Hygienists > Public Health Supervision

In 2004, the Iowa Dental Board approved a rule change allowing "public health supervision" of a dental hygienist. “Public health supervision” means 1) The dentist authorizes and delegates the services provided by a dental hygienist to a patient in a public health setting, with the exception that hygiene services may be rendered without the patient’s first being examined by a licensed dentist and 2) the dentist and the dental hygienist have entered into a written supervision agreement that details the responsibilities of each licensee. The dentist is not required to provide future dental treatment to patients served under public health supervision.

Public health supervision forms can be found here.

Eligibility

To be eligible to work under public health supervision, a dental hygienist must have an active Iowa license with a minimum of three years of clinical practice experience.

Licensee responsibilities

When working together in a public health supervision relationship, a dentist and dental hygienist shall enter into a written agreement that specifies the following responsibilities.

Dentist responsibilities:
  1. Be available to provide communication and consultation with the dental hygienist;
  2. Have age- and procedure-specific standing orders for the performance of dental hygiene 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 hygiene services;
  3. Specify a period of time in which an examination by a dentist must occur prior to providing further hygiene 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 hygiene services will be provided under public health supervision.
Hygienist Responsibilities:
  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, including where these records are to be located.

Allowable hygiene duties

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 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.

Public health settings defined

For the purposes of this rule, public health settings are limited to schools; Head Start programs; federally qualified health centers; public health dental vans; free clinics; nonprofit community health centers; nursing facilities; and federal, state, or local public health programs.