5.4 Public Health Supervision & Certified Public Health Dental Hygienists (CPHDH)
Key Takeaways
- Under public health supervision, a hygienist may work in a school, hospital, other institution, or for a homebound person without the dentist present, provided the dentist reviews the records once in 12 months (RSA 317-A:21-e, II; Den 101.28).
- A CPHDH must have practiced 3,200 hours as a dental hygienist, with 1,600 of those hours within the 2 years before certification (Den 302.08(b)(1)).
- CPHDH education may come from a bachelor's in dental hygiene with 6 semester hours of community dental health, a master's in public health, or five courses including a 6-hour caries stabilization course (Den 302.08(a)).
- CPHDH radiography is limited to bitewings, occlusal, and periapical images, and temporary restorations must be placed without excavation (RSA 317-A:21-e, I).
- CPHDH certification renews in odd-numbered years before May 1, and the hygienist must have a written collaborative agreement with an actively licensed New Hampshire dentist before practicing (Den 302.08(b)).
Public Health Supervision and the CPHDH
Public health supervision for any hygienist
Public health supervision (Den 101.28; Den 302.02(d)) means an actively licensed dentist authorizes procedures carried out by a hygienist in a school, hospital, or other institution, or for a homebound person, without the dentist present, provided the dentist reviews the records once in a 12-month period. CPHDH certification is not required: RSA 317-A:21-e, IV says certification does not stop non-certified hygienists from practicing under public health supervision as the rules allow.
Duties under public health supervision — Den 405.01(d)
- Collect and assess histories, including preliminary inspection, periodontal probing, and charting
- Complete oral prophylaxis, including scaling and root planing
- Administer, prescribe, and dispense fluoride supplements, topical fluoride, and chlorhexidine rinse
- Oral hygiene instruction
- Fluoride rinse programs: obtain consent from a legally responsible adult; train personnel in storage, dosage, safety, administration, and rinsing; and have a physician, dentist, APRN, or physician assistant dilute concentrated fluoride solutions before dispensing
- Sealants, when authorized by an actively licensed dentist, with written informed consent from the patient's legal guardian. The supervising dentist and hygienist are both responsible for the sealants being indicated and correctly placed
- Make impressions for, fabricate, and deliver athletic mouthguards
Program paperwork — Den 405.02 and 405.03
- Public health supervision status (405.02): the hygienist files an application naming the employing program. The hygienist agrees to limit duties to Den 405, to follow CDC infection control guidelines, and to advise participants that the services do not replace regular examination by a dentist. The hygienist and supervising dentist sign it.
- Program approval (405.03): the supervising dentist and hygienist file the program's name, sponsoring agency, dates, sites, population served, services, and participating hygienists.
- Annual summary: the hygienist or dentist sends the Board a summary of program results at the one-year anniversary and every year after, or at the end of a program shorter than a year.
- Changes: notify OPLC within 30 days of changes to the program information.
The certified public health dental hygienist — RSA 317-A:21-e
A licensed hygienist may apply to OPLC for CPHDH certification after completing the Board's additional education. A CPHDH may:
| RSA 317-A:21-e, I | Service |
|---|---|
| (a) | Collect and assess histories, including preliminary inspection and periodontal probing and charting |
| (b) | Instruct in oral hygiene |
| (c) | Prepare a treatment plan within the public health dental hygienist scope |
| (d) | Complete oral prophylaxis, including scaling and root planing |
| (e) | Topical fluoride, including fluoride varnish |
| (f) | Sealants, if qualified and authorized by an actively licensed dentist, with written informed consent from the legal guardian; dentist and CPHDH are both responsible |
| (g) | Temporary restorations without excavation |
| (h) | Radiographs limited to bitewings, occlusal, and periapical images |
| (i) | Nutritional counseling for dental disease control |
| (j) | Referrals |
| (k) | Other procedures within scope authorized under public health supervision |
A CPHDH practices in a school, hospital, other institution, or for a homebound person without the dentist present, provided the dentist reviewed the records once in 12 months (RSA 317-A:21-e, II). Under RSA 317-A:23, II, with a written practice agreement and the dentist's written general authorization and standing protocols, a CPHDH may treat a patient without the patient first seeing a dentist.
Qualifying as a CPHDH — Den 302.08
Education pathway (302.08(a)), one of three:
- a bachelor's degree in dental hygiene with at least 6 semester hours in community dental health;
- a master's degree in public health; or
- five courses from a qualifying CE provider, each with an exam:
| Course | Minimum | Content |
|---|---|---|
| Caries stabilization in the public health setting | 6 hours | Indications, technique, and success variables for interim therapeutic restorations (ITRs); selecting and handling intermediary materials; follow-up coding |
| Evidence-based dentistry | 4 hours | Evidence-based approach, applying it to public health, hands-on computer experience |
| Infection control in public health settings | 4 hours | Lecture and hands-on; latest procedures; asepsis in non-traditional settings |
| Medical management in public health dental settings | 6 hours | Lecture and hands-on; systemic conditions; emergencies in alternative settings; pharmacology for high-risk patients |
| Management of medical records | 4 hours | Legal requirements; FERPA; Privacy Impact Assessment; New Hampshire law for reporting patient abuse |
Requirements for all CPHDHs (302.08(b)):
- 3,200 hours of practice as a dental hygienist, 1,600 of them within the 2 years before certification;
- the 6-hour caries stabilization course, whichever education pathway was used;
- sealant qualification under Den 302.05(h) if sealant training was not in the hygiene curriculum;
- on the course pathway, courses completed within 4 years before certification;
- documented proof kept by both the collaborating dentist and the hygienist and submitted to the Board;
- a written collaborative agreement with an actively licensed New Hampshire dentist before practicing;
- registration with the Board, proof of training, and the certification fee;
- display of proof of certification at the place of practice;
- renewal in odd-numbered years before May 1, with a late fee and a reinstatement fee if the certificate lapses.
Application (302.08(c)–(e)): the form includes the supervising dentist's name, BLS-HCP status, and education and practice proof, plus a passport-type photo taken within 6 months and at least 2.5 inches square. It must be signed and notarized. Signing waives confidentiality about complaints pending in other jurisdictions, and knowingly false statements result in denial. A letter confirming the collaborative agreement accompanies the fee.
Dental assistants in public health settings
A dental assistant may work in the same settings under public health supervision, supervised by a CPHDH (Den 302.02(d)(2)), limited to the support duties in Den 404.01(d).
A hygienist has 3,400 total hours of clinical practice, but only 1,200 of them in the past 2 years. She has completed all CPHDH coursework. Does she meet Den 302.08(b)(1)?
Which radiographs may a certified public health dental hygienist take under RSA 317-A:21-e, I(h)?
A hygienist runs a school sealant program under public health supervision, without CPHDH certification. Which requirement applies under Den 405.01(d) and Den 405.02–405.03?