty-four through forty-eight month period;
(ii) Employer-verified knowledge in areas as specified by DANB;
(iii) Passage of DANB certified dental assistant examination; and
(iv) An additional dental assisting review course, which may be provided online, in person or through self-study; or
(c) A Washington limited license to practice dental hygiene; or
(d) A Washington full dental hygiene license and completion of a course in taking final impressions affiliated with or provided by a CODA accredited dental assisting program, dental hygiene school or dental school.
(4) Except for applicants qualified under subsection (3)(d) of this section, provide evidence of completing an EFDA education program approved by the commission where training includes:
(a) In a didactic, clinical and laboratory model to the clinically competent level required for close supervision:
(i) In placing and finishing composite restorations on a typodont and on clinical patients; and
(ii) In placing and finishing amalgam restorations on a typodont and on clinical patients; and
(iii) In taking final impressions on a typodont; and
(b) In a didactic, clinical and laboratory model to the clinically competent level required for general supervision:
(i) In performing coronal polish, fluoride treatment, and sealants on a typodont and on clinical patients; and
(ii) In providing patient oral health instructions; and
(iii) In placing, exposing, processing, and mounting dental radiographs; and
(c) The basic curriculum shall require didactic, laboratory, and clinical competency for the following:
(i) Tooth morphology and anatomy;
(ii) Health and safety (current knowledge in dental materials, infection control, ergonomics, mercury safety, handling);
(iii) Placement and completion of an acceptable quality reproduction of restored tooth surfaces—Laboratory and clinic only;
(iv) Radiographs (covered in path II)—Laboratory and clinic only;
(v) Ethics and professional knowledge of law as it pertains to dentistry, dental hygiene, dental assisting, and EFDA;
(vi) Current practices in infection control;
(vii) Health history alerts;
(viii) Final impression;
(ix) Matrix and wedge;
(x) Rubber dam;
(xi) Acid etch and bonding;
(xii) Occlusion and bite registration;
(xiii) Temporary restorations;
(xiv) Dental emergencies;
(xv) Risk management and charting;
(xvi) Intra-oral anatomy;
(xvii) Pharmacology; and
(xviii) Bases, cements, liners and sealers.
(5) Except for applicants qualified under subsection (3)(d) of this section, attain a passing score on:
(a) A written restorations examination approved by the commission; and
(b) A clinical restorations examination approved by the commission.
(6) Provide evidence of completion of seven clock hours of AIDS education and training as required by chapter 246-12 WAC Part 8.
(7) Provide any other information determined by the secretary.
[Statutory Authority: RCW 18.260.120 and 18.32.0365. WSR 08-14-010, § 246-817-195, filed 6/19/08, effective 7/1/08.]



246-817-200
Licensure without examination for expanded function dental auxiliary (EFDA).

To be eligible for a license as an EFDA without examination you must:
(1) Provide a completed application on forms provided by the secretary;
(2) Pay applicable fees as defined in WAC 246-817-990;
(3) Provide evidence of:
(a) A current license in another state with substantially equivalent licensing standards as determined by the commission; or
(b) A Washington full dental hygiene license and completion of a course in taking final impressions affiliated with or provided by a CODA accredited dental assisting program, dental hygiene school or dental school.
(4) Provide evidence of completion of seven clock hours of AIDS education and training as required by chapter 246-12 WAC Part 8; and
(5) Provide any other information determined by the secretary.
[Statutory Authority: RCW 18.260.120 and 18.32.0365. WSR 08-14-010, § 246-817-200, filed 6/19/08, effective 7/1/08.]



246-817-205
Dental anesthesia assistant certification requirements.

An applicant for certification as a dental anesthesia assistant must submit to the department:
(1) A completed application on forms provided by the secretary;
(2) Applicable fees as defined in WAC 246-817-99005;
(3) Evidence of:
(a) Completion of a commission approved dental anesthesia assistant education and training. Approved education and training includes:
(i) Completion of the "Dental Anesthesia Assistant National Certification Examination (DAANCE)" or predecessor program, provided by the American Association of Oral and Maxillofacial Surgeons (AAOMS); or
(ii) Completion of the "Oral and Maxillofacial Surgery Assistants Course" course provided by the California Association of Oral and Maxillofacial Surgeons (CALAOMS); or
(iii) Completion of substantially equivalent education and training approved by the commission.
(b) Completion of training in intravenous access or phlebotomy. Training must include:
(i) Eight hours of didactic training that must include:
(A) Intravenous access;
(B) Anatomy;
(C) Technique;
(D) Risks and complications; and
(ii) Hands on experience starting and maintaining intravenous lines with at least ten successful intravenous starts on a human or simulator/manikin; or
(iii) Completion of substantially equivalent education and training approved by the commission;
(c) A current and valid certification for health care provider basic life support (BLS), advanced cardiac life support (ACLS), or pediatric advanced life support (PALS);
(d) A valid Washington state general anesthesia permit of the oral and maxillofacial surgeon or dental anesthesiologist where the dental anesthesia assistant will be performing his or her services;
(e) Completion of seven clock hours of AIDS education and training as required by chapter 246-12 WAC, Part 8; and
(4) Any other information determined by the commission.
[Statutory Authority: Chapter 18.350 RCW, RCW 18.32.0365, 18.32.640, 18.130.050(14), and 18.260.120. WSR 13-15-144, § 246-817-205, filed 7/23/13, effective 8/23/13.]



246-817-210
Expired credential.

(1) If the credential has expired for three years or less, the practitioner must meet the requirements of chapter 246-12 WAC, Part 2.
(2) If the credential has expired for over three years, the practitioner must:
(a) Comply with the current statutory conditions;
(b) Meet the requirements of chapter 246-12 WAC, Part 2.
[Statutory Authority: RCW 18.260.120 and 18.32.0365. WSR 08-14-010, § 246-817-210, filed 6/19/08, effective 7/1/08. Statutory Authority: RCW 43.70.280. WSR 98-05-060, § 246-817-210, filed 2/13/98, effective 3/16/98. Statutory Authority: RCW 18.32.035. WSR 95-21-041, § 246-817-210, filed 10/10/95, effective 11/10/95.]



246-817-220
Inactive license.

(1) A dentist may obtain an inactive license by meeting the requirements of WAC 246-12-090 and RCW 18.32.185.
(2) An inactive license must be renewed every year on or before the practitioner's birthday according to WAC 246-12-100 and 246-817-990.
(3) If a license is inactive for three years or less, to return to active status a dentist must meet the requirements of WAC 246-12-110, 246-817-440, and 246-817-990.
(4) If a license is inactive for more than three years, and the dentist has been actively practicing in another United States jurisdiction, to return to active status the dentist must:
(a) Provide certification of an active dentist license, submitted directly from another licensing entity. The certification shall include the license number, issue date, expiration date and whether the applicant has been the subject of final or pending disciplinary action;
(b) Provide verification of active practice in another United States jurisdiction within the last three years; and
(c) Meet the requirements of WAC 246-12-110, 246-817-440, and 246-817-990.
(5) If a license is inactive for more than three years, and the dentist has not been actively practicing in another United States jurisdiction, to return to active status the dentist must provide:
(a) A written request to change licensure status;
(b) The applicable fees according to WAC 246-817-990;
(c) Proof of successful completion of:
(i) An approved practical/practice examination under WAC 246-817-120; or
(ii) A qualifying residency program under RCW 18.32.040 (3)(c);
(d) Written certification of all dental or health care licenses held, submitted directly from the licensing entity. The certification shall include the license number, issue date, expiration date and whether the applicant has been the subject of final or pending disciplinary action;
(e) Written declaration that continuing education and competency requirements for the two most recent years have been met according to WAC 246-817-440;
(f) Proof of successful completion of an approved written jurisprudence examination within the past year;
(g) Proof of malpractice insurance if available, including dates of coverage and any claims history; and
(h) Proof of AIDS education according to WAC 246-817-110, if not previously provided.
[Statutory Authority: RCW 18.32.002, 18.32.0365, and 18.32.040. WSR 18-01-106, § 246-817-220, filed 12/19/17, effective 1/19/18. Statutory Authority: RCW 18.32.185 and 18.32.0365. WSR 11-07-052, § 246-817-220, filed 3/17/11, effective 4/17/11.]



246-817-230
Dentist retired active status.

(1) To obtain a retired active status license, a licensed dentist must comply with chapter 246-12 WAC, Part 5, excluding WAC 246-12-120 (2)(c) and (d).
(2) A licensed dentist with a retired active status license may practice under the following conditions:
(a) In emergent circumstances calling for immediate action; or
(b) In intermittent circumstances on a nonpermanent basis.
(3) A licensed dentist with a retired active license may not receive compensation for dental services.
(4) A licensed dentist with a retired active status license must renew every year on or before the practitioner's birthday according to WAC 246-12-130 and 246-817-990 and must complete twenty-one hours of continuing education as required in WAC 246-817-440 every year with renewal.
[Statutory Authority: RCW 18.32.065 and 18.130.250. WSR 15-12-092, § 246-817-230, filed 6/2/15, effective 7/3/15.]



246-817-301
Display of licenses.

The license of any dentist, dental hygienist or other individual licensed pursuant to the laws of Washington to engage in any activity being performed in the premises under the supervision or control of a licensed dentist shall be displayed in a place visible to individuals receiving services in the premises, and readily available for inspection by any designee of the DQAC.
[Statutory Authority: RCW 18.32.035. WSR 95-21-041, § 246-817-301, filed 10/10/95, effective 11/10/95.]



246-817-304
Definitions.

The following definitions apply to WAC 246-817-304 through 246-817-315 unless the context requires otherwise:
(1) "Clinical record" is the portion of the record that contains information regarding the patient exam, diagnosis, treatment discussion, treatment performed, patient progress, progress notes, referrals, studies, tests, imaging of any type and any other information related to the diagnosis or treatment of the patient.
(2) "Financial record" is the portion of the record that contains information regarding the financial aspects of a patient's treatment including, but not limited to, billing, treatment plan costs, payment agreements, payments, insurance information or payment discussions held with a patient, insurance company or person responsible for account payments.
(3) "Notation" is a condensed or summarized written record/note.
(4) "Patient record" is the entire record of the patient maintained by a practitioner that includes all information related to the patient.
[Statutory Authority: RCW 18.32.0365, 18.32.655, and 18.32.002. WSR 16-07-084, § 246-817-304, filed 3/17/16, effective 4/17/16.]



246-817-305
Patient record content.

(1) A licensed dentist who treats patients shall maintain legible, complete, and accurate patient records.
(2) The patient record must contain the clinical records and the financial records.
(3) The clinical record must include at least the following information:
(a) For each clinical record entry note, the signature, initials, or electronic verification of the individual making the entry note;
(b) For each clinical record entry note, identify who provided treatment if treatment was provided;
(c) The date of each patient record entry, document, radiograph or model;
(d) The physical examination findings documented by subjective complaints, objective findings, an assessment or diagnosis of the patient's condition, and plan;
(e) A treatment plan based on the assessment or diagnosis of the patient's condition;
(f) Up-to-date dental and medical history that may affect dental treatment;
(g) Any diagnostic aid used including, but not limited to, images, radiographs, and test results. Retention of molds or study models is at the discretion of the practitioner, except for molds or study models for orthodontia or full mouth reconstruction which shall be retained as listed in WAC 246-817-310;
(h) A complete description of all treatment/procedures administered at each visit;
(i) An accurate record of any medication(s) administered, prescribed or dispensed including:
(i) The date prescribed or the date dispensed;
(ii) The name of the patient prescribed or dispensed to;
(iii) The name of the medication; and
(iv) The dosage and amount of the medication prescribed or dispensed, including refills.
(j) Referrals and any communication to and from any health care provider;
(k) Notation of communication to or from the patient or patient's parent or guardian, including:
(i) Notation of the informed consent discussion. This is a discussion of potential risk(s) and benefit(s) of proposed treatment, recommended tests, and alternatives to treatment, including no treatment or tests;
(ii) Notation of posttreatment instructions or reference to an instruction pamphlet given to the patient;
(iii) Notation regarding patient complaints or concerns associated with treatment, this includes complaints or concerns obtained in person, by phone call, email, mail, or text; and
(iv) Termination of doctor-patient relationship; and
(l) A copy of each laboratory referral retained for three years as required in RCW 18.32.655.
(4) Clinical record entries must not be erased or deleted from the record.
(a) Mistaken handwritten entries must be corrected with a single line drawn through the incorrect information. New or corrected information must be initialed and dated.
(b) If the record is an electronic record then a record audit trail must be maintained with the record that includes a time and date history of deletions, edits and/or corrections to electronically signed records.
[Statutory Authority: RCW 18.32.0365, 18.32.655, and 18.32.002. WSR 16-07-084, § 246-817-305, filed 3/17/16, effective 4/17/16.]



246-817-310
Patient record retention and accessibility requirements.

(1) A licensed dentist shall keep readily accessible patient records for at least six years from the date of the last treatment.
(2) A licensed dentist shall respond to a written request from a patient to examine or copy a patient's record within fifteen working days after receipt. A licensed dentist shall comply with chapter 70.02 RCW for all patient record requests.
(3) A licensed dentist shall comply with chapter 70.02 RCW and the Health Insurance Portability and Accountability Act, 45 C.F.R. destruction and privacy regulations.
[Statutory Authority: RCW 18.32.0365, 18.32.655, and 18.32.002. WSR 16-07-084, § 246-817-310, filed 3/17/16, effective 4/17/16. Statutory Authority: RCW 18.32.035. WSR 95-21-041, § 246-817-310, filed 10/10/95, effective 11/10/95.]



246-817-315
Business records accessibility.

If requested as part of an investigation authorized by the secretary, a licensed dentist who operates a dental practice in the state of Washington shall provide to the secretary:
(1) Documentation that the licensed dentist is:
(a) The owner, purchaser, or lessee of the dental equipment;
(b) The owner, purchaser, or lessee of the office the dentist occupies; and
(c) Associated with other persons in the practice of dentistry, whether or not the associate is licensed to practice dentistry.
(2) All contracts or agreements governing the dental practice business relationships with co-owners, partners, and associates.
[Statutory Authority: RCW 18.32.0365, 18.32.655, and 18.32.002. WSR 16-07-084, § 246-817-315, filed 3/17/16, effective 4/17/16.]



246-817-320
Report of patient injury or mortality.

All licensees engaged in the practice of dentistry shall submit a complete report of any patient mortality or other incident which results in temporary or permanent physical or mental injury requiring hospitalization of said patient during, or as a direct result of dental procedures or anesthesia related thereto. This report shall be submitted to the DQAC within thirty days of the occurrence.
[Statutory Authority: RCW 18.32.035. WSR 95-21-041, § 246-817-320, filed 10/10/95, effective 11/10/95.]



246-817-330
Prescriptions.

Every dentist who operates a dental office in the state of Washington must write a valid prescription to the dental laboratory or dental technician with whom he/she intends to place an order for the making, repairing, altering or supplying of artificial restorations, substitutes or appliances to be worn in the human mouth. A separate prescription must be submitted to the dental laboratory or dental technician for each patient's requirements. To be valid, such prescriptions must be written in duplicate and contain the date, the name and address of the dental laboratory or the dental technician, the name and address of the patient, description of the basic work to be done, the signature of the dentist serving the patient for whom the work is being done and the dentist's license certificate number. The original prescription shall be referred to the dental laboratory or the dental technician and the carbon copy shall be retained for three years, by the dentist, in an orderly, accessible file and shall be readily available for inspection by the secretary or his/her authorized representative.
[Statutory Authority: RCW 18.32.035. WSR 95-21-041, § 246-817-330, filed 10/10/95, effective 11/10/95.]



246-817-350
Recording requirement for scheduled drugs.

When Schedule II, III, IV or V drugs as described in chapter 69.50 RCW are stocked by the dental office for dispensing to patients, an inventory control record must be kept in such a manner to identify disposition of such medicines. Such records shall be available for inspection by the secretary or his/her authorized representative.
[Statutory Authority: RCW 18.32.035. WSR 95-21-041, § 246-817-350, filed 10/10/95, effective 11/10/95.]



246-817-370
Nondiscrimination.

It shall be unprofessional conduct for any dentist to discriminate or to permit any employee or any person under the supervision and control of the dentist to discriminate against any person, in the practice of dentistry, on the basis of race, color, creed or national origin, or to violate any of the provisions of any state or federal antidiscrimination law.
[Statutory Authority: RCW 18.32.035. WSR 95-21-041, § 246-817-370, filed 10/10/95, effective 11/10/95.]



246-817-380
Patient abandonment.

The attending dentist, without reasonable cause, shall not neglect, ignore, abandon, or refuse to complete the current procedure for a patient. If the dentist chooses to withdraw responsibility for a patient of record, the dentist shall:
(1) Advise the patient that termination of treatment is contemplated and that another dentist should be sought to complete the current procedure and for future care; and
(2) Advise the patient that the dentist shall remain reasonably available under the circumstances for up to fifteen days from the date of such notice to render emergency care related to that current procedure.
[Statutory Authority: RCW 18.32.035. WSR 95-21-041, § 246-817-380, filed 10/10/95, effective 11/10/95.]



246-817-390
Representation of care, fees, and records.

Dentists shall not represent the care being rendered to their patients or the fees being charged for providing such care in a false or misleading manner, nor alter patient records, such as but not limited to, misrepresenting dates of service or treatment codes.
[Statutory Authority: RCW 18.32.035. WSR 95-21-041, § 246-817-390, filed 10/10/95, effective 11/10/95.]



246-817-400
Disclosure of provider services.

A dentist who is personally present, operating as a dentist or personally overseeing the operations being performed in a dental office, over fifty percent of the time that such office is being operated, shall identify himself/herself in any representation to the public associated with such office or practice and shall provide readily visible signs designating his/her name at such respective office entrances or office buildings. Any representation that omits such a listing of dentists is misleading, deceptive, or improper conduct. Dentists who are present or overseeing operations under this rule less than fifty percent of the time shall identify themselves to patients prior to services being initiated or rendered in any fashion. Every office shall have readily available a list of the names of dentists who are involved in such office less than fifty percent of the time.
[Statutory Authority: RCW 18.32.035. WSR 95-21-041, § 246-817-400, filed 10/10/95, effective 11/10/95.]



246-817-410
Disclosure of membership affiliation.

It shall be misleading, deceptive or improper conduct for any dentist to represent that he/she is a member of any dental association, society, organization, or any component thereof where such membership in fact does not exist.
[Statutory Authority: RCW 18.32.035. WSR 95-21-041, § 246-817-410, filed 10/10/95, effective 11/10/95.]



