CA Dental Hygiene Law & Ethics cheat sheet

The Dental Practice Act is codified at Business and Professions Code (B&P) section 1600 et seq.; the Dental Board's implementing regulations appear in Title 16, California Code of Regulations (16 CCR), Division 10.

The Dental Board of California, a unit of the Department of Consumer Affairs, licenses dentists, registered dental hygienists, registered dental assistants, and dental corporations and adopts implementing regulations.

Board regulations are adopted under the Administrative Procedure Act (Gov. Code section 11340 et seq.) and require Office of Administrative Law review before taking effect.

Available enforcement tools include citations and fines (B&P section 1680), reprimands, probation with conditions, suspension, revocation, and interim suspension orders when public safety requires immediate action.

Formal discipline proceeds by accusation and hearing under the Administrative Procedure Act (Gov. Code section 11500 et seq.); an administrative law judge issues a proposed decision that the Board may adopt or modify.

B&P section 805 requires insurers, employers, and peer review bodies to report to the Board any settlement, judgment, or arbitration award over $3,000 within 30 days.

Unprofessional conduct for dentists and dental hygienists is defined in B&P section 1680.1 and includes incompetence, gross negligence, repeated negligent acts, and fraud.

A cited licensee contests a citation by requesting an administrative hearing within the period stated on the citation, generally 30 days.

Direct supervision means the dentist has examined the patient, authorized the procedure, and is physically present in the office and available to provide immediate care.

General supervision means the dentist has examined the patient and authorized the procedure but need not be physically present in the office while the hygienist performs it.

An RDH may perform prophylaxis, coronal polishing, pit-and-fissure sealants, fluoride application, radiographs, and self-care education under general supervision; scaling and root planing require a dentist's diagnosis and treatment plan.

A Registered Dental Hygienist in Alternative Practice (RDHAP) holds a separate license permitting independent practice in homebound patients' residences, schools, residential facilities, and dental health professional shortage areas, with referral obligations to a dentist.

Extended functions available only after additional Board-approved education and certification are soft tissue curettage, administration of local anesthesia, and administration of nitrous oxide-oxygen analgesia; anesthesia and nitrous oxide require direct supervision.

An RDH may not diagnose, prescribe, extract teeth, place restorations, or move teeth orthodontically; those services require a licensed dentist.

Delegation is limited to procedures the Act authorizes for RDHs and RDAs; unlicensed personnel may perform only specified non-clinical supportive tasks.

An RDH must refer the patient to a dentist when findings exceed hygienist scope or competence, such as suspicious lesions, uncontrolled periodontal disease, or complicating medical conditions, and must document the referral.

Initial RDH licensure requires graduation from an accredited dental hygiene program, passage of the national board examination, passage of a clinical/regional examination, fingerprint clearance, and a Board application.

Licenses renew biennially; practicing on an expired license is unlawful and constitutes unprofessional conduct.

Continuing education: 25 hours per two-year renewal cycle, including at least 2 hours in infection control; certificates must be retained and produced on Board audit.

Unprofessional conduct under B&P section 1680.1 includes incompetence, gross negligence, repeated negligent acts, convictions substantially related to practice, and fraud or deceit.

Additional unprofessional conduct includes practicing beyond authorized scope, practicing while impaired, falsifying records, aiding unlicensed practice, and failing to comply with infection control standards.

A licensee practicing while impaired is subject to discipline with conditions; voluntary evaluation and treatment may be considered in mitigation.

Licensees must keep a current address of record with the Board and must produce the license for inspection on request.

16 CCR section 1005 establishes California's minimum infection control standards for dental offices; Cal/OSHA's Bloodborne Pathogens Standard (8 CCR section 5193) applies concurrently.

Cal/OSHA requires a written exposure control plan, annual bloodborne pathogen training, PPE at no cost to employees, and post-exposure evaluation and follow-up.

Hepatitis B vaccination must be offered free of charge within 10 working days of assignment to exposure-prone duties; a declination must be documented in writing.

