NH Dental Hygiene Jurisprudence cheat sheet

New Hampshire dental hygienists practice under the supervision of a licensed dentist; RSA 317-A and the Board of Dental Examiners' administrative rules define what each supervision level permits.

Direct supervision means the dentist is physically present in the office or treatment facility, has examined the patient, and has authorized the procedure before it is performed.

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

Public health supervision allows a hygienist to provide limited services in settings such as schools, nursing homes, and community clinics without prior patient examination, under rules adopted by the Board.

A local anesthesia permit and a nitrous oxide/oxygen sedation permit each require separate Board-issued credentials and current certification in the underlying resuscitation technique.

Dental hygiene services are limited to those within the hygienist's education and licensure; diagnosis, treatment planning, and prescribing remain dentist-only functions.

A hygienist may not perform irreversible procedures or any service outside the statutory scope even if directed by a supervising dentist; the supervising dentist is not a source of expanded scope.

Continuing education in infection control and jurisprudence is a condition of maintaining the license, not merely a renewal formality.

Licensure in New Hampshire is granted by the Board of Dental Examiners; a candidate must pass the required clinical and written examinations and meet the Board's education and character requirements.

Applications require official transcripts, examination score reports, and disclosure of any prior license discipline or criminal history; omissions are grounds for denial or later discipline.

Licenses renew on a fixed cycle set by the Board; late renewal triggers a penalty fee, and practicing on a lapsed license is unlicensed practice.

Continuing education hours must be documented and retained; the Board may audit and require proof of completion.

A license is not transferable, and a hygienist may practice only under the name and license number on record with the Board.

Inactive or retired status may be available on request; an inactive licensee may not practice until reactivation requirements are met.

Out-of-state applicants should verify current reciprocity and licensure-by-credentials pathways directly with the Board, because these rules change.

Change of name or address must be reported to the Board within the timeframe set by rule; failure to do so can result in a fine or disciplinary action.

Standard precautions apply to every patient regardless of known infectious status; treat all blood and saliva as potentially infectious.

Hand hygiene with soap and water or an appropriate alcohol-based product is required before and after patient contact and after glove removal.

Personal protective equipment includes gloves, mask, protective eyewear, and gown or clinic jacket; PPE must be removed before leaving the treatment area.

Critical items that penetrate tissue or contact bone must be sterile; semicritical items contacting mucous membranes require at least high-level disinfection.

Sterilization must be monitored with biological indicators (spore tests) at the interval required by rule, plus chemical and mechanical indicators on each load.

Heat-sensitive items require an appropriate low-temperature sterilization process; flash sterilization is not a substitute for proper inventory and packaging.

Single-use items such as needles and anesthetic cartridges are never reused; sharps go into rigid, puncture-resistant containers at the point of use.

Surface barriers or an EPA-registered hospital disinfectant are used for clinical contact surfaces; housekeeping surfaces require routine cleaning.

A patient record must be accurate, contemporaneous, legible, and permanent; entries are dated and authenticated by the treating provider.

Corrections are made by a single line-through with initials and date, never by erasing, obliterating, or backdating an entry.

Records must document medical history, findings, treatment rendered, medications, and any adverse events or refusals of care.

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

Consent for minors is given by a parent or legal guardian; the record should identify the consenting adult and the relationship.

Patient information is confidential and may be released only with a valid written authorization or as required or permitted by law, such as a court order or mandatory report.

Records are retained for the period required by Board rule and applicable law, and the patient generally has a right to access and obtain copies.

Discussion of a patient in hallways, social media, or public settings is a confidentiality breach even without use of the patient's name.

The hygienist's primary obligation is the patient's oral health and welfare, placed ahead of the employer's financial interests.

A hygienist who believes a prescribed treatment is not in the patient's interest must raise the concern with the dentist and document the discussion.

Sexual or romantic relationships with current patients are prohibited; personal or financial relationships that exploit the professional relationship are boundary violations.

Accepting gifts or favors that could influence clinical judgment creates a conflict of interest and should be disclosed or declined.

Impaired practice, whether from substances, illness, or fatigue, must be addressed; a hygienist must not treat patients while impaired.

Reporting a colleague's impairment or misconduct to the appropriate authority is an ethical duty, balanced against the obligation not to make false accusations.

Advertising and public statements must be truthful and must not create unjustified expectations of results.

Ethical practice includes cultural humility and non-discrimination in the delivery of care.

New Hampshire law requires health care providers, including dental hygienists, to report suspected child abuse or neglect to the Division for Children, Youth and Families (DCYF).

Suspected abuse or neglect of a vulnerable adult is reported to the Bureau of Adult and Elderly Services within the Department of Health and Human Services.