246-817-420
Specialty representation.

(1) It shall be misleading, deceptive or improper conduct for a dentist to represent or imply that he/she is a specialist or use any of the terms to designate a dental specialty such as:
(a) Endodontist
(b) Oral or maxillofacial surgeon
(c) Oral pathologist
(d) Orthodontist
(e) Pediatric dentist
(f) Periodontist
(g) Prosthodontist
(h) Public health
or any derivation of these specialties unless he/she is entitled to such specialty designation under the guidelines or requirements for specialties approved by the Commission on Dental Accreditation and the Council on Dental Education of the American Dental Association, or such guidelines or requirements as subsequently amended and approved by the DQAC, or other such organization recognized by the DQAC.
(2) A dentist not currently entitled to such specialty designation shall not represent that his/her practice is limited to providing services in a specialty area without clearly disclosing in the representation that he/she is a general dentist. A specialist who represents services in areas other than his/her specialty is considered a general dentist.
[Statutory Authority: RCW 18.32.035. WSR 95-21-041, § 246-817-420, filed 10/10/95, effective 11/10/95.]



246-817-430
A rule applicable to dental technicians.

To be exempt from the law prohibiting the practice of dentistry, dental technicians must comply with the provisions of RCW 18.32.030(6). The form of the required prescription is defined in WAC 246-817-330.
[Statutory Authority: RCW 18.32.035. WSR 95-21-041, § 246-817-430, filed 10/10/95, effective 11/10/95.]



246-817-440
Dentist continuing education requirements.

The goal of continuing education is to encourage the lifetime professional development of the licensed dentist, and to enhance the clinical and overall skills needed to protect the health and safety of all patients.
(1) A licensed dentist shall complete a minimum of sixty-three hours of continuing education every three years.
(a) The three-year continuing education reporting period for a dentist licensed in Washington before 2019 begins January 1, 2019, and verification of completion of continuing education hours will be due on the dentist's annual license renewal date in 2022, and every three years thereafter. The three-year continuing education reporting period for a dentist initially licensed in Washington in 2019 or later begins upon date of licensure.
(b) A licensed dentist shall attest to the completion of sixty-three hours of continuing education every three years as a part of their license renewal requirement.
(c) The dental quality assurance commission (commission) may randomly audit up to twenty-five percent of licensed dentists every three years for compliance after the license is renewed as allowed by chapter 246-12 WAC, Part 7.
(d) A licensed dentist shall comply with the requirements of chapter 246-12 WAC, Part 7.
(e) The commission will not authorize or approve specific continuing education courses.
(2) A licensed dentist shall complete the commission approved dental jurisprudence examination once every three years. One hour of continuing education will be granted toward the sixty-three hour requirement.
(3) Continuing education must contribute to the professional knowledge and development of the licensed dentist or enhance services provided to patients. Continuing education must be completed in one or more of the following subject categories:
(a) Education courses relating to the practice of dentistry;
(b) Emergency management, advanced cardiac life support (ACLS), and pediatric advanced life support (PALS);
(c) Health care provider basic life support (BLS). BLS certification is required in WAC 246-817-720. One hour of continuing education for each BLS certification course will be granted. A licensed dentist may not count more than three hours every three years in this category;
(d) Infection control, federal/state safety standards, and radiation protection;
(e) Pharmacology, prescribing practices, and pain management;
(f) Ethics;
(g) Patient care related education including risk management, methods of health delivery, multicultural, and suicide prevention education;
(h) Washington state dentistry law;
(i) Practice management and billing practices. A licensed dentist may not count more than twenty-one hours every three years in this category.
(4) Continuing education in subject categories identified in subsection (3) of this section may be completed using any of the following activities or methods:
(a) Attendance at local, state, national, or international continuing education courses, live interactive webinars, dental study clubs, postdoctoral education, and dental residencies;
(b) Self-study by various means, relevant to dentistry, without an instructor physically present.
(i) Self-study can be continuing education provided online or through the mail provided by a continuing education provider. Thirty minutes will count for every one hour completed for this activity;
(ii) Self-study can be reading a book that contributes to the professional knowledge and development of the licensed dentist, or enhance services provided to patients. A two-page synopsis of what was learned written by the licensed dentist is required. Two hours of continuing education for each book and synopsis will be granted. A licensed dentist may not count more than six hours every three years for this activity.
(c) Teaching, presenting, or lecturing in a course, only if the presentation or lecture is created or authored by the dentist claiming the continuing education hours. A licensed dentist may not count more than twenty-one hours every three years in this activity;
(d) Direct clinical supervision of dental students and dental residents. A licensed dentist may not count more than twenty-one hours every three years in this activity;
(e) Publishing a paper in a peer review journal. A licensed dentist may count fifteen hours the year the paper is published and may not count more than a total of thirty hours every three years in this activity. A copy of the publication is required;
(f) Reading and critically evaluating any hypothesis-driven scientific journal article on a topic that has relevance to dentistry and is published in a peer-reviewed journal devoted to dentistry, medicine, or useful to dentistry. A licensed dentist may not count more than twenty-one hours every three years.
(i) Before completing this activity, the licensed dentist must complete at least four hours of education in evidence-based dentistry or medicine that includes journal article evaluation. The four-hour education may count toward the required sixty-three hour requirement. The four-hour education is a one-time requirement. A licensed dentist may not count more than four hours every three years.
(ii) A licensed dentist may count one hour for each article that the dentist completes a "Critical Evaluation of a Journal Article" questionnaire. The questionnaire may be obtained from the commission. The completed questionnaire is required;
(g) Volunteer dental patient care. A licensed dentist may not count more than twenty-one hours every three years; and
(h) The commission will accept a current certification or recertification from any specialty board approved and recognized by the American Dental Association (ADA), the American Board of Dental Specialties (ABDS), or other specialty board certification or recertification approved by the commission as sixty-two hours of continuing education. The commission will also accept the award of Fellow of the Academy of General Dentistry, Master of the Academy of General Dentistry, or the Lifelong Learning and Service Recognition Award as sixty-two hours of continuing education. The certification, recertification, or award must be obtained in the three-year reporting period.
(5) Proof of continuing education is a certificate of completion, letter, or other documentation verifying or confirming attendance or completion of continuing education hours. Documentation must be from the organization that provided the activity, except in subsection (4)(b)(ii), (e), and (f)(ii) of this section, and must contain at least the following:
(a) Date of attendance or completion;
(b) Hours earned; and
(c) Course title or subject.
[Statutory Authority: RCW 18.32.002 and 18.32.0365. WSR 18-12-116, § 246-817-440, filed 6/6/18, effective 1/1/19. Statutory Authority: Chapter 18.350 RCW, RCW 18.32.0365, 18.32.640, 18.130.050(14), and 18.260.120. WSR 13-15-144, § 246-817-440, filed 7/23/13, effective 8/23/13. Statutory Authority: RCW 18.32.002 and 18.32.0365. WSR 06-07-036, § 246-817-440, filed 3/8/06, effective 4/8/06. Statutory Authority: RCW 18.32.0365. WSR 01-16-007, § 246-817-440, filed 7/19/01, effective 8/19/01.]



246-817-441
Dentist suicide prevention education.

Effective August 1, 2020, a licensed dentist must complete a commission-approved one-time training that is at least three hours in length for suicide assessment that includes screening, referral, and imminent harm via lethal means elements.
(1) This training must be completed by the end of the first full continuing education reporting period after August 1, 2020, or during the first full continuing education reporting period after initial licensure, whichever is later.
(2) Training accepted by the commission must be on the department's model list as authorized in chapter 246-12 WAC, Part 14.
(3) A licensed dentist who has successfully completed the suicide assessment, treatment, and management curriculum in RCW 43.70.447, by the school of dentistry at the University of Washington prior to licensure is exempt from the training requirement in this section.
(4) Training completed between July 23, 2017, and August 1, 2020, that meets the requirements of subsection (2) or (3) of this section, is accepted as meeting the one-time training requirement of this section.
(5) The hours spent completing the training in suicide assessment under this section count toward meeting applicable continuing education requirements for dentist license renewal.
[Statutory Authority: RCW 18.32.002, 18.32.0365 and 43.70.442. WSR 18-12-112, § 246-817-441, filed 6/6/18, effective 7/7/18.]



246-817-445
Dental anesthesia assistant continuing education requirements.

(1) To renew a certification a certified dental anesthesia assistant must complete a minimum of twelve hours of continuing education every three years and follow the requirements of chapter 246-12 WAC, Part 7.
(2) Continuing education must involve direct application of dental anesthesia assistant knowledge and skills in one or more of the following categories:
(a) General anesthesia;
(b) Moderate sedation;
(c) Physical evaluation;
(d) Medical emergencies;
(e) Health care provider basic life support (BLS), advanced cardiac life support (ACLS), or pediatric advanced life support (PALS);
(f) Monitoring and use of monitoring equipment;
(g) Pharmacology of drugs; and agents used in sedation and anesthesia.
(3) Continuing education is defined as any of the following activities:
(a) Attendance at local, state, national, or international continuing education courses;
(b) Health care provider basic life support (BLS), advanced cardiac life support (ACLS), or pediatric advanced life support (PALS), or emergency related classes;
(c) Self-study through the use of multimedia devices or the study of books, research materials, or other publications.
(i) Multimedia devices. The required documentation for this activity is a letter or other documentation from the organization. A maximum of two hours is allowed per reporting period.
(ii) Books, research materials, or other publications. The required documentation for this activity is a two-page synopsis of what was learned written by the credential holder. A maximum of two hours is allowed per reporting period.
(d) Distance learning. Distance learning includes, but is not limited to, correspondence course, webinar, print, audio/video broadcasting, audio/video teleconferencing, computer aided instruction, e-learning/on-line-learning, or computer broadcasting/webcasting. A maximum of four hours of distance learning is allowed per reporting period.
[Statutory Authority: Chapter 18.350 RCW, RCW 18.32.0365, 18.32.640, 18.130.050(14), and 18.260.120. WSR 13-15-144, § 246-817-445, filed 7/23/13, effective 8/23/13.]



246-817-450
Definitions.

The definitions in this section apply throughout this section and WAC 246-817-460 unless the context requires otherwise.
(1) "Health care provider" means an individual applying for a credential or credentialed specifically as defined in chapters 18.32, 18.260, and 18.350 RCW.
(2) "Health care information" means any information, whether oral or recorded in any form or medium that identifies or can readily be associated with the identity of, and relates to the health care of, a patient.
(3) "Key party" means a person legally authorized to make health care decisions for the patient.
(4) "Legitimate health care purpose" means activities for examination, diagnosis, treatment, and personal care of patients, including palliative care, as consistent with community standards of practice for the dental profession. The activity must be within the scope of practice of the health care provider.
(5) "Patient" means an individual who receives health care services from a health care provider. The determination of when a person is a patient is made on a case-by-case basis with consideration given to a number of factors, including the nature, extent and context of the professional relationship between the health care provider and the person. The fact that a person is not receiving treatment or professional services is not the sole determining factor.
[Statutory Authority: Chapter 18.350 RCW, RCW 18.32.0365, 18.32.640, 18.130.050(14), and 18.260.120. WSR 13-15-144, § 246-817-450, filed 7/23/13, effective 8/23/13. Statutory Authority: RCW 18.32.0365 and 18.130.050 (1) and (12). WSR 08-01-137, § 246-817-450, filed 12/19/07, effective 1/19/08.]



246-817-460
Sexual misconduct.

(1) A health care provider shall not engage, or attempt to engage, in sexual misconduct with a current patient, or key party, inside or outside the health care setting. Sexual misconduct shall constitute grounds for disciplinary action. Sexual misconduct includes, but is not limited to:
(a) Sexual intercourse;
(b) Touching the breasts, genitals, anus or any sexualized body part except as consistent with accepted community standards of practice for examination, diagnosis and treatment and within the health care provider's scope of practice;
(c) Rubbing against a patient or key party for sexual gratification;
(d) Kissing;
(e) Hugging, touching, fondling or caressing of a romantic or sexual nature;
(f) Examination of or touching genitals without using gloves;
(g) Not allowing a patient privacy to dress or undress except as may be necessary in emergencies or custodial situations;
(h) Not providing the patient a gown or draping except as may be necessary in emergencies;
(i) Dressing or undressing in the presence of the patient or key party;
(j) Removing patient's clothing or gown or draping without consent, emergent medical necessity or being in a custodial setting;
(k) Encouraging masturbation or other sex act in the presence of the health care provider;
(l) Masturbation or other sex act by the health care provider in the presence of the patient or key party;
(m) Soliciting a date with a patient or key party;
(n) Discussing the sexual history, preferences or fantasies of the health care provider;
(o) Any behavior, gestures, or expressions that can reasonably be interpreted as seductive or sexual;
(p) Sexually demeaning behavior including any verbal or physical contact which can reasonably be interpreted as demeaning, humiliating, embarrassing, threatening or harming a patient or key party;
(q) Photographing or filming the body or any body part or pose of a patient or key party, other than for legitimate health care purposes; or for the educational or marketing purposes with the consent of the patient; and
(r) Showing a patient or key party sexually explicit photographs, other than for legitimate health care purposes.
(2) Sexual misconduct also includes sexual contact with any person involving force, intimidation, or lack of consent; or a conviction of a sex offense as defined in RCW 9.94A.030.
(3) A health care provider shall not:
(a) Offer to provide health care services in exchange for sexual favors;
(b) Use health care information to contact the patient or key party for the purpose of engaging in sexual misconduct;
(c) Use health care information or access to health care information to meet or attempt to meet the health care provider's sexual needs.
(4) A health care provider shall not engage in the activities listed in subsection (1) of this section with a former patient or key party if the health care provider:
(a) Uses or exploits the trust, knowledge, influence or emotions derived from the professional relationship; or
(b) Uses or exploits privileged information or access to privileged information to meet the health care provider's personal or sexual needs.
(5) When evaluating whether a health care provider has engaged or has attempted to engage in sexual misconduct, the commission will consider factors including, but not limited to:
(a) Documentation of a formal termination;
(b) Transfer of care to another health care provider;
(c) Duration of the health care provider-patient relationship;
(d) Amount of time that has passed since the last dental health care services to the patient;
(e) Communication between the health care provider and the patient between the last dental health care services rendered and commencement of the personal relationship;
(f) Extent to which the patient's personal or private information was shared with the health care provider;
(g) Nature of the patient's health condition during and since the professional relationship; and
(h) The patient's emotional dependence and vulnerability.
(6) Patient or key party initiation or consent does not excuse or negate the health care provider's responsibility.
(7) These rules do not prohibit:
(a) Providing health care services in case of emergency where the services cannot or will not be provided by another health care provider;
(b) Contact that is necessary for a legitimate health care purpose and that meets the standard of care appropriate to the dental profession; or
(c) Providing dental services for a legitimate health care purpose to a person who is in a preexisting, established personal relationship with the health care provider where there is no evidence of, or potential for, exploiting the patient.
[Statutory Authority: RCW 18.32.0365, 18.130.050, 18.130.062 and Executive Order 06-03. WSR 15-16-118, § 246-817-460, filed 8/4/15, effective 9/4/15. Statutory Authority: Chapter 18.350 RCW, RCW 18.32.0365, 18.32.640, 18.130.050(14), and 18.260.120. WSR 13-15-144, § 246-817-460, filed 7/23/13, effective 8/23/13. Statutory Authority: RCW 18.32.0365 and 18.130.050 (1) and (12). WSR 08-01-137, § 246-817-460, filed 12/19/07, effective 1/19/08.]



246-817-501
Purpose.

The purpose of WAC 246-817-501 through 246-817-570 is to establish guidelines on delegation of duties to persons who are not licensed to practice dentistry. The dental laws of Washington state authorized the delegation of certain duties to nondentist personnel and prohibit the delegation of certain other duties. By statute, the duties that may be delegated to a person not licensed to practice dentistry may be performed only under the supervision of a licensed dentist. The degree of supervision required to assure that treatment is appropriate and does not jeopardize the systemic or oral health of the patient varies with, among other considerations, the nature of the procedure and the qualifications of the person to whom the duty is delegated. The dentist is ultimately responsible for the services performed in his/her office and this responsibility cannot be delegated. In order to protect the health and well-being of the people of this state, the DQAC finds it necessary to adopt the following definitions and regulations.
[Statutory Authority: RCW 18.32.035. WSR 95-21-041, § 246-817-501, filed 10/10/95, effective 11/10/95.]



246-817-510
Definitions.

The definitions in this section apply throughout WAC 246-817-501 through 246-817-570 unless the context clearly requires otherwise.
(1) "Close supervision" means that a supervising dentist whose patient is being treated has personally diagnosed the condition to be treated and has personally authorized the procedures to be performed. The supervising dentist is continuously on-site and physically present in the treatment facility while the procedures are performed by the assistive personnel and capable of responding immediately in the event of an emergency. Close supervision does not require a supervising dentist to be physically present in the operatory.
(2) "Coronal polishing" means a procedure limited to the removal of plaque and stain from exposed tooth surfaces, using an appropriate instrument and polishing agent.
This procedure is not intended or interpreted to be an oral prophylaxis as defined in subsection (8) of this section a procedure specifically reserved to be performed by a licensed dentist or dental hygienist. Coronal polishing may, however, be a portion of the oral prophylaxis procedure.
(3) "Debridement at the periodontal surgical site" means curettage or root planing after reflection of a flap by the supervising dentist. This does not include cutting of osseous tissues.
(4) "Elevating soft tissues" means part of a surgical procedure involving the use of the periosteal elevator to raise flaps of soft tissues. Elevating soft tissue is not a separate and distinct procedure in and of itself.
(5) "General supervision" means that a supervising dentist has examined and diagnosed the patient and provided subsequent instructions to be performed by the assistive personnel, but does not require that the dentist be physically present in the treatment facility.
(6) "Incising" means part of the surgical procedure of which the end result is removal of oral tissue. Incising, or the making of an incision, is not a separate and distinct procedure in and of itself.
(7) "Luxation" means an integral part of the surgical procedure of which the end result is extraction of a tooth. It is the dislocation or displacement of a tooth or of the temporomandibular articulation.
(8) "Oral prophylaxis" means the preventive dental procedure of scaling and polishing which includes complete removal of calculus, soft deposits, plaque, stains and the smoothing of unattached tooth surfaces. The objective of this treatment is to create an environment in which hard and soft tissues can be maintained in good health by the patient.
(9) "Periodontal soft tissue curettage" means the closed removal of tissue lining the periodontal pocket, not involving the reflection of a flap.
(10) "Root planing" means the process of instrumentation by which the unattached surfaces of the root are made smooth by the removal of calculus or deposits.
(11) "Supportive services" means services that are related to clinical functions in direct relationship to treating a patient.
(12) "Suturing" is defined as the readaption of soft tissue by use of stitches as a phase of an oral surgery procedure.
(13) "Treatment facility" means a dental office or connecting suite of offices, dental clinic, room or area with equipment to provide dental treatment, or the immediately adjacent rooms or areas. A treatment facility does not extend to any other area of a building in which the treatment facility is located.
(14) "Volunteer dental assistant" means an individual who, without compensation, provides the supportive services under WAC 246-817-520 in a charitable dental clinic.
[Statutory Authority: RCW 18.260.040, 18.260.070, and 2015 c 120. WSR 17-05-056, § 246-817-510, filed 2/10/17, effective 3/13/17. Statutory Authority: RCW 18.32.0365, 18.260.110, and 18.260.120. WSR 09-15-075, § 246-817-510, filed 7/13/09, effective 8/13/09. Statutory Authority: RCW 18.260.120 and 18.32.0365. WSR 08-14-010, § 246-817-510, filed 6/19/08, effective 7/1/08. Statutory Authority: RCW 18.32.035. WSR 95-21-041, § 246-817-510, filed 10/10/95, effective 11/10/95.]



