STATE BOARD OF VETERINARY MEDICINE [49 PA. CODE. CH. 31] Dental Procedures [40 Pa.B. 4970]
[Saturday, August 28, 2010]The State Board of Veterinary Medicine (Board) proposes to amend §§ 31.1, 31.31 and 31.39 (relating to definitions; scope of practice; and grounds for disciplinary proceedings) and to add § 31.31a (related to performance of dental procedures on companion animals, excluding equines, by certified veterinary technicians, VTSs and veterinary assistants) to read as set forth in Annex A. The proposed rulemaking provides needed guidance regarding the dental procedures that may lawfully be performed by licensees and unlicensed assistants.
Effective Date
The proposed rulemaking will be effective upon final-form publication in the Pennsylvania Bulletin.
Statutory Authority
Section 11 of the Veterinary Medicine Practice Act (act) (63 P. S. § 485.11) requires the Board to promulgate by regulation the requirements for the regulation of veterinary technicians. Section 3(14) of the act (63 P. S. § 485.3(14)) defines a veterinary assistant as an individual who is not certified as a veterinary technician and who performs limited tasks involved in the care and treatment of animals as defined by regulation if requested to do so by the assistant's employing veterinarian. Section 21(22) of the act (63 P. S. § 485.21(22)) authorizes the Board to discipline a licensee who has in the licensee's employment an unlicensed person to practice veterinary medicine contrary to the act or the Board's regulations.
Background and Purpose
The practice of veterinary technology includes, by definition in section 3 of the act, performing dental prophylaxis. This proposed rulemaking intends to clarify the procedures that constitute dental prophylaxis for certified veterinary technicians (CVTs), veterinary technician specialists (VTSs) and veterinary assistants. The Board began developing this proposed rulemaking in 2005. A public hearing was held on October 27, 2005, at which the Board sought the input of veterinarians and CVTs involved in dentistry. Six veterinarians and two CVTs participated; one dental technician who practices on humans also participated.
Description of Proposed Rulemaking
To conform the regulations to amendments to the act made by the act of December 9, 2002 (P. L. 1370, No. 167), the Board proposes to replace the term ''noncertified employee'' with the term ''veterinary assistant.''
Section 31.31(a)(1)(ii) and (b)(1)(ii) allows both CVTs and veterinary assistants to ''perform dental prophylaxis'' under direct veterinary supervision. The term ''dental prophylaxis'' does not have a commonly accepted definition within the veterinary profession. The Board proposes to provide needed clarity through a new regulatory section that specifically describes the dental prophylactic procedures that may be performed by individuals. Proposed § 31.31a addresses the performance of dental procedures by CVTs, VTSs and veterinary assistants. The Board considered the education and training of CVTs and VTSs in developing the list of procedures that each group would be authorized to perform. The licensed veterinarian employing the CVT, VTS or veterinary assistant would remain responsible for ensuring that these individuals are competent to perform the assigned tasks. The Board also proposes to amend § 31.31(c) to prohibit both CVTs and veterinary assistants from performing dental procedures that invades hard or soft oral tissue or that alters the shape, structure or position of teeth including malocclusions, except those procedures specifically authorized in § 31.31a.
In § 31.31a, the Board proposes to provide detailed description of the dental procedures that may be performed by CVTs, VTSs and veterinary assistants. Subsection (a) applies to CVTs, subsection (b) applies to veterinary assistants and subsection (c) applies to VTSs.
The proposed rulemaking would be the most restrictive for veterinary assistants because these individuals do not have formal training. Under § 31.31a(b)(1), a veterinary assistant whom the supervising veterinarian has determined is competent in providing dental care may perform supra- or subgingival tooth (root) scaling using manual, ultrasonic or high speed dental cleaning equipment, manual plaque removal, polishing and application of fluoride or other recognized topical agents to teeth that are to be retained. In addition, § 31.31a(b)(2) authorizes veterinary assistants to perform dental charting and dental radiographs. Finally, § 31.31a(b)(3) authorizes veterinary assistants to perform dental extractions of a single-rooted tooth that is loose, mobile or diseased using a gauze sponge. If instruments are needed to free the tooth, a veterinary assistant may only use an elevator or dental forceps after consulting with the supervising veterinarian and after the supervising veterinarian has examined the animal and instructed the veterinary assistant to proceed.