The duty is triggered by reasonable suspicion, not proof; the reporter does not need to investigate or confirm the allegation.

Reports must be made promptly, within the statutory timeframe, and are followed by a written report if the agency requires one.

Good-faith reports are protected by immunity; failure to report when required can result in criminal penalty and Board discipline.

A hygienist who is told of abuse in the context of care is not bound by confidentiality in the same way; the mandatory reporting statute overrides it.

Intraoral signs such as injuries inconsistent with the history, bite marks, or delayed care should be documented objectively in the record.

Reporting obligations are personal and non-delegable; telling a supervisor does not satisfy the hygienist's own duty.

The New Hampshire Board of Dental Examiners regulates dentists and dental hygienists; its members are appointed and include public members as provided by statute.

The Board's authority includes licensure, rulemaking, investigations, and imposition of discipline, subject to the Administrative Procedure Act.

A complaint may be filed by a patient, employer, or member of the public; the Board screens complaints and may dismiss, investigate, or refer for hearing.

Disciplinary proceedings follow notice and an opportunity to be heard; the licensee may be represented by counsel and may present evidence.

Available sanctions include reprimand, probation with conditions, suspension, revocation, civil penalties, and required remediation or continuing education.

The Board may act on conduct occurring outside the practice setting, including criminal convictions and license discipline in another state.

Practicing on a suspended or revoked license, or aiding an unlicensed person to practice, is a separate violation subject to additional penalty.

Final disciplinary actions are generally public records and may be reported to national practitioner data banks.

Advertising must be truthful and not misleading; claims of superiority, guarantees of results, or unverifiable statistics are prohibited.

Use of the title "dental hygienist" or the abbreviation RDH is restricted to currently licensed individuals.

Soliciting patients through false urgency, deceptive pricing, or omission of material conditions of an offer is unprofessional conduct.

Fee setting is a business decision of the practice; nothing in the rules requires a hygienist to follow a fee schedule that conflicts with the patient's interest.

Fee splitting or paying a commission for patient referrals in a manner that compromises clinical judgment is prohibited.

Offering or accepting kickbacks for referrals violates state and federal law, including anti-kickback statutes.

Unprofessional conduct includes practicing outside scope, falsifying records, abandoning a patient, and failing to cooperate with a Board investigation.

Patient solicitation of a current patient of another practice through direct marketing may be restricted; verify current Board rules before engaging in it.

Direct supervision: dentist on premises, prior exam, prior authorization.

General supervision: prior exam and authorization, dentist not on premises.

Public health supervision: limited settings and services, no prior exam, Board rules apply.

Local anesthesia and nitrous oxide permits are separate credentials.

Diagnosis and treatment planning are outside the hygienist's scope.

Board-issued license required to practice; no practice on a lapsed license.

Renewal requires documented continuing education; audits are possible.

Name and address changes must be reported to the Board.

Prior discipline and criminal history must be disclosed on applications.

Reciprocity and licensure-by-credentials rules change; verify with the Board.

Standard precautions apply to all patients.

Critical items must be sterile; semicritical items need high-level disinfection.

Biological monitoring of sterilizers at the required interval.

Single-use items are never reused; sharps go in rigid containers.

Surface barriers or EPA-registered disinfectant for clinical contact surfaces.

Records must be accurate, dated, and contemporaneous.

Corrections by single line-through with initials and date.

Informed consent covers diagnosis, risks, benefits, alternatives, and no treatment.

Release of records requires written authorization or legal mandate.

Confidentiality applies even when the patient is not named.

Patient welfare comes before employer financial interest.

No romantic relationships with current patients.

Disclose or decline gifts that could influence judgment.

Never treat patients while impaired.

Advertising must be truthful and not create unjustified expectations.

Child abuse or neglect: report to DCYF.

Vulnerable adult abuse or neglect: report to the Bureau of Adult and Elderly Services.

Reasonable suspicion is enough; no investigation required.

Good-faith reports are immune; failure to report is punishable.

The duty is personal and cannot be delegated to a supervisor.

The Board licenses, investigates, and disciplines dentists and hygienists.

Proceedings follow the Administrative Procedure Act with notice and hearing.

Sanctions range from reprimand to revocation and civil penalties.

Out-of-state convictions and discipline can be acted on.

Final actions are public and may be reported to data banks.

Advertising must be truthful and not misleading.

The title "dental hygienist" is reserved for licensed individuals.

Fee splitting and kickbacks for referrals are prohibited.

Falsifying records and abandoning patients are unprofessional conduct.

Failure to cooperate with a Board investigation is itself a violation.