246-817-520
Supportive services that may be performed by registered dental assistants.

(1) A supervising dentist may delegate the supportive services in subsection (4) of this section under the dentist's close supervision, provided the registered dental assistant has demonstrated skills necessary to perform each task competently.
(2) Delegation of supportive services not in subsection (4) of this section may be subject to disciplinary action.
(3) In addition to supportive services in subsection (4) of this section, registered dental assistants may perform nonclinical tasks.
(4) Supportive services allowed under close supervision:
(a) Oral inspection, with no diagnosis.
(b) Take and record blood pressure and vital signs.
(c) Place, expose, and process radiographs.
(d) Take intra-oral and extra-oral photographs.
(e) Perform coronal polish. A licensed dentist shall determine the teeth are free of calculus or other extraneous material prior to dismissing the patient.
(f) Give fluoride treatments.
(g) Give patient education in oral hygiene.
(h) Give preoperative and postoperative instructions.
(i) Deliver an oral sedative drug to patient.
(j) Assist in the administration of inhalation minimal sedation (nitrous oxide) analgesia, including starting and stopping the flow as directed by the supervising dentist.
(k) Place topical anesthetics.
(l) Place and remove the rubber dam.
(m) Apply tooth separators as for placement for Class III gold foil.
(n) Apply sealants.
(o) Place a matrix and wedge for a direct restorative material after the dentist has prepared the cavity.
(p) Place cavity liners and bases.
(q) Perform acid etch and apply bonding agents.
(r) Polish restorations but may not intra-orally adjust or finish permanent restorations.
(s) Sterilize equipment and disinfect operatories.
(t) Place retraction cord.
(u) Hold in place and remove impression materials after the dentist has placed them.
(v) Take impressions, bite registrations, or digital scans of the teeth and jaws for:
(i) Diagnostic and opposing models;
(ii) Fixed and removable orthodontic appliances, occlusal guards, bleaching trays, and fluoride trays; and
(iii) Temporary indirect restorations such as temporary crowns.
(w) Take digital scans of prepared teeth for fabrication of permanent indirect restorations.
(x) Take a facebow transfer for mounting study casts.
(y) Fabricate and deliver bleaching and fluoride trays.
(z) Fabricate, cement, and remove temporary crowns or temporary bridges.
(aa) Remove the excess cement after the dentist has placed a permanent or temporary inlay, crown, bridge or appliance, or around orthodontic bands.
(bb) Place a temporary filling (as zinc oxide-eugenol (ZOE)) after diagnosis and examination by the dentist.
(cc) Pack and medicate extraction areas.
(dd) Place periodontal packs.
(ee) Remove periodontal packs or sutures.
(ff) Select denture shade and mold.
(gg) Place and remove orthodontic separators.
(hh) Select and fit orthodontic bands, try in fixed or removable orthodontic appliances prior to the dentist cementing or checking the appliance.
(ii) Prepare teeth for the bonding of orthodontic appliances.
(jj) Bond attachments for clear removable orthodontic aligners.
(kk) Remove and replace archwires and orthodontic wires.
(ll) Fit and adjust headgear.
(mm) Remove fixed orthodontic appliances, orthodontic cement, and orthodontic bonded resin material.
[Statutory Authority: RCW 18.260.040, 18.260.070, and 2015 c 120. WSR 17-05-056, § 246-817-520, filed 2/10/17, effective 3/13/17. Statutory Authority: RCW 18.260.120 and 18.32.0365. WSR 08-14-010, § 246-817-520, filed 6/19/08, effective 7/1/08. Statutory Authority: RCW 18.32.035. WSR 95-21-041, § 246-817-520, filed 10/10/95, effective 11/10/95.]



246-817-525
Supportive services that may be performed by licensed expanded function dental auxiliaries (EFDAs).

(1) A supervising dentist may delegate the supportive services in subsection (5) of this section under the dentist's close supervision, provided the EFDA has demonstrated skills necessary to perform each task competently.
(2) A dentist may delegate the supportive services in subsection (6) of this section under the dentist's general supervision, provided the EFDA has demonstrated skills necessary to perform each task.
(3) Delegation of supportive services not in subsection (5) or (6) of this section may be subject to disciplinary action.
(4) In addition to supportive services in subsections (5) and (6) of this section, licensed EFDAs may perform nonclinical tasks.
(5) Supportive services allowed under close supervision:
(a) Supportive services under WAC 246-817-520(4), except for supportive services in subsection (6) of this section.
(b) Place, carve, finish, and polish direct restorations.
(c) Take preliminary and final impressions and bite registrations, to include computer assisted design and computer assisted manufacture applications.
(6) Supportive services allowed under general supervision are:
(a) Perform coronal polishing.
(b) Give fluoride treatments.
(c) Apply sealants.
(d) Place, expose, and process radiographs.
(e) Give patient oral health instructions.
[Statutory Authority: RCW 18.260.040, 18.260.070, and 2015 c 120. WSR 17-05-056, § 246-817-525, filed 2/10/17, effective 3/13/17. Statutory Authority: RCW 18.260.120 and 18.32.0365. WSR 08-14-010, § 246-817-525, filed 6/19/08, effective 7/1/08.]



246-817-530
An act that may be performed by unlicensed persons outside the treatment facility.

Unlicensed persons may select shade for crowns or fixed prostheses with the use of a technique which does not contact the oral cavity to avoid contamination with blood or saliva. The procedure shall be performed pursuant to the written instructions and order of a licensed dentist.
[Statutory Authority: RCW 18.32.035. WSR 95-21-041, § 246-817-530, filed 10/10/95, effective 11/10/95.]



246-817-540
Acts that may not be performed by registered dental assistants.

This list is not all inclusive. Delegation of procedures not in subsections (1) through (22) of this section should not be assumed to be allowed. Supportive services approved for delegation to registered dental assistants are under WAC 246-817-520. A dentist may not allow registered dental assistants who are in his or her employ or are acting under his or her supervision or direction to perform any of the following procedures:
(1) Any removal of or addition to the hard or soft natural tissue of the oral cavity.
(2) Any placing of permanent restorations in natural teeth.
(3) Any diagnosis of or prescription for treatment of disease, pain, deformity, deficiency, injury, or physical condition of the human teeth or jaws, or adjacent structure.
(4) Any administration of general or local anesthetic, including intravenous sedation.
(5) Any oral prophylaxis, except coronal polishing as a part of oral prophylaxis as defined under WAC 246-817-510 and 246-817-520 (4)(e).
(6) Any scaling procedure.
(7) The taking of any impressions of the teeth or jaws, or the relationships of the teeth or jaws, for the purpose of fabricating any intra-oral restoration, appliances, or prosthesis, other than impressions allowed as a delegated task under WAC 246-817-520.
(8) Intra-orally adjust and finish permanent restorations.
(9) Cement or recement any permanent restoration or stainless steel crown.
(10) Incise gingiva or other soft tissue.
(11) Elevate soft tissue flap.
(12) Luxate teeth.
(13) Curette to sever epithelial attachment.
(14) Suture.
(15) Establish occlusal vertical dimension for dentures.
(16) Try-in of dentures set in wax.
(17) Insertion and post-insertion adjustments of dentures.
(18) Endodontic treatment - Open, extirpate pulp, ream and file canals, establish length of tooth, and fill root canal.
(19) Use of any light or electronic device for invasive procedures.
(20) Intra-oral air abrasion or mechanical etching devices.
(21) Place direct pulp caps.
(22) Fit and adjust occlusal guards.
[Statutory Authority: RCW 18.260.040, 18.260.070, and 2015 c 120. WSR 17-05-056, § 246-817-540, filed 2/10/17, effective 3/13/17. Statutory Authority: RCW 18.260.120 and 18.32.0365. WSR 08-14-010, § 246-817-540, filed 6/19/08, effective 7/1/08. Statutory Authority: RCW 18.32.035. WSR 95-21-041, § 246-817-540, filed 10/10/95, effective 11/10/95.]



246-817-545
Acts that may not be performed by licensed expanded function dental auxiliaries (EFDAs).

This list is not all inclusive. Delegation of procedures not in subsections (1) through (20) of this section should not be assumed to be allowed. Supportive services approved for delegation to licensed expanded function dental auxiliaries are under WAC 246-817-525. A dentist may not allow EFDAs who are in his or her employ or are acting under his or her supervision or direction to perform any of the following procedures:
(1) Any removal of or addition to the hard or soft natural tissue of the oral cavity except for placing and carving direct restorations.
(2) Any diagnosis of or prescription for treatment of disease, pain, deformity, deficiency, injury, or physical condition of the human teeth or jaws, or adjacent structure.
(3) Any administration of general or local anesthetic, including intravenous sedation.
(4) Any oral prophylaxis, except coronal polishing as a part of oral prophylaxis as defined under WAC 246-817-510 and 246-817-520 (4)(e).
(5) Any scaling procedure.
(6) Intra-orally adjust and finish permanent inlays, crowns, and bridges.
(7) Cement or recement any permanent restoration or stainless steel crown.
(8) Incise gingiva or other soft tissue.
(9) Elevate soft tissue flap.
(10) Luxate teeth.
(11) Curette to sever epithelial attachment.
(12) Suture.
(13) Establish occlusal vertical dimension for dentures.
(14) Try-in of dentures set in wax.
(15) Insertion and postinsertion adjustments of dentures.
(16) Endodontic treatment - Open, extirpate pulp, ream and file canals, establish length of tooth, and fill root canal.
(17) Use of any light or electronic device for invasive procedures.
(18) Intra-oral air abrasion or mechanical etching devices.
(19) Place direct pulp caps.
(20) Fit and adjust occlusal guards.
[Statutory Authority: RCW 18.260.040, 18.260.070, and 2015 c 120. WSR 17-05-056, § 246-817-545, filed 2/10/17, effective 3/13/17. Statutory Authority: RCW 18.260.120 and 18.32.0365. WSR 08-14-010, § 246-817-545, filed 6/19/08, effective 7/1/08.]



246-817-550
Acts that may be performed by licensed dental hygienists under general supervision.

A dentist may allow a dental hygienist licensed under chapter 18.29 RCW to perform the following acts under the dentist's general supervision:
(1) Head and neck examination.
(2) Oral inspection and measuring of periodontal pockets, with no diagnosis.
(3) Patient education in oral hygiene.
(4) Take intra-oral and extra-oral radiographs.
(5) Apply topical preventive or prophylactic agents.
(6) Administer local anesthetic agents and adjunctive procedures if all conditions in (a) through (d) of this subsection are met. Adjunctive procedures include local anesthetic reversal agents and buffered anesthetic.
(a) The patient is at least eighteen years of age;
(b) The patient has been examined by the delegating dentist within the previous twelve months;
(c) There has been no change in the patient's medical history since the last examination. If there has been a change in the patient's medical history within that time, the dental hygienist must consult with the dentist before administering local anesthetics;
(d) The delegating dentist who performed the examination has approved the patient for the administration of local anesthetics by a dental hygienist under general supervision and documented this approval in the patient's record;
(e) If any of the conditions in (a) through (d) of this subsection are not met, then close supervision is required.
(7) Polish and smooth restorations.
(8) Oral prophylaxis and removal of deposits and stains from the surfaces of the teeth.
(9) Record health histories.
(10) Take and record blood pressure and vital signs.
(11) Perform sub-gingival and supra-gingival scaling.
(12) Perform root planing.
(13) Apply sealants.
(14) Apply topical anesthetic agents.
(15) Deliver oral antibiotic prophylaxis as prescribed by a dentist.
(16) Take impressions, bite registration, or digital scans of the teeth and jaws for:
(a) Diagnostic and opposing models;
(b) Fixed and removable orthodontic appliances, occlusal guards, bleaching trays, and fluoride trays; and
(c) Temporary indirect restorations such as temporary crowns.
[Statutory Authority: RCW 18.32.0365 and 18.29.050. WSR 17-01-045, § 246-817-550, filed 12/13/16, effective 1/13/17. Statutory Authority: RCW 18.32.0365, 18.29.050 and 18.32.002. WSR 14-12-057, § 246-817-550, filed 5/30/14, effective 6/30/14. Statutory Authority: RCW 18.32.035. WSR 95-21-041, § 246-817-550, filed 10/10/95, effective 11/10/95.]



246-817-560
Acts that may be performed by licensed dental hygienists under close supervision.

In addition to the acts allowed in WAC 246-817-520 and 246-817-550, a dentist may allow a dental hygienist licensed under chapter 18.29 RCW to perform the following acts under the dentist's close supervision:
(1) Perform soft-tissue curettage.
(2) Administer local anesthetic agents and adjunctive procedures.
(a) General supervision is allowed if all conditions in WAC 246-817-550 (6)(a) through (d) are met.
(b) Adjunctive procedures include local anesthetic reversal agents and buffered anesthetic.
(3) Place restorations into the cavity prepared by the dentist, and thereafter could carve, contour, and adjust contacts and occlusion of the restoration.
(4) Administer nitrous oxide analgesia.
(5) Place antimicrobials.
[Statutory Authority: RCW 18.32.0365 and 18.29.050. WSR 17-01-045, § 246-817-560, filed 12/13/16, effective 1/13/17. Statutory Authority: RCW 18.32.0365. WSR 06-14-018, § 246-817-560, filed 6/23/06, effective 7/24/06. Statutory Authority: RCW 18.32.035. WSR 95-21-041, § 246-817-560, filed 10/10/95, effective 11/10/95.]



246-817-570
Acts that may not be performed by dental hygienists.

No dentist shall allow a dental hygienist duly licensed under the provisions of chapter 18.29 RCW who is in his/her employ or is acting under his/her supervision or direction to perform any of the following procedures:
(1) Any surgical removal of tissue of the oral cavity, except for soft-tissue curettage, as defined in WAC 246-817-510.
(2) Any prescription of drugs or medications requiring the written order or prescription of a licensed dentist or physician.
(3) Any diagnosis for treatment or treatment planning.
(4) The taking of any impression of the teeth or jaw, or the relationship of the teeth or jaw, for the purpose of fabricating any intra-oral restoration, appliances, or prosthesis. Not prohibited are the taking of impressions solely for diagnostic and opposing models or taking wax bites solely for study casts.
(5) Intra-orally adjust occlusal of inlays, crowns, and bridges.
(6) Intra-orally finish margins of inlays, crowns, and bridges.
(7) Cement or recement, permanently, any cast restorations or stainless steel crowns.
(8) Incise gingiva or other soft tissue.
(9) Elevate soft tissue flap.
(10) Luxate teeth.
(11) Curette to sever epithelial attachment.
(12) Suture.
(13) Establish occlusal vertical dimension for dentures.
(14) Try-in of dentures set in wax.
(15) Insertion and post-insertion adjustments of dentures.
(16) Endodontic treatment—Open, extirpate pulp, ream and file canals, establish length of tooth, and fill root canal.
[Statutory Authority: RCW 18.32.035. WSR 95-21-041, § 246-817-570, filed 10/10/95, effective 11/10/95.]



246-817-601
Purpose.

The purpose of WAC 246-817-601 through 246-817-630 is to establish requirements for infection control in dental offices to protect the health and well-being of the people of the state of Washington. For purposes of infection control, all dental staff members and all patients shall be considered potential carriers of communicable diseases. Infection control procedures are required to prevent disease transmission from patient to doctor and staff, doctor and staff to patient, and from patient to patient. Every dentist is required to comply with the applicable standard of care in effect at the time of treatment. At a minimum, the dentist must comply with the requirements defined in WAC 246-817-620 and 246-817-630.
[Statutory Authority: RCW 18.32.035. WSR 95-21-041, § 246-817-601, filed 10/10/95, effective 11/10/95.]



246-817-610
Definitions.

The following definitions pertain to WAC 246-817-601 through 246-817-660 which supersede WAC 246-816-701 through 246-816-740 which became effective May 15, 1992.
"Communicable diseases" means an illness caused by an infectious agent which can be transmitted from one person, animal, or object to another person by direct or indirect means including transmission via an intermediate host or vector, food, water or air.
"Decontamination" means the use of physical or chemical means to remove, inactivate, or destroy bloodborne pathogens on a surface or item to the point where they are no longer capable of transmitting infectious particles and the surface or item is rendered safe for handling, use, or disposal.
"Direct care staff" are the dental staff who directly provide dental care to patients.
"Sterilize" means the use of a physical or chemical procedure to destroy all microbial life including highly resistant bacterial endospores.
[Statutory Authority: RCW 18.32.035. WSR 95-21-041, § 246-817-610, filed 10/10/95, effective 11/10/95.]



246-817-620
Use of barriers and sterilization techniques.

