5.2 Hygienist Qualifications: Local Anesthesia, Nitrous Oxide & Other Expanded Duties (Den 302.05)
Key Takeaways
- To qualify in local anesthesia, a New Hampshire hygienist must complete a CODA-accredited course of at least 20 didactic and 12 clinical hours, including at least 6 infiltration and 6 block injections, and pass the CDCA local anesthesia exam (Den 302.05(i)).
- A hygienist qualified in local anesthesia administers it only under direct supervision and must display proof of the Board-approved qualification (Den 302.05(j)).
- Administering nitrous oxide requires a CODA-accredited course of at least 8 didactic and 6 clinical hours, while monitoring nitrous oxide requires a course of at least 6 hours (Den 302.05(l), (n)).
- A hygienist monitoring nitrous oxide may begin only after the dentist initiates administration and brings the patient to the intended sedation level, and must hold current BLS-HCP (Den 302.05(m)).
- Out-of-state qualified hygienists may qualify by endorsement with equivalent training and a supervising dentist's letter attesting to experience within the previous 2 years.
Hygienist Qualifications in Specific Areas
General rules — Den 302.05(a)–(c)
- A hygienist is qualified in a specific area after completing an expanded duty course, successfully challenging an exam in that area, or both (Den 101.29 defines "qualified" by reference to Den 302.05).
- The hygienist keeps course records and the completion certificate and provides them to the Board on request.
- A hygienist may petition the Board to approve an expanded duty or equivalent course by describing the provider, topic outline, lecture and practical hours, and textbooks.
- No hygienist is qualified before being officially informed by the course or exam provider of successful completion.
Qualification requirements
| Area | Course requirements | Conditions when performing |
|---|---|---|
| Provisional crown and bridge (302.05(d)–(e)) | Qualifying CE provider; at least 8 hours; provisional anatomy, occlusal requirements, cementation; signed completion certificate | Direct supervision; may fabricate intraorally, but occlusal adjustments and modifications are completed extraorally; dentist examines the provisional before cementation |
| Orthodontic duties (302.05(f)–(g)) | At least 8 hours: separators, bracket bonding prep, band and bracket removal, band trial fitting, hand-instrument cement removal, headgear fitting, emergency adjustments, impressions, ligating and removing wires, bending archwires | Direct supervision |
| Sealants (302.05(h)) | Hygiene education | General or public health supervision |
| Local anesthesia (302.05(i)–(k)) | CODA-accredited institution; at least 20 didactic and 12 clinical hours; pass the CDCA local anesthesia exam; ten required topics; at least 6 infiltration and 6 block injections | Direct supervision; display proof of the qualification at the place of practice |
| Monitoring nitrous oxide (302.05(l)–(m)) | Qualifying CE provider; at least 6 hours; written test | Direct supervision; start only after the dentist initiates administration and brings the patient to the intended level; current BLS-HCP |
| Administering nitrous oxide (minimal sedation) (302.05(n)–(p)) | CODA-accredited institution; at least 8 didactic and 6 clinical hours; twelve required topics; written test and clinical evaluation | Direct supervision; display proof of the qualification course |
| In-office tooth whitening (302.05(q)) | Not specified | General supervision |
Local anesthesia in detail — Den 302.05(i)–(k)
The ten required topics are:
- neurophysiology of pain and pain control;
- pharmacology of local anesthetics and drug interactions;
- local and systemic complications;
- medical and dental indications and contraindications;
- medical and dental history assessment;
- assembling and handling a syringe safely;
- anatomical landmarks;
- injection techniques;
- hands-on maxillary and mandibular injections, with at least 6 infiltrations and 6 blocks;
- legal issues of local anesthesia by a hygienist.
Special cases:
- New graduates: a hygienist from a CODA-accredited school whose curriculum lacked a qualifying course must complete one (302.05(j)(2)).
- Endorsement: a hygienist qualified in another jurisdiction may qualify by presenting documentation of equivalent training and a letter from a supervising dentist attesting to local anesthesia experience within the previous 2 years (302.05(j)(3)).
- Students: students in a CODA-accredited hygiene program who passed a local anesthesia course do not violate the rule when administering it as part of a dental hygiene examination (302.05(j)(4)).
- Permit application (302.05(k)): a written request; payment of the local anesthesia fee by certified check or money order to "Treasurer, State of New Hampshire" (cash if presented in person); proof of course completion, plus the syllabus if the course was taken out of state; and the hygienist's CDCA score.
Nitrous oxide in detail
The statute authorizes hygienists to administer nitrous oxide/oxygen minimal sedation (anxiolysis) once qualified by the Board after training and an approved exam (RSA 317-A:21-c, II(f)).
Monitoring and administering are separate qualifications:
| Monitor N2O (302.05(l)–(m)) | Administer N2O (302.05(n)–(p)) | |
|---|---|---|
| Course provider | Qualifying CE provider | CODA-accredited institution |
| Minimum hours | 6 | 8 didactic + 6 clinical |
| Assessment | Written test | Written test and clinical evaluation |
| Who starts the gas? | The dentist initiates and titrates to the intended level | The qualified hygienist administers |
| Supervision | Direct | Direct |
| Other | Current BLS-HCP | Display proof; hygienists qualifying on or after January 1, 2018 get a permit on proof of the course, a written request, and the fee |
Both qualifications allow endorsement with equivalent training and a supervising dentist's letter covering experience in the previous 2 years. Students who passed a nitrous oxide course may administer it during a dental hygiene examination.
Renewal questions
The hygienist renewal addendum asks whether the applicant administers nitrous oxide to New Hampshire patients and, if so, whether he or she holds the qualification (Den 401.04(e)(5)). Answering yes without the qualification is a false statement to the Board (Den 501.01(o)).
Worked scenario
Pat, RDH, qualified in local anesthesia in Massachusetts 5 years ago and has given injections weekly since. To qualify in New Hampshire by endorsement, Pat submits documentation of training equivalent to the 20-didactic/12-clinical CODA course and a letter from a supervising dentist attesting to local anesthesia experience within the previous 2 years. Once qualified, Pat must display proof of the qualification and may inject only while a dentist is in the office (direct supervision).
Which course satisfies the local anesthesia qualification for a New Hampshire dental hygienist under Den 302.05(i)?
A hygienist qualified only to monitor nitrous oxide is assigned a pediatric patient. When may she begin monitoring under Den 302.05(m)?
A hygienist qualified in local anesthesia in another state asks how to qualify in New Hampshire without repeating a course. What does Den 302.05(j)(3) allow?