If the dentist has not examined the patient, general supervision is not available for that procedure.

If the setting is a school or nursing home, check whether public health supervision applies.

If the procedure is irreversible or diagnostic, it is outside the hygienist's scope.

If the procedure requires a permit (anesthesia, sedation), verify the permit is current.

If the direction conflicts with scope, the scope controls.

Track the Board's renewal cycle and apply before the expiration date.

Keep continuing education certificates for the full audit period.

Report address and name changes promptly.

Inactive status requires reactivation before returning to practice.

Verify reciprocity rules directly with the Board each cycle.

Hand hygiene before and after every patient contact.

PPE removed before leaving the treatment area.

Chemical and mechanical indicators on every load; spore tests at the required interval.

Heat-sensitive items use low-temperature sterilization.

Sharps containers are rigid and puncture-resistant and replaced when full.

Document medical history, findings, treatment, and refusals.

Date and authenticate every entry.

Never erase or backdate; correct with a single line and initials.

Identify the consenting parent or guardian for minors.

Retain records for the period required by rule and law.

No romantic relationships with current patients.

Disclose or decline gifts that could influence care.

Raise and document concerns when prescribed treatment is not in the patient's interest.

Do not practice while impaired; seek help and report impaired colleagues.

Treat all patients with cultural humility and without discrimination.

Recognize: injuries inconsistent with history, bite marks, delayed care.

Document objectively in the record.

Report promptly to DCYF for children or the Bureau of Adult and Elderly Services for vulnerable adults.

Follow up with a written report if required.

Do not delegate the duty; the hygienist reports personally.

Complaint filed by patient, employer, or public.

Board screens and may dismiss, investigate, or refer for hearing.

Notice and opportunity to be heard; right to counsel.

Sanctions: reprimand, probation, suspension, revocation, penalties, remediation.

Practicing on a suspended license is a separate violation.

No guarantees of results or unverifiable superiority claims.

Disclose material conditions of any offer.

Do not use deceptive urgency or pricing.

Reserve the title "dental hygienist" for licensed individuals.

No kickbacks or fee splitting that compromises clinical judgment.

Available only in settings named by Board rule, such as schools and community clinics.

Services are limited to preventive care defined by rule.

No prior dentist examination is required in this setting.

Referral to a dentist is required when findings exceed the hygienist's scope.

Document the setting and the referral in the record.

Disclose all prior license discipline in any state.

Disclose criminal history as required by the application.

Submit official transcripts and score reports.

Omissions are grounds for denial or later discipline.

Keep copies of everything submitted to the Board.

Critical: enters tissue or contacts bone; must be sterile.

Semicritical: contacts mucous membranes; high-level disinfection minimum.

Noncritical: contacts intact skin; low-level disinfection.

Classification drives the reprocessing method.

When in doubt, use the higher level of processing.

Diagnosis and nature of the condition.

Proposed treatment and its material risks and benefits.

Alternatives, including no treatment.

Voluntary agreement by the patient or guardian.

Document the discussion and the consent in the record.

Do not treat patients while impaired by substances, illness, or fatigue.

Impaired practice is a disciplinary violation.

Reporting an impaired colleague to the Board is an ethical duty.

False accusations are themselves misconduct.

Document concerns objectively and factually.

Good-faith reports are protected by statutory immunity.

Failure to report when required can be a criminal offense.

Failure to report can also lead to Board discipline.

The reporting duty overrides patient confidentiality in these cases.

Reporters do not need to prove the allegation.

The Board acts through statute and adopted rules.

Proceedings are governed by the Administrative Procedure Act.

The Board may investigate conduct outside the practice setting.

The Board may not exceed its statutory authority.

Licensees have a right to notice and a hearing.

Practicing outside the scope of practice.

Falsifying or altering patient records.

Abandoning a patient without proper notice.

Failing to cooperate with a Board investigation.

Offering or accepting kickbacks for referrals.

Local anesthesia permit requires separate Board credential.

Nitrous oxide/oxygen sedation permit requires separate Board credential.

Both require current certification in resuscitation.

Permits renew on the Board's cycle and can lapse independently of the license.

Performing permitted procedures without a current permit is unprofessional conduct.

Document all continuing education hours completed.

Retain certificates for the audit period.

Some hours must cover infection control and jurisprudence.

The Board may audit and require proof of completion.

Deficient continuing education can block renewal.

Biological indicators (spore tests) at the interval required by rule.

Chemical indicators on every package.

Mechanical indicators (time, temperature, pressure) on every load.

Failed spore test requires retesting and corrective action.

Document all monitoring results.

Valid written patient authorization.

Court order or subpoena issued according to law.

