MT Dental Jurisprudence cheat sheet

The Montana Dental Practice Act is codified at Title 37, Chapter 4, MCA; the Board of Dentistry adopts implementing rules in Title 24, Chapter 11, ARM.

The Board of Dentistry sits within the Department of Labor and Industry, Division of Professional and Occupational Licensing; the Board writes rules and the Department issues licenses.

"Practice of dentistry" includes diagnosis, treatment planning, surgery, and correction of conditions of the oral cavity, plus prescribing and dispensing of dental appliances.

"Practice of dental hygiene" is limited to procedures the Board defines by rule, performed under a dentist's authorization unless an exemption applies.

A dental assistant may perform only reversible, delegated intraoral procedures that the supervising dentist is licensed and competent to perform.

Only a licensed dentist may own a dental practice or employ licensed dental personnel; a non-dentist may not control clinical decisions.

The Board may issue licenses, deny, suspend, or revoke them, and impose probation or fines; it also adopts the standard of care by rule.

A person practicing without a license is subject to criminal penalties and to injunctive action by the Department in district court.

Dentist and dental hygienist licenses renew annually on a schedule set by the Department; dental assistant registration also renews on the Department's cycle.

Applicants must pass a Board-approved clinical and written examination or hold a license in good standing in another state that the Board accepts.

Continuing education is required each renewal cycle in amounts set by Board rule, with specific hours for infection control and ethics where the Board mandates them.

A lapsed license may be reinstated on application, payment of fees, and proof of continuing education; practice during a lapse is unlicensed practice.

Licenses are not transferable, and a licensee must report a change of name or address to the Department within the time set by rule.

An inactive or retired status may be requested; a licensee in inactive status may not practice until restored to active status.

Temporary or limited permits may be issued for supervised practice or for out-of-state practitioners in Board-approved circumstances.

The Department maintains a public license lookup; verification of licensure status is the employer's and supervising dentist's responsibility.

Direct supervision: the dentist is on the premises, has examined the patient, and is available to immediately intervene during the procedure.

Indirect supervision: the dentist has authorized the procedure in advance and is available by phone or in person but need not be on the premises.

General supervision: the dentist authorizes the procedure but does not require the dentist's presence during performance.

Dental hygienists may perform prophylaxis, scaling, and root planing; local anesthesia and nitrous oxide require additional Board-approved training and authorization.

Dental assistants may take radiographs, place and remove rubber dams, and perform coronal polishing only after Board-required training and under the specified supervision level.

Expanded-function dental assistants perform additional reversible procedures only after completing a Board-approved course and holding the corresponding endorsement.

No auxiliary may diagnose, treatment plan, prescribe, or perform an irreversible procedure; those acts are reserved to the licensed dentist.

A dentist may not delegate a procedure the dentist is not competent to perform or that Board rule does not list as delegable.

The standard of care is the degree of skill and care a reasonably prudent dentist in the same or similar community would exercise under like circumstances.

Informed consent requires disclosure of diagnosis, proposed treatment, material risks, alternatives including no treatment, and the likely consequences.

Consent must be voluntary and given by a patient with capacity; a minor's consent is generally given by a parent or legal guardian.

A dentist may treat a minor without parental consent in an emergency or where statute authorizes treatment of a minor for specified conditions.

Records must be legible, contemporaneous, dated, and signed or authenticated by the treating provider, and must document consent discussions.

Radiographs, charting, and treatment notes are part of the dental record and must be retained for the period set by Board rule and statute.

Records must be released on a patient's written authorization, and a patient is entitled to a copy of the record on request under Montana law.

Amendments to a record must be made by dated addendum; alteration or destruction of a record to conceal care is unprofessional conduct.

The dental office must follow current CDC and OSHA standards for bloodborne pathogens, hand hygiene, and personal protective equipment.

Sterilization of critical and semicritical instruments requires an autoclave with monitoring by biological indicators at the interval the office's protocol specifies.