The use of barriers and sterilization techniques is the primary means of assuring that there is the least possible chance of the transmission of communicable diseases from doctor and staff to patients, from patient to patient and from patient to doctor and staff. To prevent patient to patient cross contamination, instruments and supplies contaminated or likely to be contaminated with blood or saliva and touched during treatment must be sterilized between patients or discarded except as otherwise set forth below. Surfaces and equipment which are likely to be contaminated with blood or saliva and touched during treatment must be decontaminated or covered with a barrier which is discarded and replaced between patients except as otherwise set forth below:
(1) Dentists shall comply with the following barrier techniques:
(a) Gloves shall be used by the dentist and direct care staff during treatment which involves intra-oral procedures or contact with items potentially contaminated with the patient's bodily fluids. Fresh gloves shall be used for every intraoral patient contact. Gloves shall not be washed or reused for any purpose. The same pair of gloves shall not be used, removed, and reused for the same patient at the same visit or for any other purpose. Gloves that have been used for dental treatment shall not be reused for any nondental purpose.
(b) Masks shall be worn by the dentist and direct care staff when splatter or aerosol is likely. Masks shall be worn during surgical procedures except in those specific instances in which the dentist determines that the use of a mask would prevent the delivery of health care services or would increase the hazard and risk to his/her patient. In those circumstances where a dentist determines not to wear a mask during a surgical procedure, such determination shall be documented in the patient record.
(c) Unless effective surface decontamination methods are used, protective barriers shall be placed over areas of the dental operatory which are likely to be touched during treatment, not removable to be sterilized, and likely to be contaminated by blood or saliva. These procedures must be followed between each patient. These include but are not limited to:
(i) Delivery unit.
(ii) Chair controls (not including foot controls).
(iii) Light handles.
(iv) High volume evacuator and air-water syringe controls.
(v) X-ray heads and controls.
(vi) Head rest.
(vii) Instrument trays.
(viii) Low speed handpiece motors.
(d) Protective eyewear shall be worn by the dentist and direct care staff and offered to all patients during times when splatter or aerosol is expected.
(2) Dentists shall comply with the following sterilization requirements:
(a) Every dental office shall have the capability to ultrasonically clean and sterilize contaminated items by autoclave, dry heat, unsaturated formaldehyde/alcohol vapor (such as MDT Chemiclave®) or ethylene oxide. Sterilizers shall be tested by biological spore test on at least a weekly basis. In the event of a positive biological spore test, the dentist shall take immediate remedial action to ensure the objectives of (a) of this subsection are accomplished. Documentation shall be maintained either in the form of a log reflecting dates and person(s) conducting the testing or copies of reports from an independent testing entity. The documentation shall be maintained for a period of at least five years.
(b) The following items shall be sterilized by an appropriate autoclave, dry heat, unsaturated formaldehyde/alcohol vapor (such as MDT Chemiclave®) or ethylene oxide sterilization method between patients:
(i) Low speed handpiece contra angles, prophy angles and nose cone sleeves.
(ii) High speed handpieces.
(iii) Hand instruments.
(iv) Burs.
(v) Endodontic instruments.
(vi) Air-water syringe tips.
(vii) High volume evacuator tips.
(viii) Surgical instruments.
(ix) Sonic or ultrasonic periodontal scalers and tips.
(x) Surgical handpieces.
(c) Gross debris shall be removed from items prior to sterilization. Ultrasonic cleaning shall be used whenever possible.
(d) Nondisposable items used in patient care which cannot be autoclaved, dry heat, unsaturated formaldehyde/alcohol vapor (such as MDT Chemiclave®) or ethylene oxide sterilized shall be immersed in a chemical sterilant. If such a technique is used, the solution shall be approved by the Environmental Protection Agency and used in accordance with the manufacturer's directions for sterilization.
(e) Items such as impressions contaminated with blood or saliva shall be thoroughly rinsed, placed in and transported to the dental laboratory in an appropriate case containment device that is properly sealed and labeled.
[Statutory Authority: RCW 18.32.035. WSR 95-21-041, § 246-817-620, filed 10/10/95, effective 11/10/95.]



246-817-630
Management of single use items.

(1) Sterile disposable needles shall be used. The same needle may be recapped with a single-handed recapping technique or recapping device and subsequently reused for the same patient during the same visit.
(2) Single use items used in patient treatment which have been contaminated by saliva or blood shall be discarded and not reused. These include, but are not limited to, disposable needles, local anesthetic carpules, saliva ejectors, polishing discs, bonding agent brushes, prophy cups, prophy brushes, fluoride trays and interproximal wedges.
[Statutory Authority: RCW 18.32.035. WSR 95-21-041, § 246-817-630, filed 10/10/95, effective 11/10/95.]



246-817-701
Administration of anesthetic agents for dental procedures.

The purpose of WAC 246-817-701 through 246-817-790 is to govern the administration of sedation and general anesthesia by dentists licensed in the state of Washington in settings other than hospitals as defined in WAC 246-320-010 and ambulatory surgical facilities as defined in WAC 246-310-010, pursuant to the DQAC authority in RCW 18.32.640.
(1) The DQAC has determined that anesthesia permitting should be based on the "level" of anesthesia because anesthesia/sedation is a continuum, and the route of administration and drug combinations are both capable of producing a deeper level of sedation/anesthesia than is initially intended. Practitioners intending to produce a given level of sedation should be able to rescue patients who enter a state deeper than initially intended.
(2) All anesthesia providers must provide twenty-four hour, on-call availability following an anesthesia procedure, excluding those procedures using only local anesthetic.
(3) The dental assistant and expanded function dental auxiliary may not administer any general or local anesthetic, including intravenous sedation.
[Statutory Authority: RCW 18.32.640 and 18.32.0365. WSR 10-23-001, § 246-817-701, filed 11/3/10, effective 12/4/10; WSR 09-04-042, § 246-817-701, filed 1/30/09, effective 3/2/09. Statutory Authority: RCW 18.32.035. WSR 95-21-041, § 246-817-701, filed 10/10/95, effective 11/10/95.]



246-817-710
Definitions.

The definitions in this section apply throughout WAC 246-817-701 through 246-817-790 unless the context clearly requires otherwise.
(1) "Analgesia" is the diminution of pain in the conscious patient.
(2) "Anesthesia" is the loss of feeling or sensation, especially loss of sensation of pain.
(3) "Anesthesia monitor" means a credentialed health care provider specifically trained in monitoring patients under sedation and capable of assisting with procedures, problems and emergency incidents that may occur as a result of the sedation or secondary to an unexpected medical complication.
(4) "Anesthesia provider" means a dentist, physician anesthesiologist, dental hygienist or certified registered nurse anesthetist licensed and authorized to practice within the state of Washington.
(5) "Close supervision" means that a supervising dentist whose patient is being treated has personally diagnosed the condition to be treated and has personally authorized the procedures to be performed. The supervising dentist is continuously on-site and physically present in the treatment facility while the procedures are performed by the assistive personnel and capable of responding immediately in the event of an emergency. The term does not require a supervising dentist to be physically present in the operatory.
(6)"Deep sedation/analgesia" is a drug induced depression of consciousness during which patients cannot be easily aroused but respond purposefully following repeated or painful stimulation. The ability to independently maintain ventilatory function may be impaired. Patients may require assistance in maintaining a patent airway, and spontaneous ventilation may be inadequate. Cardiovascular function is usually maintained.
(7) "Dental anesthesia assistant" means a health care provider certified under chapter 18.350 RCW and specifically trained to perform the functions authorized in RCW 18.350.040 under supervision of an oral and maxillofacial surgeon or dental anesthesiologist.
(8) "Direct visual supervision" means supervision by an oral and maxillofacial surgeon or dental anesthesiologist by verbal command and under direct line of sight.
(9) "General anesthesia" is a drug induced loss of consciousness during which patients are not arousable, even by painful stimulation. The ability to independently maintain an airway and respond purposefully to physical stimulation or verbal command, produced by a pharmacologic or nonpharmacologic method, or combination thereof may be impaired. Patients often require assistance in maintaining a patent airway, and positive pressure ventilation may be required because of depressed spontaneous ventilation or drug-induced depression of neuromuscular function. Cardiovascular function may be impaired.
(10) "Local anesthesia" is the elimination of sensations, especially pain, in one part of the body by the topical application or regional injection of a drug.
(11) "Minimal sedation" is a drug induced state during which patients respond normally to verbal commands. Although cognitive function and coordination may be impaired, ventilatory and cardiovascular functions are unaffected.
(12) "Moderate sedation" is a drug induced depression of consciousness during which patients respond purposefully to verbal commands, either alone or accompanied by light tactile stimulation. No interventions are required to maintain a patent airway, and spontaneous ventilation is adequate. Cardiovascular function is usually maintained. Moderate sedation can include both moderate sedation/analgesia (conscious sedation) and moderate sedation with parenteral agent.
(13) "Parenteral" means a technique of administration in which the drug bypasses the gastrointestinal (GI) tract (i.e., intramuscular, intravenous, intranasal, submuscosal, subcutaneous, intraosseous).
[Statutory Authority: Chapter 18.350 RCW, RCW 18.32.0365, 18.32.640, 18.130.050(14), and 18.260.120. WSR 13-15-144, § 246-817-710, filed 7/23/13, effective 8/23/13. Statutory Authority: RCW 18.32.640 and 18.32.0365. WSR 09-04-042, § 246-817-710, filed 1/30/09, effective 3/2/09. Statutory Authority: RCW 18.32.035. WSR 95-21-041, § 246-817-710, filed 10/10/95, effective 11/10/95.]



246-817-720
Basic life support requirements.

Dental staff providing direct patient care in an in-office or out-patient setting must hold a current and valid health care provider basic life support (BLS) certification. Dental staff providing direct patient care include: Licensed dentists, licensed dental hygienists, licensed expanded function dental auxiliaries, certified dental anesthesia assistants, and registered dental assistants.
Newly hired office staff providing direct patient care are required to obtain the required certification within forty-five days from the date hired.
[Statutory Authority: Chapter 18.350 RCW, RCW 18.32.0365, 18.32.640, 18.130.050(14), and 18.260.120. WSR 13-15-144, § 246-817-720, filed 7/23/13, effective 8/23/13. Statutory Authority: RCW 18.32.640 and 18.32.0365. WSR 09-04-042, § 246-817-720, filed 1/30/09, effective 3/2/09. Statutory Authority: RCW 18.32.035. WSR 95-21-041, § 246-817-720, filed 10/10/95, effective 11/10/95.]



246-817-722
Defibrillator.

(1) Every dental office in the state of Washington that administers minimal, moderate, or deep sedation, or general anesthesia, as defined in WAC 246-817-710, must have an automated external defibrillator (AED) or defibrillator.
(2) The dentist and staff must have access to the AED or defibrillator in an emergency, and it must be available and in reach within sixty seconds.
(3) A dental office may share a single AED or defibrillator with adjacent businesses if it meets the requirements in this section.
[Statutory Authority: RCW 18.32.640 and 18.32.0365. WSR 10-23-001, § 246-817-722, filed 11/3/10, effective 12/4/10; WSR 09-04-042, § 246-817-722, filed 1/30/09, effective 3/2/09.]



246-817-724
Recordkeeping, equipment and emergency medications or drugs required in all sites where anesthetic agents of any kind are administered.

(1) Dental records must contain an appropriate medical history and patient evaluation. Any adverse reactions, and all medications and dosages, must be recorded.
(2) When sedation of any level is to be administered, excluding minimal sedation by inhalation, presedation vitals including, but not limited to, blood pressure and heart rate must be obtained and recorded, unless the cooperation of the patient or circumstances of the case will not allow it. If presedation vitals cannot be obtained, the reason(s) why must be recorded.
(3) Office facilities and equipment must include:
(a) Suction equipment capable of aspirating gastric contents from the mouth and pharynx;
(b) Portable oxygen delivery system including full face masks and a bag-valve-mask combination with appropriate connectors capable of delivering positive pressure, oxygen enriched ventilation to the patient;
(c) Blood pressure cuff (sphygmomanometer) of appropriate size;
(d) Stethoscope or equivalent monitoring device.
(4) The following emergency drugs must be available and maintained:
(a) Bronchodilator;
(b) Sugar (glucose);
(c) Aspirin;
(d) Antihistaminic;
(e) Coronary artery vasodilator;
(f) Anti-anaphylactic agent.
[Statutory Authority: RCW 18.32.0365 and 18.32.640. WSR 16-06-106, § 246-817-724, filed 3/1/16, effective 4/1/16; WSR 09-04-042, § 246-817-724, filed 1/30/09, effective 3/2/09.]



246-817-730
Local anesthesia.

Local anesthesia shall be administered only by a person qualified under this chapter and dental hygienists as provided in chapter 18.29 RCW.
(1) All offices must comply with the requirements listed in WAC 246-817-724.
(2) A permit of authorization is not required.
[Statutory Authority: RCW 18.32.640 and 18.32.0365. WSR 09-04-042, § 246-817-730, filed 1/30/09, effective 3/2/09. Statutory Authority: RCW 18.32.035. WSR 95-21-041, § 246-817-730, filed 10/10/95, effective 11/10/95.]



246-817-740
"Minimal sedation by inhalation" (to include, but not limited to, nitrous oxide).

(1) Training requirements: To administer inhalation minimal sedation a dentist must have completed a course containing a minimum of fourteen hours of either predoctoral dental school or postgraduate instruction in inhalation minimal sedation.
(2) Procedures for administration: Inhalation minimal sedation must be administered under the close supervision of a person qualified under this chapter and dental hygienists as provided in chapter 18.29 RCW:
(a) When administering inhalation minimal sedation, a second individual must be on the office premises and able to immediately respond to any request from the person administering the inhalation minimal sedation;
(b) The patient must be continuously observed while inhalation minimal sedation is administered.
(3) Equipment and emergency medications: All offices in which inhalation minimal sedation is administered must comply with the recordkeeping and equipment standards listed in WAC 246-817-724.
(4) Dental records must contain documentation in the chart of either nitrous oxide, oxygen or any other inhalation sedation agent dispensed.
(a) In the case of nitrous oxide sedation only "N2O used" is required.
(b) Other inhalation agents require a dose record noting the time each concentration or agent was used.
(5) Continuing education: A dentist who administers inhalation sedation to patients must participate in seven hours of continuing education or equivalent every five years.
(a) The education must include instruction in one or more of the following areas:
(i) Sedation;
(ii) Physiology;
(iii) Pharmacology;
(iv) Inhalation analgesia;
(v) Patient evaluation;
(vi) Patient monitoring; and
(vii) Medical emergencies.
(b) In addition to education requirements in (a) of this subsection, the dentist must obtain health care provider basic life support (BLS), or advanced cardiac life support (ACLS) certification. Hourly credits earned from certification in BLS or ACLS courses may not be used to meet the education requirements in (a) of this subsection. However, the hourly credits earned in BLS or ACLS certification may be used to meet the requirements of WAC 246-817-440 to renew the dentist license.
(6) A permit of authorization is not required.
[Statutory Authority: RCW 18.32.0365 and 18.32.640. WSR 16-06-106, § 246-817-740, filed 3/1/16, effective 4/1/16; WSR 09-04-042, § 246-817-740, filed 1/30/09, effective 3/2/09. Statutory Authority: RCW 18.32.035. WSR 95-21-041, § 246-817-740, filed 10/10/95, effective 11/10/95.]



246-817-745
"Minimal sedation."

(1) Training requirements: To administer "minimal sedation," including:
(a) A single oral agent, a dentist must have completed a course containing a minimum of fourteen hours of a predoctoral dental school, postgraduate instruction, or continuing education (as defined in WAC 246-817-440) in the use of oral agents;
(b) Any oral agent in combination with a different agent or multiple agents other than nitrous oxide or injectable agents, a dentist must have completed a course containing a minimum of twenty-one hours of either predoctoral dental school or postgraduate instruction.
(2) Procedures for administration:
(a) Oral sedative agents can be administered in the treatment setting or prescribed for patient dosage prior to the appointment;
(b) A second individual must be on the office premises and able to immediately respond to any request from the person administering the drug;
(c) The patient must be continuously observed while in the office under the influence of the drug;
(d) Any adverse reactions must be documented in the records;
(e) If a patient unintentionally enters into a moderate level of sedation, the patient must be returned to a level of minimal sedation as quickly as possible. While returning the patient to the minimal sedation level, periodic monitoring of pulse, respiration, and blood pressure must be maintained. In such cases, these same parameters must be taken and recorded at appropriate intervals throughout the procedure and vital signs and level of consciousness must be recorded during the sedation and prior to dismissal of the patient.
(3) Dental records must contain documentation in the chart of all agents administered, time administered, and dosage for minimal sedation.
(a) In the case of nitrous oxide sedation only "N2O used" is required.
(b) Other inhalation agents require a dose record noting the time each concentration and agent was used.
(4) Continuing education: A dentist who administers minimal sedation to patients must participate in seven hours of continuing education or equivalent every five years.
(a) The education must include instruction in one or more of the following areas:
(i) Sedation;
(ii) Physiology;
(iii) Pharmacology;
(iv) Nitrous oxide analgesia;
(v) Patient evaluation;
(vi) Patient monitoring; and
(vii) Medical emergencies.
(b) In addition to education requirements in (a) of this subsection, the dentist must obtain health care provider basic life support (BLS) or advanced cardiac life support (ACLS) certification. Hourly credits earned from certification in BLS or ACLS courses may not be used to meet the education requirements in (a) of this subsection. However, the hourly credit hours earned in BLS or ACLS certification may be used to meet the renewal requirements of WAC 246-817-440 to renew the dentist license.
(5) A permit of authorization is not required.
[Statutory Authority: RCW 18.32.0365 and 18.32.640. WSR 16-06-106, § 246-817-745, filed 3/1/16, effective 4/1/16; WSR 09-04-042, § 246-817-745, filed 1/30/09, effective 3/2/09.]



246-817-755
Moderate sedation.

