Senator Allen M. Christensen proposes the following substitute bill:




Chief Sponsor: Allen M. Christensen

House Sponsor: Steve Eliason


8     General Description:
9          This bill addresses the use of teledentistry to provide dental care.
10     Highlighted Provisions:
11          This bill:
12          ▸     defines terms;
13          ▸     provides for the use of teledentistry within the state by dental professionals licensed
14     within the state;
15          ▸     provides that the standard of dental care for teledentistry is the same for in-person
16     dental care;
17          ▸     establishes the dental services a dental professional may provide using teledentistry;
18          ▸     directs the Division of Occupational and Professional Licensing to make rules
19     regarding teledentistry; and
20          ▸     makes technical and conforming changes.
21     Money Appropriated in this Bill:
22          None
23     Other Special Clauses:
24          None
25     Utah Code Sections Affected:

26     AMENDS:
27          58-69-102, as last amended by Laws of Utah 2015, Chapter 343
28          58-69-301, as last amended by Laws of Utah 2015, Chapter 320
29          58-69-802, as enacted by Laws of Utah 1996, Chapter 116
30     ENACTS:
31          58-69-807, Utah Code Annotated 1953

33     Be it enacted by the Legislature of the state of Utah:
34          Section 1. Section 58-69-102 is amended to read:
35          58-69-102. Definitions.
36          In addition to the definitions in Section 58-1-102, as used in this chapter:
37          (1) "Asynchronous technology" means store-and-forward technology that allows a
38     licenced dental professional or a dental hygienist to transmit a patient's health information to a
39     dentist for viewing at a later time.
40          [(1)] (2) "Board" means the Dentist and Dental Hygienist Licensing Board created in
41     Section 58-69-201.
42          [(2)] (3) "Dental assistant" means an unlicensed individual who engages in, directly or
43     indirectly, supervised acts and duties as defined by division rule made in collaboration with the
44     board.
45          [(3)] (4) "Direct supervision" means the supervising dentist is present and available for
46     face-to-face communication with the person being supervised when and where professional
47     services are being provided.
48          [(4)] (5) "General supervision" means that the supervising dentist is available for
49     consultation regarding work the supervising dentist has authorized, without regard as to
50     whether the supervising dentist is located on the same premises as the person being supervised.
51          [(5)] (6) "Indirect supervision" means that the supervising dentist is present within the
52     facility in which the person being supervised is providing services and is available to provide
53     immediate face-to-face communication with the person being supervised.
54          [(6)] (7) "Practice of dental hygiene" means, regarding humans:
55          (a) under the general supervision of a dentist, or under a written agreement with a
56     dentist licensed under this chapter, as provided in Section 58-69-801, to:

57          (i) perform preliminary clinical examination of human teeth and gums;
58          (ii) make preliminary instrumental examination of patients' teeth;
59          (iii) expose dental radiographs;
60          (iv) assess dental hygiene status and collaborate with the supervising dentist regarding
61     a dental hygiene treatment plan for a patient;
62          (v) remove deposits, accumulations, calculus, and concretions from the surfaces of
63     human teeth;
64          (vi) remove toxins and debris from subgingival surfaces;
65          (vii) provide dental hygiene care in accordance with a dentist's treatment plan for a
66     patient;
67          (viii) take impressions of teeth or jaws except for impressions or registrations to supply
68     artificial teeth as substitutes for natural teeth; or
69          (ix) engage in other practices of dental hygiene as defined by division rule;
70          (b) under the indirect supervision of a dentist to administer in accordance with
71     standards and ethics of the professions of dentistry and dental hygiene:
72          (i) local anesthesia; or
73          (ii) nitrous oxide analgesia;
74          (c) to represent oneself by any title, degree, or in any other way as being a dental
75     hygienist; or
76          (d) to direct a dental assistant when the supervising dentist is not on the premises.
77          [(7)] (8) "Practice of dentistry" means the following, regarding humans:
78          (a) to offer, undertake, or represent that a person will undertake by any means or
79     method, including teledentistry, to:
80          (i) examine, evaluate, diagnose, treat, operate, or prescribe therapy for any disease,
81     pain, injury, deficiency, deformity, or any other condition of the human teeth, alveolar process,
82     gums, jaws, or adjacent hard and soft tissues and structures in the maxillofacial region;
83          (ii) take an appropriate history and physical consistent with the level of professional
84     service to be provided and the available resources in the facility in which the service is to be
85     provided;
86          (iii) take impressions or registrations;
87          (iv) supply artificial teeth as substitutes for natural teeth;