Single-use items such as needles and scalpel blades must be discarded in sharps containers and never recapped by hand unless a safe device is used.

The office must maintain a written exposure control plan, offer hepatitis B vaccination to at-risk staff, and document post-exposure evaluation.

Waterlines and suction systems require the flushing and testing regimen set by the office's infection control protocol and manufacturer instructions.

Surface barriers or disinfectants must be used between patients on all clinical contact surfaces, and handpieces must be sterilized between patients.

The office must post signage, keep safety data sheets, and comply with hazard communication requirements for chemicals used in the practice.

A licensee must report a known or suspected breach of infection control to the Board where the breach creates a risk of transmission.

A dentist may prescribe only within the scope of dental practice and for a legitimate dental purpose after establishing a dentist-patient relationship.

A prescriber must be registered with the DEA and hold a Montana controlled substances registration to prescribe controlled substances.

Schedule II prescriptions are subject to refill prohibitions and to the quantity and time limits set by federal and Montana law.

Montana's prescription drug monitoring program requires dispensers to report and authorizes prescribers to query the database for patient history.

A prescriber should check the PDMP before prescribing an opioid or benzodiazepine and must document the review in the record.

Prescriptions must include the patient's name, drug, strength, quantity, directions, date, and prescriber information, and must be signed.

Prescribing to a family member or self, or prescribing without a documented dental indication, is unprofessional conduct.

Lost or stolen prescription pads and compromised DEA registration must be reported as required by federal and state rules.

Grounds for discipline include fraud in licensing, gross negligence, incompetence, practicing while impaired, and violating Board rules.

The Board may impose a reprimand, fine, probation with conditions, suspension, or revocation, and may require remedial education.

A licensee must report another licensee's conduct that raises a reasonable suspicion of impairment or serious harm to patients.

Mandatory reporting also covers child abuse, elder abuse, and neglect under Montana reporting statutes, with immunity for good-faith reports.

A licensee must self-report an arrest or conviction for a crime involving moral turpitude or a controlled substance within the time set by rule.

The Department may summarily suspend a license where the public health, safety, or welfare requires immediate action, subject to a prompt hearing.

Disciplinary proceedings follow the Montana Administrative Procedure Act, including notice, an opportunity to be heard, and appeal rights.

Failure to cooperate with a Board investigation, or intimidating a complainant or witness, is itself a separate ground for discipline.

A patient has the right to be informed of the diagnosis, to refuse treatment, and to receive a copy of the dental record on request.

Protected health information may be disclosed for treatment, payment, and health care operations without authorization; other disclosures need authorization.

Montana law and HIPAA both protect patient information; where the two differ, the stricter rule generally governs the disclosure.

Disclosures required by law, such as for abuse reporting or a court order, are permitted without patient authorization to the extent required.

The office must provide a notice of privacy practices and train staff on safeguards for paper and electronic records.

A patient may request restrictions on disclosure and may request an accounting of disclosures as provided by HIPAA.

Minimum necessary standard applies to routine uses and disclosures; incidental disclosures must be limited by reasonable safeguards.

A breach of unsecured PHI must be assessed and, where required, reported to affected individuals and to federal authorities within statutory deadlines.

Advertising may not be false, deceptive, or misleading, and may not state or imply superior quality without a factual basis.

A dentist may advertise specialty practice only if the dentist holds the corresponding specialty certification recognized by the Board.

Use of a patient testimonial or before-and-after image requires consent and must not create an unjustified expectation of results.

A licensee may not pay or receive a fee for patient referrals where the payment is for referral rather than for actual services rendered.

Fee splitting with a non-dentist for clinical services is prohibited; the dentist may not divide clinical fees with a referral source.

A dentist may set fees independently; participation in a plan does not permit a third party to control clinical judgment.

Discount or coupon advertising must disclose material terms and may not misrepresent the usual fee or the scope of the offer.

Use of another dentist's name, a trade name, or a practice name may not mislead the public about who provides the care.