(1) Training requirements: To administer moderate sedation the dentist must have completed a course containing a minimum of seven hours of a predoctoral dental school, postgraduate instruction, or continuing education (as defined in WAC 246-817-440) in moderate sedation in addition to twenty-one hours for minimal sedation.
(2) Procedures for administration:
(a) Oral sedative agents can be administered in the treatment setting or prescribed for patient dosage prior to the appointment.
(b) A second individual must be on the office premises who can immediately respond to any request from the person administering the drug.
(c) The patient must be continuously observed while in the office under the influence of the drug.
(d) Any adverse reactions must be documented in the records.
(e) If a patient unintentionally enters a deeper level of sedation, the patient must be returned to a level of moderate sedation as quickly as possible. While returning the patient to the moderate level of sedation, periodic monitoring of pulse, respiration, and blood pressure and pulse oximetry must be maintained. In such cases, these same parameters must be taken and recorded at appropriate intervals throughout the procedure and vital signs and level of consciousness must be recorded during the sedation and prior to dismissal of the patient.
(f) Patients receiving these forms of sedation must be accompanied by a responsible adult upon departure from the treatment facility.
(3) Equipment and emergency medications: All offices must comply with the requirements listed in WAC 246-817-724. When a sedative drug is used that has a reversal agent, the reversal agent must be in the office emergency kit and the equipment to administer the reversal agent must be stored with the delivery device. Pulse oximetry equipment or equivalent respiratory monitoring equipment must be available in the office.
(4) Continuing education: A dentist who administers moderate sedation to patients must participate in seven hours of continuing education or equivalent every five years.
(a) The education must include instruction in one or more of the following areas:
(i) Sedation;
(ii) Physiology;
(iii) Pharmacology;
(iv) Nitrous oxide analgesia;
(v) Patient evaluation;
(vi) Patient monitoring; and
(vii) Medical emergencies.
(b) In addition to education requirements in (a) of this subsection, the dentist must obtain health care provider basic life support (BLS), advanced cardiac life support (ACLS), or pediatric advanced life support (PALS) certification to renew the moderate sedation permit. Hourly credits earned from certification in BLS, ACLS, or PALS courses may not be used to meet the education requirements in (a) of this subsection. However, the hourly credits earned in BLS, ACLS, or PALS certification may be used to meet the requirements of WAC 246-817-440 to renew the dentist license.
(5) A permit of authorization is required. See WAC 246-817-774 for permitting requirements.
[Statutory Authority: RCW 18.32.0365 and 18.32.640. WSR 16-06-106, § 246-817-755, filed 3/1/16, effective 4/1/16; WSR 09-04-042, § 246-817-755, filed 1/30/09, effective 3/2/09.]



246-817-760
Moderate sedation with parenteral agents.

(1) Training requirements: To administer moderate sedation with parenteral agents, the dentist must have successfully completed a postdoctoral course(s) of sixty clock hours or more which includes training in basic moderate sedation, physical evaluation, venipuncture, technical administration, recognition and management of complications and emergencies, monitoring, and supervised experience in providing moderate sedation to fifteen or more patients. If treating an adult, the dentist must have training in adult sedation. If treating a minor, the dentist must have training in pediatric sedation.
(2) In addition to meeting the criteria in subsection (1) of this section, the dentist must also have a current certification in advanced cardiac life support (ACLS) or pediatric advanced life support (PALS). If treating an adult, the dentist must have ACLS certification. If treating a minor, the dentist must have PALS certification.
(3) The drugs, drug amounts, and techniques used must carry a margin of safety wide enough to render unintended loss of consciousness highly unlikely.
(4) Procedures for administration of moderate sedation with parenteral agents by a dentist and an individual trained in monitoring sedated patients:
(a) In the treatment setting, a patient receiving moderate sedation with parenteral agents must have that sedation administered by a person qualified under this chapter.
(b) A patient may not be left alone in a room and must be continually monitored by a dentist with a valid moderate sedation with parenteral agent permit or trained anesthesia monitor.
(c) An intravenous infusion must be maintained during the administration of a parenteral agent. Two exceptions for intravenous infusion may occur, but reasons why intravenous infusion was not used must be documented for:
(i) Pediatric sedation cases using agents for brief procedures; and
(ii) When the pediatric patient is uncooperative or the emotional condition is such that intravenous access is not possible.
(d) When the operative dentist is also the person administering the moderate sedation with parenteral agents, the operative dentist must be continuously assisted by at least one individual experienced in monitoring sedated patients. If treating an adult, the additional individual must have experience or training in adult sedation. If treating a minor, the additional individual must have experience or training in pediatric sedation.
(e) In the treatment setting, a patient experiencing moderate sedation with parenteral agents must be visually and tactilely monitored by the dentist or an individual trained in monitoring sedated patients. Patient monitoring must include:
(i) Heart rate;
(ii) Blood pressure;
(iii) Respiration;
(iv) Pulse oximetry; and
(v) Expired carbon dioxide (CO2). Two exceptions for expired CO2 monitoring may occur, but reasons why expired CO2 monitoring was not used must be documented for:
(A) Pediatric sedation cases using agents for brief procedures; and
(B) When the pediatric patient is uncooperative or the emotional condition is such that CO2 monitoring is not possible.
(f) Requirements of immobilization devices for pediatric patients:
(i) Immobilization devices, such as, papoose boards, must be applied in such a way as to avoid airway obstruction or chest restriction.
(ii) The pediatric patient head position and respiratory excursions must be checked frequently to ensure airway patency.
(iii) If an immobilization device is used, a hand or foot must be kept exposed.
(g) The patient's blood pressure and heart rate must be recorded every five minutes, pulse oximetry recorded every five minutes, and respiration rate must be recorded at least every fifteen minutes.
(h) The patient's level of consciousness must be recorded prior to the dismissal of the patient.
(i) Patients receiving moderate sedation with parenteral agents must be accompanied by a responsible adult upon departure from the treatment facility.
(j) If a patient unintentionally enters a deeper level of sedation, the patient must be returned to a level of moderate sedation as quickly as possible. While returning the patient to the moderate level of sedation, periodic monitoring of pulse, respiration, blood pressure and continuous monitoring of oxygen saturation must be maintained. In such cases, these same parameters must be taken and recorded at appropriate intervals throughout the procedure and vital signs and level of consciousness must be recorded during the sedation and prior to dismissal of the patient.
(5) Dental records must contain appropriate medical history and patient evaluation. Sedation records must be recorded during the procedure in a timely manner and must include:
(a) Blood pressure;
(b) Heart rate;
(c) Respiration;
(d) Pulse oximetry;
(e) End-tidal CO2. Two exceptions for end-tidal CO2 monitoring may occur, but reasons why end-tidal CO2 monitoring was not used must be documented for:
(i) Pediatric sedation cases using agents for brief procedures; and
(ii) When the pediatric patient is uncooperative or the emotional condition is such that end-tidal CO2 monitoring is not possible.
(f) Drugs administered including amounts and time administered;
(g) Length of procedure; and
(h) Any complications of sedation.
(6) Equipment and emergency medications: All offices in which moderate sedation with parenteral agents is administered or prescribed must comply with the following equipment standards:
Office facilities and equipment shall include:
(a) Suction equipment capable of aspirating gastric contents from the mouth and pharynx;
(b) Portable oxygen delivery system including full face masks and a bag-valve-mask combination with appropriate connectors capable of delivering positive pressure, oxygen-enriched patient ventilation and oral and nasal pharyngeal airways. If treating an adult, the equipment must be appropriate for adult sedation. If treating a minor, the equipment must be appropriate for pediatric sedation;
(c) A blood pressure cuff (sphygmomanometer) of appropriate size and stethoscope; or equivalent monitoring devices;
(d) End-tidal CO2 monitor;
(e) Pulse oximetry; and
(f) An emergency drug kit with minimum contents of:
(i) Sterile needles, syringes, and tourniquet;
(ii) Narcotic antagonist;
(iii) Alpha and beta adrenergic stimulant;
(iv) Vasopressor;
(v) Coronary vasodilator;
(vi) Antihistamine;
(vii) Parasympatholytic;
(viii) Intravenous fluids, tubing, and infusion set; and
(ix) Sedative antagonists for drugs used, if available.
(7) Continuing education: A dentist who administers moderate sedation with parenteral agents must participate in eighteen hours of continuing education or equivalent every three years.
(a) The education must include instruction in one or more of the following areas:
(i) Venipuncture;
(ii) Intravenous sedation;
(iii) Physiology;
(iv) Pharmacology;
(v) Nitrous oxide analgesia;
(vi) Patient evaluation;
(vii) Patient monitoring; and
(viii) Medical emergencies.
(b) In addition to the education requirements in (a) of this subsection, the dentist must have a current certification in advanced cardiac life support (ACLS) or pediatric advanced life support (PALS) to renew the moderate sedation with parenteral agents permit. Hourly credits earned from certification in BLS, ACLS, or PALS courses may not be used to meet the education requirements in (a) of this subsection to renew a moderate sedation with parenteral agents permit. However, the hourly credits earned in ACLS or PALS certification may be used to meet the requirements of WAC 246-817-440 to renew the dentist license.
(8) A permit of authorization is required. See WAC 246-817-774 for permitting requirements.
[Statutory Authority: RCW 18.32.0365 and 18.32.640. WSR 17-07-037, § 246-817-760, filed 3/8/17, effective 4/8/17; WSR 16-06-106, § 246-817-760, filed 3/1/16, effective 4/1/16; WSR 09-04-042, § 246-817-760, filed 1/30/09, effective 3/2/09. Statutory Authority: RCW 18.32.035. WSR 95-21-041, § 246-817-760, filed 10/10/95, effective 11/10/95.]



246-817-770
General anesthesia and deep sedation.

Deep sedation and general anesthesia must be administered by an individual qualified to do so under this chapter.
(1) Training requirements: To administer deep sedation or general anesthesia, the dentist must meet one or more of the following criteria:
(a) Any provider currently permitted as of the effective date of this revision to provide deep sedation or general anesthesia by the state of Washington will be grandfathered regarding formal training requirements, provided they meet current continuing education and other ongoing applicable requirements.
(b) New applicants with anesthesia residency training will be required to have had two years of continuous full-time anesthesia training meeting the following requirements based on when they began their anesthesia training:
(i) For dentists who began their anesthesia training prior to 2008, training must include two full years of continuous full-time training in anesthesiology beyond the undergraduate dental school level, in a training program as outlined in part 2 of "Guidelines for Teaching the Comprehensive Control of Anxiety and Pain in Dentistry," published by the American Dental Association, Council on Dental Education (last revised October 2005).
(ii) For dentists who begin their anesthesia training in January 2008 or after, must have either received a certificate of completion.
(A) From a dental anesthesiology program accredited by CODA (ADA Commission on Dental Accreditation, "Accreditation Standards for Advanced General Dentistry Education Programs in Dental Anesthesiology," January 2007); or
(B) From a dental anesthesiology program approved by the Dental Quality Assurance Commission; or
(C) With a minimum of two years of full-time anesthesia residency training at a medical program accredited by the Accreditation Council for Graduate Medical Education (ACGME).
(c) New applicants who completed residency training in oral and maxillofacial surgery must meet at least one of the following requirements:
(i) Be a diplomate of the American Board of Oral and Maxillofacial Surgery;
(ii) Be a fellow of the American Association of Oral and Maxillofacial Surgeons; or
(iii) Be a graduate of an Oral and Maxillofacial Residency Program accredited by CODA.
(2) In addition to meeting one or more of the above criteria, the dentist must also have a current and documented proficiency in advanced cardiac life support (ACLS).
(3) Procedures for administration:
(a) Patients receiving deep sedation or general anesthesia must have continual monitoring of their heart rate, blood pressure, respiration, and expired carbon dioxide (CO2). In so doing, the licensee must utilize electrocardiographic monitoring, pulse oximetry, and end-tidal CO2 monitoring;
(b) The patient's blood pressure and heart rate shall be recorded every five minutes and respiration rate shall be recorded at least every fifteen minutes;
(c) During deep sedation or general anesthesia, the person administering the anesthesia and the person monitoring the patient may not leave the immediate area;
(d) During the recovery phase, the patient must be continually observed by the anesthesia provider or credentialed personnel;
(e) A discharge entry shall be made in the patient's record indicating the patient's condition upon discharge and the responsible party to whom the patient was discharged.
(4) Dental records must contain appropriate medical history and patient evaluation. Anesthesia records shall be recorded during the procedure in a timely manner and must include:
(a) Blood pressure;
(b) Heart rate;
(c) Respiration;
(d) Pulse oximetry;
(e) End-tidal CO2;
(f) Drugs administered including amounts and time administered;
(g) Length of procedure; and
(h) Any complications of anesthesia.
(5) Equipment and emergency medications: All offices in which general anesthesia (including deep sedation) is administered must comply with the following equipment standards:
(a) An operating theater large enough to adequately accommodate the patient on a table or in an operating chair and permit an operating team consisting of at least three individuals to freely move about the patient;
(b) An operating table or chair which permits the patient to be positioned so the operating team can maintain the airway, quickly alter patient position in an emergency, and provide a firm platform for the administration of basic life support;
(c) A lighting system which is adequate to permit evaluation of the patient's skin and mucosal color and a backup lighting system of sufficient intensity to permit conclusion of any operation underway at the time of general power failure;
(d) Suction equipment capable of aspirating gastric contents from the mouth and pharyngeal cavities. A backup suction device must be available;
(e) An oxygen delivery system with adequate full face masks and appropriate connectors that is capable of delivering high flow oxygen to the patient under positive pressure, together with an adequate portable backup system;
(f) A recovery area that has available oxygen, adequate lighting, suction, and electrical outlets. The recovery area can be the operating theater;
(g) Ancillary equipment which must include the following:
(i) Laryngoscope complete with adequate selection of blades, spare batteries, and bulb;
(ii) Endotracheal tubes and appropriate connectors, and laryngeal mask airway (LMA) and other appropriate equipment necessary to do an intubation;
(iii) Oral airways;
(iv) Tonsillar or pharyngeal suction tip adaptable to all office outlets;
(v) Endotracheal tube forceps;
(vi) Sphygmomanometer and stethoscope;
(vii) Adequate equipment to establish an intravenous infusion;
(viii) Pulse oximeter or equivalent;
(ix) Electrocardiographic monitor;
(x) End-tidal CO2 monitor;
(xi) Defibrillator or automatic external defibrillator (AED) available and in reach within sixty seconds from any area where general or deep anesthesia care is being delivered. Multiple AEDs or defibrillators may be necessary in large facilities. The AED or defibrillator must be on the same floor. (In dental office settings where sedation or general anesthesia are not administered, AEDs or defibrillators are required as defined in WAC 246-817-722.)
(h) Emergency drugs of the following types shall be maintained:
(i) Vasopressor or equivalent;
(ii) Corticosteroid or equivalent;
(iii) Bronchodilator;
(iv) Muscle relaxant;
(v) Intravenous medications for treatment of cardiac arrest;
(vi) Narcotic antagonist;
(vii) Benzodiazepine antagonist;
(viii) Antihistaminic;
(ix) Anticholinergic;
(x) Antiarrhythmic;
(xi) Coronary artery vasodilator;
(xii) Antihypertensive;
(xiii) Anticonvulsant.
(6) Continuing education:
(a) A dentist granted a permit to administer general anesthesia (including deep sedation) under this chapter, must complete eighteen hours of continuing education every three years.
A dentist granted a permit must maintain records that can be audited and must submit course titles, instructors, dates attended, sponsors, and number of hours for each course every three years.
(b) The education must be provided by organizations approved by the DQAC and must be in one or more of the following areas: General anesthesia; conscious sedation; physical evaluation; medical emergencies; pediatric advanced life support (PALS); monitoring and use of monitoring equipment; pharmacology of drugs; and agents used in sedation and anesthesia.
(c) Hourly credits earned from certification in health care provider basic life support (BLS) and advanced cardiac life support (ACLS) courses may not be used to meet the continuing education hourly requirements for obtaining or renewing a general anesthesia and deep sedation permit, however these continuing education hours may be used to meet the renewal requirement for the dental license.
(7) A permit of authorization is required. See WAC 246-817-774 for permitting requirements.
[Statutory Authority: RCW 18.32.0365, 18.32.640 and 18.32.002. WSR 14-21-068, § 246-817-770, filed 10/10/14, effective 11/10/14. Statutory Authority: RCW 18.32.640 and 18.32.0365. WSR 09-04-042, § 246-817-770, filed 1/30/09, effective 3/2/09. Statutory Authority: RCW 18.32.035. WSR 95-21-041, § 246-817-770, filed 10/10/95, effective 11/10/95.]



246-817-771
Dental anesthesia assistant.

(1) A dental anesthesia assistant must be certified under chapter 18.350 RCW and WAC 246-817-205.
(2) A dental anesthesia assistant may only accept delegation from an oral and maxillofacial surgeon or dental anesthesiologist who holds a valid Washington state general anesthesia permit.
(3) Under close supervision, the dental anesthesia assistant may:
(a) Initiate and discontinue an intravenous line for a patient being prepared to receive intravenous medications, sedation, or general anesthesia; and
(b) Adjust the rate of intravenous fluids infusion only to maintain or keep the line patent or open.
(4) Under direct visual supervision, the dental anesthesia assistant may:
(a) Draw up and prepare medications;
(b) Follow instructions to deliver medications into an intravenous line upon verbal command;
(c) Adjust the rate of intravenous fluids infusion beyond a keep open rate;
(d) Adjust an electronic device to provide medications, such as an infusion pump;
(e) Administer emergency medications to a patient in order to assist the oral and maxillofacial surgeon or dental anesthesiologist in an emergency.
(5) The responsibility for monitoring a patient and determining the selection of the drug, dosage, and timing of all anesthetic medications rests solely with the supervising oral and maxillofacial surgeon or dental anesthesiologist.
(6) A certified dental anesthesia assistant shall notify the commission in writing, on a form provided by the department, of any changes in his or her supervisor.
(a) The commission must be notified of the change prior to the certified dental anesthesia assistant accepting delegation from another supervisor. The certified dental anesthesia assistant may not practice under the authority of this chapter unless he or she has on file with the commission such form listing the current supervisor.
(b) A supervisor must be an oral and maxillofacial surgeon or dental anesthesiologist who holds a valid Washington state general anesthesia permit.
(c) For the purposes of this subsection "any change" means the addition, substitution, or deletion of supervisor from whom the certified dental anesthesia assistant is authorized to accept delegation.
[Statutory Authority: Chapter 18.350 RCW, RCW 18.32.0365, 18.32.640, 18.130.050(14), and 18.260.120. WSR 13-15-144, § 246-817-771, filed 7/23/13, effective 8/23/13.]



246-817-772
Requirements for anesthesia monitor.