88          (v) remove deposits, accumulations, calculus, and concretions from the surfaces of
89     teeth; and
90          (vi) correct or attempt to correct malposition of teeth;
91          (b) to administer anesthetics necessary or proper in the practice of dentistry only as
92     allowed by an anesthesia permit obtained from the division;
93          (c) to administer and prescribe drugs related to and appropriate in the practice of
94     dentistry;
95          (d) to supervise the practice of a dental hygienist or dental assistant as established by
96     division rule made in collaboration with the board; or
97          (e) to represent oneself by any title, degree, or in any other way that one is a dentist.
98          [(8)] (9) "Public health setting" means:
99          (a) an individual's residence, if the individual is unable to leave the residence;
100          (b) a school, as part of a school-based program;
101          (c) a nursing home;
102          (d) an assisted living or long-term care facility;
103          (e) a community health center;
104          (f) a federally-qualified health center; or
105          (g) a mobile dental health program that employs a dentist who is licensed under this
106     chapter.
107          [(9)] (10) "Supervising dentist" means a licensed dentist who has agreed to provide
108     supervision of a dental hygienist or unlicensed individual in accordance with the provisions of
109     this chapter.
110          (11) "Synchronous technology" means two-way audiovisual technology that allows a
111     licensed dental professional to see and communicate in real time with a patient who is located
112     in a different physical location.
113          (12) "Teledentistry" means the practice of dentistry using synchronous or asynchronous
114     technology.
115          [(10)] (13) "Unlawful conduct" means the same as that term is defined in Sections
116     58-1-501 and 58-69-501.
117          [(11)] (14) "Unprofessional conduct" means the same as that term is defined in
118     Sections 58-1-501 and 58-69-502 and as may be further defined by rule.

119          Section 2. Section 58-69-301 is amended to read:
120          58-69-301. License required -- License classifications -- Anesthesia and analgesia
121     permits.
122          (1) A license is required to engage in the practice of dentistry, including teledentistry,
123     or dental hygiene except as specifically provided in Section 58-69-306 or 58-1-307.
124          (2) The division shall issue to individuals qualified under the provisions of this chapter
125     a license in the classification:
126          (a) dentist; or
127          (b) dental hygienist.
128          (3) A permit is required to engage in administration of anesthesia or analgesia in the
129     practice of dentistry or dental hygiene.
130          (4) The division in collaboration with the board shall establish by rule:
131          (a) the classifications of anesthesia and analgesia permits and the scope of practice
132     permitted under each permit; and
133          (b) the qualifications for each classification of anesthesia and analgesia permit.
134          Section 3. Section 58-69-802 is amended to read:
135          58-69-802. Practice within limits of law, education, training, experience, and
136     competency -- Standard of care.
137          (1) Each individual licensed under this chapter shall confine his practice to those acts
138     or practices:
139          [(1)] (a) permitted by law; and
140          [(2)] (b) in which the individual is competent by education, training, and experience.
141          (2) (a) The standard of dental care a licensed dental professional provides through
142     teledentistry is the same as the standard of dental care a licensed dental professional provides in
143     a traditional physical setting.
144          (b) (i) A treating dentist may use teledentistry to delegate duties to a dental hygienist or
145     dental auxiliaries within the relevant applicable scopes of practice and under the appropriate
146     level of dentist supervision, in accordance with existing supervision laws.
147          (ii) A dental hygienist, other dental auxiliary, or any other teledentistry provider may
148     not carry out any duties through teledentistry that require the in-person supervision of a dentist
149     licensed under this chapter.

150          (c) A dentist may not conduct a dental examination using teledentistry if the standard
151     of care necessitates a traditional physical dental examination.
152          Section 4. Section 58-69-807 is enacted to read:
153          58-69-807. Use of teledentistry -- Informed consent -- Rulemaking.
154          (1) A dentist may provide dental services using teledentistry, including the following:
155          (a) supervising a licensed dental professional in the completion of the following at a
156     public health setting, generally with a written collaborative agreement, directly, or indirectly, in
157     accordance with this chapter:
158          (i) gathering diagnostic information to be used by the dentist at a remote location to
159     form a tentative basic treatment plan and provide appropriate preventive or urgent
160     prescriptions;
161          (ii) perform preventive dental procedures;
162          (iii) provide oral health education; and
163          (iv) perform any palliative or interim treatment or caries arresting treatment outlined in
164     the dentist's treatment plan and authorized by the dentist, in accordance with this chapter and
165     rules made in accordance with this chapter; and
166          (b) at a remote location, using records and diagnostic information that a dental
167     hygienist provides to form a tentative treatment plan for basic dental procedures.
168          (2) A licensed dental professional or any entity employing a licensed dental
169     professional may not require a patient to sign an agreement that limits the patient's ability to
170     file a complaint with the division.
171          (3) When a licensed dental professional uses teledentistry, the licensed dental
172     professional shall ensure informed consent covers the following additional information:
173          (a) a description of the types of dental care services provided through teledentistry,
174     including limitations on services;
175          (b) the name, contact information, licensure, credentials, and qualifications of all
176     dentists and dental hygienists involved in the patient's dental care; and
177          (c) precautions and protocols for technological failures or emergency situations.
178          (4) The division shall make rules, in accordance with Title 63G, Chapter 3, Utah
179     Administrative Rulemaking Act, to establish requirements and parameters regarding
180     teledentistry to ensure the safe use of teledentistry, including additional provisions for:

181          (a) transparency, disclosure, and informed consent;
182          (b) standard of care;
183          (c) proper documentation;
184          (d) supervision and scope of practice;
185          (e) patient complaints; and
186          (f) protocols for referrals.