Mandatory reports of abuse or neglect.

Certain public health reporting required by statute.

Discussion in public settings is a breach even without naming the patient.

Patient welfare comes before employer financial interest.

Raise concerns about prescribed treatment with the dentist.

Document the discussion and the patient's decision.

Do not let fee pressure change clinical recommendations.

Decline gifts that could influence judgment.

Children: Division for Children, Youth and Families (DCYF).

Vulnerable adults: Bureau of Adult and Elderly Services, DHHS.

Reports must be made promptly within the statutory timeframe.

A written report may follow the oral report.

Keep a record of the report and the agency response.

Reprimand.

Probation with conditions.

Suspension, with or without stay.

Revocation.

Civil penalties and required remediation or continuing education.

Fee setting is a business decision of the practice.

Fee splitting with a referral source is prohibited.

Kickbacks for referrals violate state and federal law.

Commissions that compromise clinical judgment are prohibited.

Disclose any financial interest that could affect recommendations.

Dental hygiene services: prophylaxis, scaling, root planing, polishing, radiographs, sealants, fluoride.

Dentist-only: diagnosis, treatment planning, prescribing, irreversible surgery.

If a procedure is not in the statute or rules, it is outside scope.

A dentist's direction cannot expand the statutory scope.

Refer out when findings exceed the hygienist's scope.

Practice only under the name and license number on record.

A license is not transferable to another person.

Use the title "dental hygienist" or RDH only when currently licensed.

Report name changes to the Board within the required timeframe.

Keep the Board informed of a current practice address.

Hand hygiene before and after every patient contact.

Gloves, mask, eyewear, and gown for every patient encounter.

Remove PPE before leaving the treatment area.

Change gloves between patients and when torn or contaminated.

Perform hand hygiene after glove removal.

Never erase, obliterate, or use correction fluid.

Draw a single line through the error.

Initial and date the correction.

Add the correct information and the reason if needed.

Never backdate an entry.

The professional relationship is fiduciary; the patient's interest comes first.

No romantic or sexual relationships with current patients.

Avoid dual relationships that could exploit the patient.

Disclose conflicts of interest.

Maintain appropriate physical and emotional boundaries.

Record injuries objectively with measurements and location.

Note whether the history is consistent with the findings.

Record who accompanied the patient and what was said.

Do not photograph without following policy and consent rules.

Document the report made and the agency contacted.

Complaint is received and screened by the Board.

Board may dismiss, investigate, or refer for hearing.

Licensee receives notice of the allegations.

Licensee may be represented by counsel and present evidence.

Decision and sanction are issued and may be appealed.

No guarantee of results.

No unverifiable superiority claims.

Disclose material conditions of any offer.

No deceptive urgency or pricing.

Advertising must not create unjustified expectations.

Record the supervising dentist and the level of supervision.

Document the dentist's prior examination when required.

Record any referral made when findings exceed scope.

Note the setting when public health supervision applies.

Keep authorization records available for Board review.

Inactive status may be requested from the Board.

An inactive licensee may not practice.

Reactivation requires meeting current requirements.

Back continuing education may be required.

Verify reactivation requirements with the Board before returning.

Use barriers or EPA-registered hospital disinfectant on clinical contact surfaces.

Clean before disinfecting.

Housekeeping surfaces require routine cleaning.

Replace barriers between patients.

Discard single-use items after one patient.

Patients generally have a right to access and copy their records.

Respond within the timeframe required by law.

A reasonable copying fee may apply.

Release requires proper authorization or legal mandate.

Keep a log of disclosures.

Report impairment or misconduct to the appropriate authority.

Do not make false accusations.

Document concerns objectively.

Follow employer policy in addition to legal duties.

Cooperate with Board investigations.

The duty is triggered by reasonable suspicion, not proof.

The reporter does not investigate or confirm the allegation.

A suspicion based on observed signs or disclosures is sufficient.

Report promptly within the statutory timeframe.

Good-faith reports are immune from liability.

Practicing outside the scope of practice.

Unlicensed or lapsed-license practice.

Fraud or misrepresentation in licensure.

Criminal conviction related to practice.

Violation of a Board order or probation condition.

Reserve "dental hygienist" and RDH for licensed individuals.

Do not imply credentials not held.

State the license type accurately in advertising.

Do not use misleading specialty designations.

Verify current Board rules on titles before advertising.

Refer to a dentist when findings exceed the hygienist's scope.

Document the referral in the record.

Inform the patient of the reason for referral.

Follow up to confirm the patient was seen.

Do not delay referral to retain the patient.

Pass the required clinical examination.

Pass the required written jurisprudence examination.