(1) When the dentist is also administering the deep sedation or general anesthesia, one additional appropriately trained team member must be designated for patient monitoring.
(2) When deep sedation or general anesthesia is administered by a dedicated anesthesia provider, the anesthesia provider may serve as the monitoring personnel.
(3) The dentist cannot employ an individual to monitor patients receiving deep sedation or general anesthesia unless that individual has received a minimum of fourteen hours of documented training (such as national certification American Association of Oral and Maxillofacial Surgeons "AAOMS") in a course specifically designed to include instruction and practical experience in use of equipment to include, but not be limited to, the following equipment:
(a) Sphygmomanometer; or a device able to measure blood pressure;
(b) Pulse oximeter; or other respiratory monitoring equipment;
(c) Electrocardiogram;
(d) Bag-valve-mask resuscitation equipment;
(e) Oral and nasopharyngeal airways;
(f) Defibrillator; automatic external defibrillator.
(4) The course referred to in subsection (3) of this section must also include instruction in:
(a) Basic sciences;
(b) Evaluation and preparation of patients with systemic diseases;
(c) Anesthetic drugs and techniques;
(d) Anesthesia equipment and monitoring; and
(e) Office anesthesia emergencies.
[Statutory Authority: RCW 18.32.0365 and 18.32.640. WSR 16-06-106, § 246-817-772, filed 3/1/16, effective 4/1/16; WSR 09-04-042, § 246-817-772, filed 1/30/09, effective 3/2/09.]



246-817-774
Permitting/renewal requirements.

(1) To administer moderate sedation (oral and/or parenteral), or general anesthesia (including deep sedation), a dentist must first meet the requirements of this chapter, possess and maintain a current dental license pursuant to chapter 18.32 RCW and obtain a permit of authorization from the DQAC through the department of health. Application forms for permits may be obtained online or from the department and must be fully completed and include the current application fee.
(2) A permit of authorization is valid for three years from the date of issuance and must be renewed prior to the expiration date.
(3) In addition to the renewal application form, the permit holder must:
(a) Demonstrate continuing compliance with this chapter.
(b) Submit satisfactory evidence of continuing education hours as required by this chapter.
The dentist must maintain records that can be audited and must submit course titles, instructors, dates of attendance, sponsors and number of hours for each course every three years as required by this chapter.
(c) Pay the applicable renewal fee.
(4) Site visits may be conducted at the DQAC discretion. Site visits will be conducted by an anesthesia provider permitted at the same level, in conjunction with a department of health investigator. Site visits may include the evaluation of equipment, medications, patient records, documentation of training of personnel, and other items as determined necessary.
[Statutory Authority: RCW 18.32.640 and 18.32.0365. WSR 09-04-042, § 246-817-774, filed 1/30/09, effective 3/2/09.]



246-817-776
Discharge criteria for all levels of sedation/general anesthesia.

The anesthesia provider must assess patient responsiveness using preoperative values as normal guidelines and discharge the patient only when the following criteria are met:
(1) Vital signs including blood pressure, pulse rate and respiratory rate are stable;
(2) The patient is alert and oriented to person, place and time as appropriate to age and preoperative psychological status;
(3) The patient can talk and respond coherently to verbal questioning as appropriate to age and preoperative psychological status;
(4) The patient can sit up unassisted;
(5) The patient can walk with minimal assistance;
(6) The patient does not have uncontrollable nausea or vomiting and has minimal dizziness;
(7) A discharge entry must be made in the patient's record by the anesthesia provider indicating the patient's condition upon discharge, and the name of the responsible party to whom the patient is released (if a patient is required to be released to a responsible party);
(8) If the patient does not meet established discharge criteria, the anesthesia provider must evaluate the patient and determine if the patient has safely recovered to be discharged. The evaluation determining that the patient can be safely discharged must be noted in the patient's record.
[Statutory Authority: RCW 18.32.640 and 18.32.0365. WSR 09-04-042, § 246-817-776, filed 1/30/09, effective 3/2/09.]



246-817-778
Nondental anesthesia providers.

(1) A licensed dentist, certified registered nurse anesthetist (CRNA) or physician anesthesiologist may provide anesthesia services in dental offices where dentists do not have an anesthesia permit when the anesthesia provider ensures that all equipment, facility, monitoring and assistant training requirements as established within this chapter related to anesthesia have been met. The anesthesia provider is exclusively responsible for the pre, intra, and post operative anesthetic management of the patient.
(2) The dentist without a general anesthesia permit must establish a written contract with the anesthesia provider to guarantee that when anesthesia is provided, all facility, equipment, monitoring and training requirements, for all personnel, as established by DQAC related to anesthesia, have been met.
(a) The dentist and the anesthesia provider may agree upon and arrange for the provision of items such as facility, equipment, monitoring and training requirements to be met by either party, provided the delineation of such responsibilities is written into the contract.
(b) Any contract under this section must state that the anesthesia provider must ensure anesthesia related requirements as set forth in this chapter have been met.
[Statutory Authority: RCW 18.32.640 and 18.32.0365. WSR 09-04-042, § 246-817-778, filed 1/30/09, effective 3/2/09.]



246-817-780
Mandatory reporting of death or significant complication as a result of any dental procedure.

All licensees engaged in the practice of dentistry must submit a report of any patient death or other life-threatening incident or complication, permanent injury or admission to a hospital that results in a stay at the hospital for more than twenty-four hours, which is or may be a result of a dental procedure caused by a dentist or dental treatment.
(1) The dentist involved must notify the department of health/DQAC, by telephone, email or fax within seventy-two hours of discovery and must submit a complete written report to the DQAC within thirty days of the incident.
(2) When a patient comes into an office with an existing condition, and hospital admission is the result of that condition and not the dental procedure, it is not reportable.
(3) The written report must include the following:
(a) Name, age, and address of the patient.
(b) Name of the dentist and other personnel present during the incident.
(c) Address of the facility or office where the incident took place.
(d) Description of the type of sedation or anesthetic being utilized at the time of the incident.
(e) Dosages, if any, of drugs administered to the patient.
(f) A narrative description of the incident including approximate times and evolution of symptoms.
(g) Additional information which the DQAC may require or request.
[Statutory Authority: RCW 18.32.640 and 18.32.0365. WSR 09-04-042, § 246-817-780, filed 1/30/09, effective 3/2/09. Statutory Authority: RCW 18.32.035. WSR 95-21-041, § 246-817-780, filed 10/10/95, effective 11/10/95.]



246-817-790
Application of chapter 18.130 RCW.

The provisions of the Uniform Disciplinary Act, chapter 18.130 RCW, apply to the permits of authorization that may be issued and renewed under this chapter.
[Statutory Authority: RCW 18.32.035. WSR 95-21-041, § 246-817-790, filed 10/10/95, effective 11/10/95.]



246-817-801
Intent.

It is the intent of the legislature that the DQAC seek ways to identify and support the rehabilitation of dentists where practice or competency may be impaired due to the abuse of drugs including alcohol. The legislature intends that these dentists be treated so that they can return to or continue to practice dentistry in a way which safeguards the public. The legislature specifically intends that the DQAC establish an alternate program to the traditional administrative proceedings against such dentists.
In lieu of disciplinary action under RCW 18.130.160 and if the DQAC determines that the unprofessional conduct may be the result of substance abuse, the DQAC may refer the license holder to a voluntary substance abuse monitoring program approved by the DQAC.
[Statutory Authority: RCW 18.32.035. WSR 95-21-041, § 246-817-801, filed 10/10/95, effective 11/10/95.]



246-817-810
Terms used in WAC 246-817-801 through 246-817-830.

"Aftercare" is that period of time after intensive treatment that provides the dentist or the dentist's family with group or individual counseling sessions, discussions with other families, ongoing contact and participation in self-help groups, and ongoing continued support of treatment and/or monitoring program staff.
"Approved substance abuse monitoring program" or "approved monitoring program" is a program the DQAC has determined meets the requirements of the law and the criteria established by the DQAC in the Washington Administrative Code which enters into a contract with dentists who have substance abuse problems regarding the required components of the dentist's recovery activity and oversees the dentist's compliance with these requirements. Substance abuse monitoring programs may provide evaluation and/or treatment to participating dentists.
"Approved treatment facility" is a facility approved by the bureau of alcohol and substance abuse, department of social and health services according to RCW 18.130.175.
"Contract" is a comprehensive, structured agreement between the recovering dentist and the approved monitoring program wherein the dentist consents to comply with the monitoring program and the required components for the dentist's recovery activity.
"Dentist support group" is a group of dentists and/or other health professionals meeting regularly to support the recovery of its members. The group provides a confidential setting with a trained and experienced facilitator in which participants may safely discuss drug diversion, licensure issues, return to work, and other professional issues related to recovery.
"Random drug screens" are laboratory tests to detect the presence of drugs of abuse in bodily fluids collected under observation which are performed at irregular intervals not known in advance by the person to be tested.
"Substance abuse" is the impairment, as determined by the DQAC, of a dentist's professional services by an addiction to, a dependency on, or the use of alcohol, legend drugs, or controlled substances.
"Twelve-steps groups" are groups such as Alcoholics Anonymous, Narcotics Anonymous, and related organizations based on a philosophy of anonymity, belief in a power outside of oneself, peer group association, and self-help.
[Statutory Authority: RCW 18.32.035. WSR 95-21-041, § 246-817-810, filed 10/10/95, effective 11/10/95.]



246-817-820
Approval of substance abuse monitoring programs.

The DQAC will approve the monitoring program(s) which will participate in the recovery of dentists. The DQAC will enter into a contract with the approved substance abuse monitoring program(s) on an annual basis.
(1) An approved monitoring program may provide evaluations and/or treatment to the participating dentists.
(2) An approved monitoring program staff must have the qualifications and knowledge of both substance abuse and the practice of dentistry as defined in this chapter to be able to evaluate:
(a) Drug screening laboratories;
(b) Laboratory results;
(c) Providers of substance abuse treatment, both individual and facilities;
(d) Dentists' support groups;
(e) The dentists' work environment; and
(f) The ability of the dentist to practice with reasonable skill and safety.
(3) An approved monitoring program shall enter into a contract with the dentist and the DQAC to oversee the dentist's compliance with the requirements of the program.
(4) An approved monitoring program staff shall evaluate and recommend to the DQAC, on an individual basis, whether a dentist will be prohibited from engaging in the practice of dentistry for a period of time and restrictions, if any, on the dentist's access to controlled substances in the work place.
(5) An approved monitoring program shall maintain records on participants.
(6) An approved monitoring program shall be responsible for providing feedback to the dentist as to whether treatment progress is acceptable.
(7) An approved monitoring program shall report to the DQAC any dentist who fails to comply with the requirements of the monitoring program.
(8) An approved monitoring program shall provide the DQAC with a statistical report on the program, including progress of participants, at least annually, or more frequently as requested by the DQAC.
(9) The approved monitoring program shall receive from the DQAC guidelines on treatment, monitoring, and/or limitations on the practice of dentistry for those participating in the program.
(10) An approved monitoring program shall provide for the DQAC a complete financial breakdown of cost for each individual dental participant by usage at an interval determined by the DQAC in the annual contract.
(11) An approved monitoring program shall provide for the DQAC a complete annual audited financial statement.
(12) An approved monitoring program shall enter into a written contract with the DQAC and submit monthly billing statements supported by documentation.
[Statutory Authority: RCW 18.32.035. WSR 95-21-041, § 246-817-820, filed 10/10/95, effective 11/10/95.]



246-817-830
Participation in approved substance abuse monitoring program.

(1) In lieu of disciplinary action, the dentist may accept DQAC referral into an approved substance abuse monitoring program.
(a) The dentist shall undergo a complete physical and psychosocial evaluation before entering the approved monitoring program. This evaluation shall be performed by health care professionals with expertise in chemical dependency.
(b) The dentist shall enter into a contract with the approved substance abuse monitoring program to comply with the requirements of the program which shall include, but not be limited to the following:
(i) The dentist shall agree to remain free of all mind-altering substances, including alcohol, except for medications prescribed by an authorized prescriber, as defined in RCW 69.41.030 and 69.50.101.
(ii) The dentist shall submit to random drug screening as specified by the approved monitoring program.
(iii) The dentist shall sign a waiver allowing the approved monitoring program to release information to the DQAC if the dentist does not comply with the requirements of this contract.
(iv) The dentist shall undergo intensive substance abuse treatment in an approved treatment facility.
(v) The dentist must complete the prescribed aftercare program of the approved treatment facility, which may include individual and/or group psychotherapy.
(vi) The treatment counselor(s) shall provide reports, as requested by the dentist, to the approved monitoring program at specified intervals. Reports shall include treatment prognosis and goals.
(vii) The dentist shall attend dentists' support groups and/or twelve-step group meetings as specified by the contract.
(viii) The dentist shall comply with specified practice conditions and restrictions as defined by the contract.
(ix) Except for (b)(i) through (iii) of this subsection, an approved monitoring program may make an exception to the foregoing comments on individual contracts.
(c) The dentist is responsible for paying the costs of the physical and psychosocial evaluation, substance abuse treatment, random drug screens, and therapeutic group sessions.
(d) The dentist may be subject to disciplinary action under RCW 18.130.160 and 18.130.180 if the dentist does not consent to be referred to the approved monitoring program, does not comply with specified practice restrictions, or does not successfully complete the program.
(2) A dentist who is not being investigated by the DQAC or subject to current disciplinary action, not currently being monitored by the DQAC for substance abuse, may voluntarily participate in the approved substance abuse monitoring program without being referred by the DQAC. Such voluntary participants shall not be subject to disciplinary action under RCW 18.130.160 and 18.130.180 for their substance abuse, and shall not have their participation made known to the DQAC if they meet the requirements of the approved monitoring program:
(a) The dentist shall undergo a complete physical and psychosocial evaluation before entering the approved monitoring program. This evaluation shall be performed by health care professional(s) with expertise in chemical dependency.
(b) The dentist shall enter into a contract with the approved substance abuse monitoring program to comply with the requirements of the program which may include, but not be limited to the following:
(i) The dentist shall undergo approved substance abuse treatment in an approved treatment facility.
(ii) The dentist shall agree to remain free of all mind-altering substances, including alcohol, except for medications prescribed by an authorized prescriber as defined in RCW 69.41.030 and 69.50.101.
(iii) The dentist must complete the prescribed aftercare program of the approved treatment facility, which may include individual and/or group psychotherapy.
(iv) The dentist must cause the treatment counselor(s) to provide reports to the approved monitoring program at specified intervals. Reports shall include treatment prognosis and goals.
(v) The dentist shall submit to random observed drug screening as specified by the approved monitoring program.
(vi) The dentist shall attend dentists' support groups and/or twelve-step group meetings as specified by the contract.
(vii) The dentist shall comply with practice conditions and restrictions as defined by the contract.
(viii) The dentist shall sign a waiver allowing the approved monitoring program to release information to the DQAC if the dentist does not comply with the requirements of this contract.
(c) The dentist is responsible for paying the costs of the physical and psychosocial evaluation, substance abuse treatment, random drug screens, and therapeutic group sessions.
(3) Treatment and pretreatment records shall be confidential as provided by law.
[Statutory Authority: RCW 18.32.035. WSR 95-21-041, § 246-817-830, filed 10/10/95, effective 11/10/95.]



246-817-901
Intent and scope.

WAC 246-817-901 through 246-817-980 govern the prescribing of opioids in the treatment of pain.
[Statutory Authority: RCW 18.32.002, 18.32.0365, 18.32.800 and 2017 c 297. WSR 19-02-043, § 246-817-901, filed 12/26/18, effective 1/26/19. Statutory Authority: RCW 18.32.785 and 18.32.0365. WSR 11-10-061, § 246-817-901, filed 5/2/11, effective 7/1/11.]



246-817-905
Exclusions.

WAC 246-817-901 through 246-817-980 do not apply to:
(1) The treatment of patients with cancer-related pain. Cancer-related pain means pain that is unpleasant, persistent, subjective sensory and emotional experience associated with actual or potential tissue injury or damage or described in such terms and is related to cancer or cancer treatment that interferes with usual functioning;
(2) The provision of palliative, hospice, or other end-of-life care;
(3) The treatment of inpatient hospital patients. Inpatient means a person who has been admitted to the hospital for more than twenty-four hours; or
(4) The provision of procedural medications.
[Statutory Authority: RCW 18.32.002, 18.32.0365, 18.32.800 and 2017 c 297. WSR 19-02-043, § 246-817-905, filed 12/26/18, effective 1/26/19. Statutory Authority: RCW 18.32.785 and 18.32.0365. WSR 11-10-061, § 246-817-905, filed 5/2/11, effective 7/1/11.]



246-817-906
Definitions.

The definitions in this section apply to WAC 246-817-901 through 246-817-980 unless the context clearly requires otherwise:
(1) "Aberrant behavior" means behavior that indicates misuse, diversion or substance use disorder. This includes, but is not limited to, multiple early refills or renewals, or obtaining prescriptions for the same or similar drugs from more than one dentist or other health care practitioner.
(2) "Acute pain" means the normal, predicted physiological response to a noxious chemical, thermal, or mechanical stimulus and typically is associated with invasive procedures, trauma, and disease. Acute pain is considered to be six weeks or less in duration.
(3) "Biological specimen test" or "biological specimen testing" means tests of urine, hair or other biological samples for various drugs and metabolites.
(4) "Chronic pain" means a state in which pain persists beyond the usual course of an acute disease or healing of an injury, or that may or may not be associated with an acute or chronic pathologic process, that causes continuous or intermittent pain over months or years.
(5) "Comorbidities" means a preexisting or coexisting physical or psychiatric disease or condition.
(6) "High dose" means ninety milligram MED or more, per day.
(7) "High-risk" is a category of patient at increased risk of morbidity or mortality, such as from comorbidities, polypharmacy, history of substance use disorder or abuse, aberrant behavior, high dose opioid prescription, or the use of any central nervous system depressant.
(8) "Hospice" means a model of care that focuses on relieving symptoms and supporting patients with life expectancy of six months or less.
(9) "Hospital" means any institution, place, building, or agency licensed under chapter 70.41 or 71.12 RCW, or designated under chapter 72.23 RCW to provide accommodations, facilities, and services over a continuous period of twenty-four hours or more, for observation, diagnosis, or care of two or more individuals not related to the operator who are suffering from illness, injury, deformity, or abnormality, or from any other condition for which obstetrical, medical, or surgical services would be appropriate for care or diagnosis.
(10) "Low-risk" means a category of patient at low risk of opioid induced morbidity or mortality, based on factors and combinations of factors such as medical and behavioral comorbidities, polypharmacy, and dose of opioids of less than 50 MED.
(11) "Medication assisted treatment" or "MAT" means the use of pharmacologic therapy, often in combination with counseling and behavioral therapies, for the treatment of substance use disorders.
(12) "Moderate-risk" means a category of patient at moderate risk of opioid induced morbidity or mortality, based on factors and combinations of factors such as medical and behavioral comorbidities, polypharmacy, past history of substance use disorder or abuse, aberrant behavior, and dose of opioids between 50-90 MED.
(13) "Morphine equivalent dose" or "MED" means a conversion of various opioids to a morphine equivalent dose by the use of accepted conversion tables.
(14) "Multidisciplinary pain clinic" means a facility that provides comprehensive pain management and includes care provided by multiple available disciplines, practitioners, or treatment modalities.
(15) "Nonoperative pain" means acute pain which does not occur as a result of surgery.
(16) "Opioid analgesic" or "opioid" means a drug that is used to alleviate moderate to severe pain that is either an opiate derived from the opium poppy or opiate-like that is a semi-synthetic or synthetic drug. Examples include morphine, codeine, hydrocodone, oxycodone, fentanyl, meperidine, and methadone.
(17) "Palliative care" means care that maintains or improves the quality of life of patients and their families facing serious, advanced, or life-threatening illness. With palliative care particular attention is given to the prevention, assessment, and treatment of pain and other symptoms, and to the provision of psychological, spiritual, and emotional support.
(18) "Pain" means an unpleasant sensory or emotional experience associated with actual or potential tissue damage, or described in terms of such damage.
(19) "Perioperative pain" means acute pain that occurs as the result of surgery.
(20) "Practitioner" means an advanced registered nurse practitioner licensed under chapter 18.79 RCW, a dentist licensed under chapter 18.32 RCW, a physician licensed under chapter 18.71 or 18.57 RCW, a physician assistant licensed under chapter 18.71A or 18.57A RCW, or a podiatric physician licensed under chapter 18.22 RCW.
(21) "Prescription monitoring program" or "PMP" means the Washington state prescription monitoring program authorized under chapter 70.225 RCW.
(22) "Subacute pain" is considered to be a continuation of pain, of six to twelve weeks in duration.
(23) "Substance use disorder" means a primary, chronic, neurobiological disease with genetic, psychosocial, and environmental factors influencing its development and manifestations. Substance use disorder is not the same as physical dependence or tolerance that are normal physiological consequences of extended opioid therapy for pain. It is characterized by behaviors that include, but are not limited to, impaired control over drug use, craving, compulsive use, or continued use despite harm.
[Statutory Authority: RCW 18.32.002, 18.32.0365, 18.32.800 and 2017 c 297. WSR 19-02-043, § 246-817-906, filed 12/26/18, effective 1/26/19.]



