Public Health Supervision

Public Health Settings

For the purposes of this rule, public health settings are limited to schools; Head Start programs; programs affiliated with the early childhood Iowa (ECI) initiative authorized by Iowa Code chapter 256I; child care centers (excluding home-based child care centers); federally qualified health centers; public health dental vans; free clinics; nonprofit community health centers; nursing facilities; and federal, state, or local public health programs. 

In December 2020, the board issued a statement clarifying public health settings as established in rule.  You may review that statement here.

Eligibility

To be eligible to work under public health supervision, a dental hygienist or a registered dental assistant must have an active Iowa license or registration with a minimum of one year of active clinical practice experience.

Public Health Supervision Agreements

When working together in a public health supervision relationship, a dental hygienist or dental assistant shall enter into a written agreement with a licensed dentist that authorizes and delegates the services that may be provided under the agreement. You may access the public health supervision forms made available by the Dental and Oral Health team here.

• Dental hygienists must file the public health supervision agreement with the Dental & Oral Health team of the Iowa Department of Health & Human Services.
• Dental assistants must file the public health supervision agreement with the Iowa Dental Board and the Dental & Oral Health team of the Iowa Department of Health & Human Services.

Responsibilities

Responsibilities of the Dentist

1. Be available to provide communication and consultation with the dental hygienist or dental assistant;
2. Have age- and procedure-specific standing orders for the performance of dental services. Those standing orders must include consideration for medically-compromised patients and medical conditions for which a dental evaluation must occur prior to the provision of dental services;
3. Specify a period of time in which an examination by a dentist must occur prior to providing further services. However, this examination requirement does not apply to educational services, assessments, screenings, and fluoride if specified in the supervision agreement; and
4. Specify the location or locations where the services will be provided under public health supervision.

Responsibilities of the Dental Hygienist

A dental hygienist providing services under public health supervision may provide assessments; screenings; data collection; and educational, therapeutic, preventive, and diagnostic services as defined in rule IAC 650--10.3(153), except for the administration of local anesthesia or nitrous oxide inhalation analgesia. The hygienist can only provide services as specified in the written supervision agreement and under the protocols specified in the agreement.

1. Maintain contact and communication with the dentist providing public health supervision;
2. Practice according to age- and procedure-specific standing orders as directed by the supervising dentist, unless otherwise directed by the dentist for a specific patient;
3. Provide to the patient, parent, or guardian a written plan for referral to a dentist and assessment of further dental treatment needs;
4. Have each patient sign a consent form that notifies the patient that the services that will be received do not take the place of regular dental checkups at a dental office and are meant for people who otherwise would not have access to services; and
5. Specify a procedure for creating and maintaining dental records for the patients that are treated by the dental hygienist or dental assistant, including where these records are to be located.

Information about the application of silver diamine fluoride is copied below.

Responsibilities of the Dental Assistant

A registered dental assistant providing services under public health supervision may only provide services which are limited to all extraoral duties, dental radiography, intraoral suctioning, and use of a curing light and intraoral camera and must:

1. Maintain contact and communication with the dentist providing public health supervision;
2. Practice according to age- and procedure-specific standing orders as directed by the supervising dentist, unless otherwise directed by the dentist for a specific patient;
3. Provide to the patient, parent, or guardian a written plan for referral to a dentist and assessment of further dental treatment needs;
4. Have each patient sign a consent form that notifies the patient that the services that will be received do not take the place of regular dental checkups at a dental office and are meant for people who otherwise would not have access to services; and
5. Specify a procedure for creating and maintaining dental records for the patients that are treated by the dental hygienist or dental assistant, including where these records are to be located.

Annual Reporting Requirements

Each dental hygienist or dental assistant who has rendered services under public health supervision must complete a summary report at the completion of a program or, in the case of an ongoing program, at least annually. The report shall be filed with the Dental & Oral Health team at the Iowa Department of Health & Human Services on forms provided by the department and shall include information related to the number of patients seen and services provided so that the department may assess the impact of the program. The department will provide summary reports to the board on an annual basis.

Effective October 3, 2018, the board adopted rules that allow dental hygienists to use silver diamine fluoride under public health supervision.  The written agreements for public health supervision must be filed with the Dental & Oral Health team, and must also be maintained by the dentist and the dental hygienist and made available to the board upon request.  The agreement must be reviewed, at a minimum, every two years.  The agreement establishes the locations and services that may be provided under public health supervision. 

Iowa Administrative Code 650-10.5(3) establishes the requirements for the use of silver diamine fluoride in public health settings.

• The supervising dentist and the dental hygienist must complete Board-approved training on the use of silver diamine fluoride if the services are included in the supervision agreement; and
• The agreement must include specific guidelines for the use of silver diamine fluoride and must comply with board-approved protocols.

Board-Approved SDF Protocols

At its September 28, 2018 meeting, the board approved protocols for the use of silver diamine fluoride in public health settings.  The protocols were developed by the Iowa Department of Public Health, now the Department of Health & Human Services, in conjunction with the University of Iowa College of Dentistry.  The approved protocols are available here.

Board-Approved SDF Training Courses

The Iowa Dental Board has approved the following courses for the purposes of training in the use of silver diamine fluoride under public health supervision:

University of Iowa College of Dentistry
Contact: Amanda Shoemaker
Email: Amanda-Shoemaker@uiowa.edu
Website: www.dentistry.uiowa/ce
Phone: (319) 335-7166; Fax: (319) 335-7155

Mary Kelly, L.L.C.
Contact: Mary Kelly, R.D.H., B.S., M.S.
Email: MaryKellyRDH@msn.com
Phone: (515) 321-5125

Iowa Dental Association
May 2019 Meeting
"Medical Model of Caries for the Modern Dental Practice: Silver Diamine Fluoride (SDF) and More"
Presented by: Dr. Jeremy Horst
Approved by the Iowa Dental Board: 4/5/2019