Critical items such as scalers and surgical instruments require cleaning followed by heat sterilization; semi-critical items require sterilization or high-level disinfection.

Each sterilizer must be monitored with biological indicators (spore tests) at least weekly; records are retained, and a positive result requires corrective action and retesting before reuse.

Handpieces and other intraoral devices must be cleaned and heat-sterilized between patients; disinfection alone is not acceptable.

Dental unit waterlines must be maintained so output meets drinking water standards, generally no more than 500 colony-forming units per milliliter, with flushing and treatment per manufacturer instructions.

Sharps belong in closable, puncture-resistant, labeled containers placed near use areas and replaced when about three-quarters full; needles are never recapped by hand.

Surfaces are barrier-protected or cleaned then disinfected with an EPA-registered hospital disinfectant; utility gloves are worn for cleanup.

Informed consent requires disclosure of the diagnosis, nature of the proposed treatment, material risks and benefits, alternatives including no treatment, and the patient's voluntary agreement, documented in the record.

A competent adult may refuse any treatment; document the refusal, the risks explained, and the continuing offer of available care.

Confidentiality is governed by HIPAA (45 CFR Parts 160 and 164) and California's Confidentiality of Medical Information Act (Civil Code section 56 et seq.); CMIA is often stricter and requires authorization for most disclosures.

Disclosures without authorization are permitted for treatment, payment, health care operations, and reports required by law such as abuse reporting, communicable disease reporting, and court orders.

Fiduciary duty requires the patient's welfare to precede the hygienist's financial interest; paying or receiving compensation for patient referrals violates B&P section 650.

Advertising must not be false, misleading, or deceptive (B&P section 651); guarantees of outcome and unverifiable superiority claims are prohibited.

Sexual contact or a romantic relationship with a patient is unprofessional conduct; dual relationships that impair professional judgment must be avoided or disclosed.

Consent for minors generally comes from a parent or legal guardian; emancipated minors may consent for themselves.

Negligence requires four elements: duty of care, breach of the standard of care, causation of injury, and damages; the standard is that of a reasonably prudent similarly situated hygienist.

Code of Civil Procedure section 340.5 requires suit within one year of discovery or three years of injury, whichever occurs first; minors under six may sue until age eight.

MICRA (Civil Code section 3333.2) caps non-economic damages with a base of $250,000 and requires a 90-day notice of intent to sue (CCP section 364).

Record entries must be contemporaneous, objective, dated, and signed, and must never be obliterated; late entries are added with the actual date and an explanation.

Record retention practice is at least seven years after the last treatment for adults, and for minors seven years after reaching majority.

HIPAA breach notification must reach affected individuals without unreasonable delay and no later than 60 days after discovery; CMIA imposes separate notification duties.

Child abuse: reasonable suspicion triggers an immediate or as-soon-as-practicable telephone report plus a written report within 36 hours (Penal Code section 11166); failure is a misdemeanor.

Elder or dependent adult physical abuse: report immediately by telephone and in writing within two working days; neglect reports are due within two working days (Welfare and Institutions Code section 15630).

B&P section 805 reports of settlements, judgments, or arbitration awards over $3,000 must reach the Board within 30 days.

Patient rights include informed consent, privacy, access to records, respectful communication, and the right to refuse or discontinue treatment.

Health and Safety Code section 123110 requires copies of records within 15 days of a signed request, with only statutorily permitted fees charged.

Use a qualified interpreter for consent discussions with limited-English-proficient patients; California's Dymally-Alatorre Bilingual Services Act requires bilingual services from state and local agencies.

When findings exceed the hygienist's scope or competence, refer promptly to a dentist or appropriate specialist and document the referral in the record.

Abandonment is unilateral termination of care without written notice, time to obtain another provider, emergency instructions, and transfer of records.

When a patient refuses a recommended referral, document the risks explained and the informed refusal, and continue to offer available care.

Share relevant clinical findings with dentists and physicians only as authorized, and apply the confidentiality rules of each practice setting.

Hygienists identify but do not diagnose systemic disease; abnormal findings are reported to the dentist and, with authorization, to the patient's physician.