246-817-907
Patient notification, secure storage, and disposal.

(1) The dentist shall provide information to the patient educating them of risks associated with the use of opioids. The dentist shall document such notification in the patient record.
(2) Patient notification must occur, at a minimum, at the following points of treatment:
(a) The first issuance of a prescription for an opioid; and
(b) The transition between phase of treatment, as follows:
(i) Acute nonoperative pain or acute perioperative pain to subacute pain; and
(ii) Subacute pain to chronic pain.
(3) Patient notification must include information regarding:
(a) The safe and secure storage of opioid prescriptions; and
(b) The proper disposal of unused opioid medication including, but not limited to, the availability of recognized drug take-back programs.
(4) This requirement may be satisfied with a document provided by the department of health.
[Statutory Authority: RCW 18.32.002, 18.32.0365, 18.32.800 and 2017 c 297. WSR 19-02-043, § 246-817-907, filed 12/26/18, effective 1/26/19.]



246-817-908
Use of alternative modalities for pain treatment.

The dentist shall consider multimodal pharmacologic and nonpharmacologic therapy for pain rather than defaulting to the use of opioid therapy alone whenever reasonable, evidence-based, clinically appropriate alternatives exist.
[Statutory Authority: RCW 18.32.002, 18.32.0365, 18.32.800 and 2017 c 297. WSR 19-02-043, § 246-817-908, filed 12/26/18, effective 1/26/19.]



246-817-909
Continuing education requirements for opioid prescribing.

(1) In order to prescribe an opioid in Washington state, a dentist licensed to prescribe opioids shall complete a one-time continuing education requirement regarding best practices in the prescribing of opioids and the rules in this chapter. The continuing education must be at least three hours in length.
(2) The dentist shall complete the one-time continuing education requirement described in subsection (1) of this section by the end of the dentist's first full continuing education reporting period after January 1, 2019, or during the first full continuing education reporting period after initial licensure, whichever is later.
(3) The hours spent completing the training in opioid prescribing under this section count toward meeting applicable continuing education requirements for dentist license renewal.
[Statutory Authority: RCW 18.32.002, 18.32.0365, 18.32.800 and 2017 c 297. WSR 19-02-043, § 246-817-909, filed 12/26/18, effective 1/26/19.]



246-817-911
Diagnosis identified on prescription.

The practitioner shall include the diagnosis, indication for use, or the International Classification of Diseases (ICD) code on all opioid prescriptions.
[Statutory Authority: RCW 18.32.002, 18.32.0365, 18.32.800 and 2017 c 297. WSR 19-02-043, § 246-817-911, filed 12/26/18, effective 1/26/19.]



246-817-913
Treatment planAcute nonoperative pain and acute perioperative pain.

The dentist shall comply with the requirements in this section when prescribing opioid analgesics for acute nonoperative pain or acute perioperative pain and shall document completion of these requirements in the patient record:
(1) The dentist shall consider prescribing nonopioid analgesics as the first line of pain control in patients in accordance with the provisions of WAC 246-817-908 unless not clinically appropriate.
(2) The dentist, or their designee, shall conduct queries of the PMP in accordance with the provisions of WAC 246-817-980 to identify any Schedule II-V medications or drugs of concern received by the patient and document their review and any concerns in the patient record.
(3) If the dentist prescribes opioids for effective pain control, such prescription must not be in a greater quantity than needed for the expected duration of pain severe enough to require opioids.
(a) A three-day supply or less will often be sufficient;
(b) More than a seven-day supply will rarely be needed;
(c) The dentist shall not prescribe beyond a seven-day supply without clinical documentation in the patient record to justify the need for such a quantity. For more specific best practices, the dentist may refer to clinical practice guidelines including, but not limited to, those produced by the agency medical directors' group, the Centers for Disease Control and Prevention, or the Bree collaborative.
(4) The dentist shall reevaluate the patient who does not follow the expected course of recovery. If significant and documented improvement in function or pain control has not occurred, the dentist shall reconsider the continued use of opioids or whether tapering or discontinuing opioids is clinically indicated.
(5) Follow-up visits for pain control must include objectives or metrics to be used to determine treatment success if opioids are to be continued. This includes, at a minimum:
(a) Change in pain level;
(b) Change in physical function;
(c) Change in psychosocial function; and
(d) Additional planned diagnostic evaluations to investigate causes of continued acute nonoperative pain or acute perioperative pain or other treatments.
(6) Long-acting or extended release opioids are not indicated for acute nonoperative pain. Should a dentist need to prescribe a long-acting opioid for acute pain, the dentist shall document the reason in the patient record.
(7) A dentist shall not discontinue medication assisted treatment medications when treating acute pain, except as consistent with the provisions of WAC 246-817-976.
(8) If the dentist elects to prescribe a combination of opioids with a medication listed in WAC 246-817-975 or to a patient known to be receiving a medication listed in WAC 246-817-975 from another practitioner, such prescribing must be in accordance with WAC 246-817-975.
(9) If the dentist elects to treat a patient with opioids beyond the six-week time period of acute nonoperative pain or acute perioperative pain, the dentist shall document in the patient record that the patient is transitioning from acute pain to subacute pain. Rules governing the treatment of subacute pain in WAC 246-817-915 and 246-817-916 shall apply unless there is documented improvement in function or pain control and there is a documented plan and timing for discontinuation of all opioid medications.
[Statutory Authority: RCW 18.32.002, 18.32.0365, 18.32.800 and 2017 c 297. WSR 19-02-043, § 246-817-913, filed 12/26/18, effective 1/26/19.]



246-817-915
Patient evaluation and patient record.

The dentist shall comply with the requirements in this section when prescribing opioid analgesics for subacute pain, and shall document completion of these requirements in the patient record:
(1) Prior to prescribing an opioid for subacute pain, the dentist shall:
(a) Conduct an appropriate history and physical examination or review and update the patient's existing history and examination taken during the acute nonoperative or acute perioperative phase;
(b) Evaluate the nature and intensity of the pain;
(c) Inquire about other medications the patient is prescribed or taking, including date, type, dosage, and quantity prescribed;
(d) Conduct, or cause their designee to conduct, a query of the PMP in accordance with the provisions of WAC 246-817-980 to identify any Schedule II-V medications or drugs of concern received by the patient and document in their review and any concerns;
(e) Obtain a biological specimen test if the patient's function is deteriorating or if pain is escalating; and
(f) Screen or refer the patient for further consultation for psychosocial factors which may be impairing recovery including, but not limited to, depression or anxiety.
(2) The dentist treating a patient for subacute pain with opioids shall ensure that, at a minimum, the following are documented in the patient record:
(a) The presence of one or more recognized diagnoses or indications for the use of opioid pain medication;
(b) The observed significant and documented improvement in function or pain control forming the basis to continue prescribing opioid analgesics beyond the acute pain episode;
(c) The result of any queries of the PMP and any concerns the dentist may have;
(d) All medications the patient is known to be prescribed or taking;
(e) An appropriate pain treatment plan, including the consideration of, or attempts to use, nonpharmacological modalities and nonopioid therapy;
(f) Results of any aberrant biological specimen testing results and the risk-benefit analysis if opioids are to be continued;
(g) Results of screening or referral for further consultation for psychosocial factors which may be impairing recovery including, but not limited to, depression or anxiety;
(h) Results of screening for the patient's level of risk for aberrant behavior and adverse events related to opioid therapy;
(i) The risk-benefit analysis of any combination of prescribed opioid and benzodiazepines or sedative-hypnotics, if applicable; and
(j) All other required components of the patient record, as established in statute or rule.
(3) Follow-up visits for pain control must include objectives or metrics to be used to determine treatment success if opioids are to be continued. This includes at a minimum:
(a) Change in pain level;
(b) Change in physical function;
(c) Change in psychosocial function; and
(d) Additional planned diagnostic evaluations or other treatments.
[Statutory Authority: RCW 18.32.002, 18.32.0365, 18.32.800 and 2017 c 297. WSR 19-02-043, § 246-817-915, filed 12/26/18, effective 1/26/19. Statutory Authority: RCW 18.32.785 and 18.32.0365. WSR 11-10-061, § 246-817-915, filed 5/2/11, effective 7/1/11.]



246-817-916
Treatment planSubacute pain.

(1) The dentist shall recognize the progression of a patient from the acute nonoperative or acute perioperative phase to the subacute phase and take into consideration the risks and benefits of continued opioid prescribing for the patient.
(2) If tapering has not begun prior to the six- to twelve-week subacute phase, the dentist shall reevaluate the patient who does not follow the expected course of recovery. If significant and documented improvement in function or pain control has not occurred, the dentist shall reconsider the continued use of opioids or whether tapering or discontinuing opioids is clinically indicated. The dentist shall make reasonable attempts to discontinue the use of opioids prescribed for the acute pain event by no later than the twelve-week conclusion of the subacute phase.
(3) If the dentist prescribes opioids for effective pain control, such prescriptions must not be in a greater quantity than needed for the expected duration of pain severe enough to require opioids. The dentist shall not prescribe beyond a fourteen-day supply of opioids without clinical documentation to justify the need for such a quantity during the subacute phase.
(4) If the dentist elects to prescribe a combination of opioids with a medication listed in WAC 246-817-975 or prescribes opioids to a patient known to be receiving a medication listed in WAC 246-817-975 from another practitioner, the dentist shall prescribe in accordance with WAC 246-817-975.
(5) If the dentist elects to treat a patient with opioids beyond the six- to twelve-week subacute phase, the dentist shall document in the patient record that the patient is transitioning from subacute pain to chronic pain. Rules governing the treatment of chronic pain in WAC 246-817-919 through 246-817-967, shall apply.
[Statutory Authority: RCW 18.32.002, 18.32.0365, 18.32.800 and 2017 c 297. WSR 19-02-043, § 246-817-916, filed 12/26/18, effective 1/26/19.]



246-817-919
Patient evaluation and patient record.

The dentist shall evaluate and document the patient's health history and physical examination in the patient record prior to treating for chronic pain.
(1) History. The patient's health history must include:
(a) The nature and intensity of the pain;
(b) The effect of pain on physical and psychosocial function;
(c) Current and past treatments for pain, including medications and their efficacy;
(d) Review of any significant comorbidities;
(e) Any current or historical substance use disorder;
(f) Current medications and, as related to treatment of the pain, the efficacy of medications tried; and
(g) Medication allergies.
(2) Evaluation. The patient evaluation prior to opioid prescribing must include:
(a) Appropriate physical examination;
(b) Consideration of the risks and benefits of chronic pain treatment for the patient;
(c) Medications the patient is taking including indication(s), date, type, dosage, quantity prescribed, and, as related to treatment of the pain, efficacy of medications tried;
(d) Review of the PMP to identify any Schedule II-V medications or drugs of concern received by the patient in accordance with the provisions of WAC 246-817-980;
(e) Any available diagnostic, therapeutic, and laboratory results;
(f) Use of a risk assessment tool and assignment of the patient to a high, moderate or low-risk category;
(i) The dentist should use caution and shall monitor a patient more frequently when prescribing opioid analgesics to a patient identified as high-risk;
(ii) "Risk assessment tool" means professionally developed, clinically accepted questionnaires appropriate for identifying a patient's level of risk for substance abuse or misuse.
(g) Any available consultations, particularly as related to the patient's pain;
(h) Pain related diagnosis, including documentation of the presence of one or more recognized indications for the use of pain medication;
(i) Written agreements, as described in WAC 246-817-930, for treatment between the patient and the dentist;
(j) Patient counseling concerning risks, benefits, and alternatives to chronic opioid therapy; and
(k) Treatment plan and objectives including:
(i) Documentation of any medication prescribed;
(ii) Biologic specimen testing ordered; and
(iii) Any labs or imaging ordered.
(3) The health record must be maintained in an accessible manner, readily available for review, and contain documentation of requirements in subsections (1) and (2) of this section, as well as all other required components of the patient record, as set out in statute or rule.
[Statutory Authority: RCW 18.32.002, 18.32.0365, 18.32.800 and 2017 c 297. WSR 19-02-043, § 246-817-919, filed 12/26/18, effective 1/26/19.]



246-817-920
Treatment plan.

(1) When the patient enters the chronic pain phase, the dentist shall reevaluate the patient by treating the situation as a new disease.
(2) The chronic pain treatment plan must state the objectives that will be used to determine treatment success and must include, at a minimum:
(a) Any change in pain relief;
(b) Any change in physical and psychosocial function; and
(c) Additional diagnostic evaluations or other planned treatments.
(3) After treatment begins, the dentist shall adjust drug therapy to the individual health needs of the patient.
(4) The dentist shall complete patient notification in accordance with the provisions of WAC 246-817-907.
[Statutory Authority: RCW 18.32.002, 18.32.0365, 18.32.800 and 2017 c 297. WSR 19-02-043, § 246-817-920, filed 12/26/18, effective 1/26/19. Statutory Authority: RCW 18.32.785 and 18.32.0365. WSR 11-10-061, § 246-817-920, filed 5/2/11, effective 7/1/11.]



246-817-930
Written agreement for treatment.

The dentist shall use a written agreement for treatment with the patient who requires long-term opioid therapy for chronic pain that outlines the patient's responsibilities. This written agreement for treatment must include:
(1) The patient's agreement to provide biological samples for biological specimen testing when requested by the dentist;
(2) The patient's agreement to take medications at the dose and frequency prescribed with a specific protocol for lost prescriptions and early refills or renewals. "Refill" or "renewal" means a second or subsequent filling of a previously issued prescription that is authorized to be dispensed when the patient has exhausted their current supply. For the purposes of WAC 246-817-901 through 246-817-980, refills or renewals are subject to the same limitation and requirements as initial prescriptions;
(3) Reasons for which opioid therapy may be discontinued such as, but not limited to, violation of agreement;
(4) The requirement that all chronic opioid prescriptions are provided by a single prescriber, a single clinic, or multidisciplinary pain clinic;
(5) The requirement that all chronic opioid prescriptions are to be dispensed by a single pharmacy or pharmacy system whenever possible;
(6) The patient's agreement to not abuse substances that can put the patient at risk for adverse outcomes;
(7) A written authorization for:
(a) The dentist to release the agreement for treatment to:
(i) Local emergency departments;
(ii) Urgent care facilities;
(iii) Other practitioners caring for the patient who might prescribe pain medications; and
(iv) Pharmacies.
(b) The dentist to release the agreement to other practitioners so other practitioners can report violations of the agreement to the dentist treating the patient's chronic pain and to the PMP.
(8) Acknowledgment that it is the patient's responsibility to safeguard all medications and keep them in a secure location; and
(9) Acknowledgment that if the patient violates the terms of the agreement, the violation and the dentist's response to the violation will be documented, as well as the rationale for changes in the treatment plan.
[Statutory Authority: RCW 18.32.002, 18.32.0365, 18.32.800 and 2017 c 297. WSR 19-02-043, § 246-817-930, filed 12/26/18, effective 1/26/19. Statutory Authority: RCW 18.32.785 and 18.32.0365. WSR 11-10-061, § 246-817-930, filed 5/2/11, effective 7/1/11.]



246-817-935
Periodic review.

(1) The dentist shall periodically review the course of treatment for chronic pain. The frequency of visits, biological testing, and PMP queries must be determined based on the patient's risk category:
(a) For a high-risk patient, at least quarterly;
(b) For a moderate-risk patient, at least semiannually;
(c) For a low-risk patient, at least annually;
(d) Immediately upon indication of concerning aberrant behavior; and
(e) More frequently at the dentist's discretion.
(2) During the periodic review, the dentist shall determine:
(a) The patient's compliance with any medication treatment plan;
(b) If pain, function, or quality of life have improved, diminished, or are maintained using objective evidence; and
(c) If continuation or modification of medications for pain management treatment is necessary based on the dentist's evaluation of progress towards treatment objectives.
(3) Periodic patient evaluations must also include:
(a) History and physical examination related to the pain;
(b) Use of validated tools to document either maintenance of function and pain control or improvement in function and pain level; and
(c) Review of the Washington state PMP to identify any Schedule II-V medications or drugs of concern received by the patient at a frequency determined by the patient's risk category, and otherwise in accordance with the provisions of WAC 246-817-980 and subsection (1) of this section.
(4) The dentist shall assess the appropriateness of continued use of the current treatment plan if the patient's progress or compliance with current treatment plan is unsatisfactory. The dentist shall consider tapering, changing, or discontinuing treatment in accordance with the provisions of WAC 246-817-966.
[Statutory Authority: RCW 18.32.002, 18.32.0365, 18.32.800 and 2017 c 297. WSR 19-02-043, § 246-817-935, filed 12/26/18, effective 1/26/19. Statutory Authority: RCW 18.32.785 and 18.32.0365. WSR 11-10-061, § 246-817-935, filed 5/2/11, effective 7/1/11.]