Meet the Board's education requirement.

Meet character and fitness requirements.

Submit official transcripts and score reports.

Use a new needle and syringe for every injection.

Never reuse a cartridge on another patient.

Dispose of sharps immediately in a rigid container.

Do not recap by hand; use a scoop technique or device.

Report needlestick injuries per policy.

Consent is given by a parent or legal guardian.

Identify the consenting adult and relationship in the record.

Document the discussion and the consent.

Emergencies may allow treatment without consent under law.

Verify current rules on adolescent consent before relying on them.

Provide care without discrimination.

Respect patient values and preferences.

Use interpreter services when needed.

Document language and communication needs.

Avoid assumptions based on appearance or background.

The mandatory reporting statute overrides confidentiality.

Report only the information required.

Do not discuss the report with the patient's family without guidance.

Document the report and the agency contacted.

Follow agency instructions on further disclosure.

Final disciplinary actions are generally public records.

Actions may be reported to national practitioner data banks.

Licensee may request a hearing on the allegations.

Appeals follow the Administrative Procedure Act.

Compliance with sanctions is monitored by the Board.

Offering or accepting kickbacks for referrals violates state and federal law.

Fee splitting with a referral source is prohibited.

Commissions that compromise clinical judgment are prohibited.

Disclose any financial interest that could affect recommendations.

Verify current rules before entering any referral arrangement.

In an emergency, a hygienist may provide care within their competence to prevent harm.

Document the emergency and the care provided.

Delegation to unlicensed personnel is limited by statute and rule.

A hygienist may not delegate tasks reserved to licensed providers.

Verify current delegation rules with the Board.

Verify licensure status through the Board before hiring or practicing.

Keep the Board informed of a current address.

Report name changes within the required timeframe.

Request written confirmation of any rule interpretation.

Check the Board website for current forms and fees.

Follow the manufacturer's and Board's waterline maintenance schedule.

Flush lines according to policy.

Monitor and document waterline testing.

Maintain and document equipment sterilization.

Replace filters and parts as recommended.

Retain records for the period required by Board rule and law.

Retain records of minors for the required period after majority.

Keep records secure and confidential.

Provide copies on valid request.

Do not destroy records during an investigation.

Decline gifts that could influence clinical judgment.

Disclose financial interests that could affect recommendations.

Avoid dual relationships that could exploit the patient.

Do not accept payment for referrals.

Document any conflict disclosure.

Identify the child or adult and the suspected abuse or neglect.

Describe the observed signs and the basis for suspicion.

Provide the reporter's name and contact information.

Do not include unnecessary details.

Keep a copy of the report for your records.

Comply with all conditions of probation.

Submit to monitoring and reporting requirements.

Complete required remediation or continuing education.

Report any violation of conditions to the Board.

Failure to comply can lead to further discipline.

Do not use deceptive urgency or pricing to solicit patients.

Disclose material conditions of any offer.

Verify current Board rules before direct marketing to another practice's patients.

Do not misrepresent credentials or results.

Keep advertising records available for review.

Dental hygiene services are defined by statute and Board rules.

Diagnosis and treatment planning are dentist-only.

Irreversible procedures are outside the hygienist's scope.

A dentist's direction cannot expand the statutory scope.

Refer out when findings exceed the hygienist's scope.

A Board-issued license is required to practice.

Renewal requires documented continuing education.

Report name and address changes to the Board.

Disclose prior discipline and criminal history.

Verify reciprocity rules with the Board.

Standard precautions apply to all patients.

Critical items must be sterile.

Biological monitoring at the required interval.

Single-use items are never reused.

Use barriers or EPA-registered disinfectant on surfaces.

Records must be accurate and contemporaneous.

Correct with a single line and initials.

Informed consent covers risks, benefits, and alternatives.

Release requires authorization or legal mandate.

Confidentiality applies even without naming the patient.

Patient welfare comes first.

No romantic relationships with current patients.

Disclose or decline gifts that could influence judgment.

Never treat patients while impaired.

Advertising must be truthful.

Children: report to DCYF.

Vulnerable adults: report to the Bureau of Adult and Elderly Services.

Reasonable suspicion is enough.

Good-faith reports are immune.

The duty is personal and non-delegable.

The Board investigates and disciplines licensees.

Proceedings follow the Administrative Procedure Act.

Sanctions range from reprimand to revocation.

Out-of-state conduct can be acted on.

Final actions are public.

Advertising must be truthful and not misleading.

The title "dental hygienist" is reserved for licensed individuals.

Fee splitting and kickbacks are prohibited.

Falsifying records is unprofessional conduct.

Failure to cooperate with an investigation is a violation.