246-817-950
ConsultationRecommendations and requirements.

(1) The dentist shall consider referring the patient for additional evaluation and treatment as needed to achieve treatment objectives. Special attention should be given to those chronic pain patients who are under eighteen years of age or who are potential high-risk patients. The management of pain in patients with a history of substance abuse or with comorbid psychiatric disorders may require extra care, monitoring, documentation, and consultation with, or referral to, an expert in the management of such patients.
(2) The mandatory consultation threshold is one hundred twenty MED. Unless the consultation is exempted under WAC 246-817-955 or 246-817-960, the dentist who prescribes a dosage amount that meets or exceeds the mandatory consultation threshold shall comply with the pain management specialist consultation requirements described in WAC 246-817-965. The mandatory consultation must consist of at least one of the following:
(a) An office visit with the patient and the pain management specialist;
(b) A consultation between the pain management specialist and the dentist;
(c) An audio-visual evaluation conducted by the pain management specialist remotely, where the patient is present with either the dentist or with a licensed health care practitioner designated by the dentist or the pain management specialist; or
(d) Other chronic pain evaluation services as approved by the dental quality assurance commission.
(3) A dentist shall document each consultation with the pain management specialist. If the pain management specialist provides a written record of the consultation to the dentist, the dentist shall maintain it as part of the patient record.
(4) The dentist shall use great caution when prescribing opioids to children and adolescents with chronic pain, appropriate referral to a specialist is encouraged.
[Statutory Authority: RCW 18.32.002, 18.32.0365, 18.32.800 and 2017 c 297. WSR 19-02-043, § 246-817-950, filed 12/26/18, effective 1/26/19. Statutory Authority: RCW 18.32.785 and 18.32.0365. WSR 11-10-061, § 246-817-950, filed 5/2/11, effective 7/1/11.]



246-817-955
ConsultationExemptions for exigent and special circumstances.

A dentist is not required to consult with a pain management specialist as described in WAC 246-817-965 when the dentist has documented adherence to all standards of practice as defined in WAC 246-817-919 through 246-817-967 and when one or more of the following conditions are met:
(1) The patient is following a tapering schedule;
(2) The patient requires treatment for acute pain, which may or may not include hospitalization, requiring a temporary escalation in opioid dosage with expected return to their baseline dosage level or below;
(3) The dentist documents reasonable attempts to obtain a consultation with a pain management specialist and the circumstances justifying prescribing above one hundred twenty milligrams MED per day without first obtaining a consultation; or
(4) The dentist documents the patient's pain and function is stable and the patient is on a nonescalating dosage of opioids.
[Statutory Authority: RCW 18.32.002, 18.32.0365, 18.32.800 and 2017 c 297. WSR 19-02-043, § 246-817-955, filed 12/26/18, effective 1/26/19. Statutory Authority: RCW 18.32.785 and 18.32.0365. WSR 11-10-061, § 246-817-955, filed 5/2/11, effective 7/1/11.]



246-817-960
ConsultationExemptions for the dentist.

The dentist is exempt from the consultation requirement in WAC 246-817-950 if one or more of the following qualifications are met:
(1) The dentist is a pain management specialist under WAC 246-817-965;
(2) The dentist has successfully completed every four years a minimum of twelve continuing education hours on chronic pain management, with at least two of these hours dedicated [to ] substance use disorders;
(3) The dentist is a pain management practitioner working in a multidisciplinary chronic pain treatment center or a multidisciplinary academic research facility; or
(4) The dentist has a minimum three years of clinical experience in a chronic pain management setting, and at least thirty percent of their current practice is the direct provision of pain management care.
[Statutory Authority: RCW 18.32.002, 18.32.0365, 18.32.800 and 2017 c 297. WSR 19-02-043, § 246-817-960, filed 12/26/18, effective 1/26/19. Statutory Authority: RCW 18.32.785 and 18.32.0365. WSR 11-10-061, § 246-817-960, filed 5/2/11, effective 7/1/11.]



246-817-965
Pain management specialist.

A pain management specialist shall meet the following qualifications:
(1) A dentist shall be board certified or board eligible in oral medicine or orofacial pain by the American Board of Oral Medicine or the American Board of Orofacial Pain.
(2) An allopathic physician shall meet requirements in WAC 246-919-945 and an allopathic physician assistant shall meet requirements in WAC 246-918-895.
(3) An osteopathic physician shall meet requirements in WAC 246-853-750 and an osteopathic physician assistant shall meet requirements in WAC 246-854-330.
(4) An advanced registered nurse practitioner (ARNP) shall meet requirements in WAC 246-840-493.
(5) A podiatric physician shall meet requirements in WAC 246-922-750.
[Statutory Authority: RCW 18.32.002, 18.32.0365, 18.32.800 and 2017 c 297. WSR 19-02-043, § 246-817-965, filed 12/26/18, effective 1/26/19. Statutory Authority: RCW 18.32.785 and 18.32.0365. WSR 11-10-061, § 246-817-965, filed 5/2/11, effective 7/1/11.]



246-817-966
Assessment of treatment plan.

(1) The dentist shall assess and document the appropriateness of continued use of the current treatment plan if the patient's response to or compliance with the current treatment plan is unsatisfactory.
(2) The dentist shall consider tapering, changing, discontinuing treatment, or referral for a substance use disorder evaluation when:
(a) The patient requests;
(b) The patient experiences deterioration in function or pain;
(c) The patient is noncompliant with the written agreement;
(d) Other treatment modalities are indicated;
(e) There is evidence of misuse, abuse, substance use disorder, or diversion;
(f) The patient experiences a severe adverse event or overdose;
(g) There is unauthorized escalation of doses; or
(h) The patient is receiving an escalation in opioid dosage with no improvement in pain, function, or quality of life.
[Statutory Authority: RCW 18.32.002, 18.32.0365, 18.32.800 and 2017 c 297. WSR 19-02-043, § 246-817-966, filed 12/26/18, effective 1/26/19.]



246-817-967
Patients with chronic pain, including those on high doses, establishing a relationship with a new dentist.

(1) When a patient receiving chronic opioid pain medications changes to a new dentist, it is normally appropriate for the new dentist to initially maintain the patient's current opioid doses. Over time, the dentist may evaluate if any tapering or other adjustments in the treatment plan can or should be done.
(2) A dentist's treatment of a new high dose chronic pain patient is exempt from the mandatory consultation requirements of WAC 246-817-950 and the tapering requirements of WAC 246-817-966 if:
(a) The patient was previously being treated with a dosage of opioids in excess of one hundred twenty milligram MED for chronic pain under an established written agreement for treatment of the same chronic condition or conditions;
(b) The patient's dose is stable and nonescalating;
(c) The patient has a demonstrated history in their record of compliance with treatment plans and written agreements as documented by medical records and PMP queries; and
(d) The patient has documented functional stability, pain control, or improvements in function or pain control, in excess of one hundred twenty milligram MED dose.
(3) With respect to the treatment of a new patient under subsection (1) or (2) of this section, this exemption applies for the first three months of newly established care, after which the requirements of WAC 246-817-950 and 246-817-966 shall apply.
[Statutory Authority: RCW 18.32.002, 18.32.0365, 18.32.800 and 2017 c 297. WSR 19-02-043, § 246-817-967, filed 12/26/18, effective 1/26/19.]



246-817-970
Special populationsPatients twenty-four years of age or under, pregnant patients, and aging populations.

(1) Patients twenty-four years of age or under. In the treatment of pain for patients twenty-four years of age or under, the dentist shall treat pain in a manner equal with that of an adult but must account for the weight of the patient and adjust the dosage prescribed accordingly. Eight to twelve tablets supply will often be sufficient. The dentist shall not prescribe beyond twelve tablets without clinical documentation in the patient record to justify the need for such a quantity.
(2) Pregnant patients. A dentist shall not discontinue use of MAT opioids, such as methadone or buprenorphine, by a pregnant patient without oversight by the MAT prescribing practitioner. The dentist shall weigh carefully the risks and benefits of opioid detoxification during pregnancy.
(3) Aging populations. As people age, their tolerance and metabolizing of opioids may change. The dentist shall consider the distinctive needs of patients who are sixty-five years of age or older and who have been on chronic opioid therapy or who are initiating opioid treatment.
[Statutory Authority: RCW 18.32.002, 18.32.0365, 18.32.800 and 2017 c 297. WSR 19-02-043, § 246-817-970, filed 12/26/18, effective 1/26/19.]



246-817-971
Episodic care of chronic opioid patients.

(1) When providing episodic care for a patient who the dentist knows is being treated with opioids for chronic pain, such as for emergency or urgent care, the dentist shall review the PMP to identify any Schedule II-V or drugs of concern received by the patient and document in the patient record their review and any concerns.
(2) A dentist providing episodic care to a patient who the dentist knows is being treated with opioids for chronic pain should provide additional opioids to be equal to the severity of the acute pain. If opioids are provided, the dentist shall limit the use of opioids to the minimum amount necessary to control the acute nonoperative pain, acute perioperative pain, or similar acute exacerbation of pain until the patient can receive care from the practitioner who is managing the patient's chronic pain treatment.
(3) The episodic care dentist shall report known violations of the patient's written agreement to the patient's treatment practitioner who provided the agreement for treatment.
(4) The episodic care dentist shall coordinate care with the patient's chronic pain treatment practitioner if that person is known to the episodic care dentist, when practicable.
(5) For the purpose of this section "episodic care" means medical or dental care provided by a practitioner other than the designated primary care practitioner in the acute care setting; for example, urgent care or emergency department.
[Statutory Authority: RCW 18.32.002, 18.32.0365, 18.32.800 and 2017 c 297. WSR 19-02-043, § 246-817-971, filed 12/26/18, effective 1/26/19.]



246-817-975
Coprescribing of opioids with certain medications.

(1) The dentist shall not knowingly prescribe opioids in combination with the following Schedule II-IV medications without documentation of clinical judgment and discussion of risks with patient:
(a) Benzodiazepines;
(b) Barbiturates;
(c) Sedatives;
(d) Carisoprodol; or
(e) Sleeping medications also known as Z drugs.
(2) If a patient receiving an opioid prescription is known to be concurrently prescribed one or more of the medications listed in subsection (1) of this section, the dentist prescribing opioids shall consult with the other prescriber(s) to establish a patient care plan for the use of the medications concurrently or consider whether one of the medications should be tapered.
[Statutory Authority: RCW 18.32.002, 18.32.0365, 18.32.800 and 2017 c 297. WSR 19-02-043, § 246-817-975, filed 12/26/18, effective 1/26/19.]



246-817-976
Coprescribing of opioids for patients receiving medication assisted treatment.

(1) Where practicable, the dentist providing acute nonoperative pain or acute perioperative pain treatment to a patient known to be receiving MAT shall prescribe opioids for pain relief either in consultation with the MAT prescribing practitioner or a pain specialist.
(2) A dentist shall not discontinue MAT medications when treating acute nonoperative pain or acute perioperative pain without documentation of the reason for doing so.
(3) A dentist shall not deny necessary operative intervention for use of these medications by a patient.
[Statutory Authority: RCW 18.32.002, 18.32.0365, 18.32.800 and 2017 c 297. WSR 19-02-043, § 246-817-976, filed 12/26/18, effective 1/26/19.]



246-817-977
Coprescribing of naloxone.

The dentist shall confirm or provide a current prescription for naloxone or refer the patient to a pharmacist for further counseling and evaluation when opioids are prescribed to a high-risk patient.
[Statutory Authority: RCW 18.32.002, 18.32.0365, 18.32.800 and 2017 c 297. WSR 19-02-043, § 246-817-977, filed 12/26/18, effective 1/26/19.]



246-817-980
Prescription monitoring programRequired registration, queries, and documentation.

(1) The dentist shall register to access the PMP or demonstrate proof of having assured access to the PMP if they prescribe opioids in Washington state.
(2) The dentist is permitted to delegate performance of a required PMP query to an authorized designee.
(3) At a minimum, the dentist shall ensure a PMP query is performed prior to the prescription of an opioid at the following times:
(a) Upon the first refill or renewal of an opioid prescription for acute nonoperative pain or acute perioperative pain;
(b) The time of transition from acute to subacute pain; and
(c) The time of transition from subacute to chronic pain.
(4) For chronic pain management, the dentist shall ensure a PMP query is performed at a minimum frequency determined by the patient's risk assessment, as follows:
(a) For a high-risk patient, a PMP query must be completed at least quarterly;
(b) For a moderate-risk patient, a PMP must be completed at least semiannually; and
(c) For a low-risk patient, a PMP must be completed at least annually.
(5) The dentist shall ensure a PMP query is performed for any chronic pain patient immediately upon identification of aberrant behavior.
(6) The dentist shall ensure a PMP query is performed when providing episodic care to a patient whom the dentist knows to be receiving opioids for chronic pain, in accordance with WAC 246-817-971.
(7) If the dentist is using an electronic medical record or EMR that integrates access to the PMP into the workflow of the EMR, the dentist shall ensure a PMP query is performed for all prescriptions of opioids and medications listed in WAC 246-817-975.
(8) For the purposes of this section, the requirement to consult the PMP does not apply when the PMP or the EMR cannot be accessed by the dentist or their designee due to a temporary technological or electrical failure.
(9) Pertinent concerns discovered in the PMP must be documented in the patient record.
[Statutory Authority: RCW 18.32.002, 18.32.0365, 18.32.800 and 2017 c 297. WSR 19-02-043, § 246-817-980, filed 12/26/18, effective 1/26/19.]



246-817-990
Dentist fees and renewal cycle.

(1) Licenses must be renewed every year on the practitioner's birthday as provided in chapter 246-12 WAC, Part 2, except faculty and resident licenses.
(2) Faculty and resident licenses must be renewed every year on July 1 as provided in chapter 246-12 WAC, Part 2.
(3) The following nonrefundable fees will be charged:
Title of Fee
Fee
Original application by examination*
Initial application
$500.00
Original application - Without examination
Initial application
500.00
Initial license
500.00
Faculty license application
500.00
Resident license application
115.00
Active license renewal:
Renewal
350.00
Surcharge - Impaired dentist
50.00
Late renewal penalty
288.00
Expired license reissuance
300.00
Inactive license renewal:
 
Renewal
125.00
Surcharge - Impaired dentist
50.00
Late renewal penalty
50.00
Retired active license renewal
 
Renewal
150.00
Surcharge - Impaired dentist
50.00
Late renewal penalty
75.00
Duplicate license
15.00
Certification of license
25.00
Anesthesia permit
Initial application
150.00
Renewal - (Three-year renewal
cycle)
150.00
Late renewal penalty
75.00
Expired permit reissuance
50.00
On-site inspection fee
To be determined by future rule adoption.
*
In addition to the initial application fee above, applicants for licensure via examination will be required to submit a separate application and examination fee directly to the dental testing agency accepted by the dental quality assurance commission.
[Statutory Authority: RCW 18.130.250, 43.70.250 and 18.32.534. WSR 15-07-004, § 246-817-990, filed 3/6/15, effective 4/6/15. Statutory Authority: RCW 43.70.250, 43.70.280, and 2013 c 129. WSR 13-21-069, § 246-817-990, filed 10/16/13, effective 1/1/14. Statutory Authority: RCW 43.70.110, 43.70.250, and 2010 c 37. WSR 10-19-071, § 246-817-990, filed 9/16/10, effective 10/15/10. Statutory Authority: RCW 43.70.110, 43.70.250 and 2008 c 329. WSR 08-16-008, § 246-817-990, filed 7/24/08, effective 7/25/08. Statutory Authority: RCW 43.70.250, [43.70.]280 and 43.70.110. WSR 05-12-012, § 246-817-990, filed 5/20/05, effective 7/1/05. Statutory Authority: RCW 18.32.0365 and 43.70.250. WSR 01-11-166, § 246-817-990, filed 5/23/01, effective 7/1/01. Statutory Authority: RCW 43.70.250. WSR 99-08-101, § 246-817-990, filed 4/6/99, effective 7/1/99. Statutory Authority: RCW 43.70.280. WSR 98-05-060, § 246-817-990, filed 2/13/98, effective 3/16/98. Statutory Authority: RCW 43.70.040. WSR 95-16-122, § 246-817-990, filed 8/2/95, effective 9/1/95.]



246-817-99005
Dental assistant, dental anesthesia assistant, and expanded function dental auxiliary fees and renewal cycle.

(1) Credentials must be renewed every year on the practitioner's birthday as provided in chapter 246-12 WAC, Part 2.
(2) The following nonrefundable fees will be charged for dental assistant, dental anesthesia assistant, and expanded function dental auxiliary credentials:
Title of Fee - Dental Professionals
Fee
Registered dental assistant application
$40.00
Registered dental assistant renewal
21.00
Registered dental assistant late renewal
21.00
Registered dental assistant expired reactivation
20.00
Certified dental anesthesia assistant application
100.00
Certified dental anesthesia assistant renewal
75.00
Certified dental anesthesia assistant late renewal
50.00
Certified dental anesthesia assistant expired reactivation
75.00
Licensed expanded function dental auxiliary application
175.00
Licensed expanded function dental auxiliary renewal
160.00
Licensed expanded function dental auxiliary late renewal
80.00
Licensed expanded function dental auxiliary expired reactivation
50.00
Duplicate credential
15.00
Certification of credential
25.00
[Statutory Authority: 2012 c 208, 2012 c 23, 2012 c 137, 2012 c 153, RCW 43.70.110, and 43.70.250. WSR 12-24-015, § 246-817-99005, filed 11/27/12, effective 7/1/13. Statutory Authority: RCW 43.70.110, 43.70.250, and 2010 c 37. WSR 10-19-071, § 246-817-99005, filed 9/16/10, effective 10/15/10. Statutory Authority: RCW 43.70.250. WSR 08-13-069, § 246-817-99005, filed 6/13/08, effective 7/1/08.]