The proposed rulemaking permits CVTs, who have completed a 2- or 4-year educational program accredited by the American Veterinary Medical Association, taken a National examination and been certified by the Board, to perform the procedures permitted for a veterinary assistant. In addition, the proposed rulemaking permits CVTs to perform dental extractions of a single-rooted tooth that is loose, mobile or diseased using a gauze sponge and, if instruments are needed to free the tooth, use an elevator or dental forceps after consulting with the supervising veterinarian. The Board further proposes, in § 31.31a(4), to authorize CVTs to perform appropriate skin gingival closure after consultation with the supervising veterinarian.
The proposed rulemaking allows VTSs who hold current certification in dentistry to perform additional advanced procedures. Section 31.31a(c) authorizes a VTS to perform single or multiple-rooted tooth extractions that require dental instrumentation or sectioning; prepare dental impressions and models; assist with dental nerve blocks; identify normal dentition and eruption schedules; identify abnormal oral pathology; perform sub-gingival scaling, root planing and curettage; prepare instruments in sequence; prepare dental stone laboratory models; position for intra-oral radiology; maintain hand instruments, equipment and dental delivery systems; and assess and manage pain in consultation with the treating veterinarian.
Fiscal Impact
The proposed rulemaking should not have fiscal impact on the Commonwealth, the Board's licensees, the general public or political subdivisions.
Paperwork Requirements
The proposed rulemaking does not create additional paperwork for the Board, the Board's licensees or the general public.
Sunset Date
The Board continuously monitors its regulations. Therefore, a sunset date has not been assigned.
Regulatory Review
Under section 5(a) of the Regulatory Review Act (71 P. S. § 745.5(a)), on August 17, 2010, the Board submitted a copy of this proposed rulemaking and a copy of a Regulatory Analysis Form to the Independent Regulatory Review Commission (IRRC) and to the Senate Consumer Protection and Professional Licensure Committee and the House Professional Licensure Committee. A copy of this material is available to the public upon request.
Under section 5(g) of the Regulatory Review Act, IRRC may convey comments, recommendations or objections to the proposed rulemaking within 30 days of the close of the public comment period. The comments, recommendations or objections must specify the regulatory review criteria which have not been met. The Regulatory Review Act specifies detailed procedures for review, prior to final publication of the rulemaking, by the Board, the General Assembly and the Governor of comments, recommendations or objections raised.
Public Comment
Interested persons are invited to submit written comments, suggestions or objections regarding this proposed rulemaking to Michelle Roberts, Administrative Assistant, State Board of Veterinary Medicine, P. O. Box 2649, Harrisburg, PA 17105-2649 within 30 days of publication of this proposed rulemaking in the Pennsylvania Bulletin. Reference No. 16A-5718, Dental Procedures, when submitting comments.
ROBIN J. BERNSTEIN, Esq.,
ChairpersonFiscal Note: 16A-5718. No fiscal impact; (8) recommends adoption.
Annex A TITLE 49. PROFESSIONAL AND
VOCATIONAL STANDARDSPART I. DEPARTMENT OF STATE Subpart A. PROFESSIONAL AND
OCCUPATIONAL AFFAIRSCHAPTER 31. STATE BOARD OF
VETERINARY MEDICINEGENERAL PROVISIONS § 31.1. Definitions.
The following words and terms, when used in this chapter, have the following meanings, unless the context clearly indicates otherwise:
* * * * * [Noncertified employee—An employee of a veterinarian who does not hold certification as a veterinary technician and whom the veterinarian deems competent to administer medication or render auxiliary or supporting assistance under direct veterinary supervision or immediate veterinary supervision.]
* * * * * Veterinary assistant—An employee of a veterinarian who does not hold certification as a veterinary technician to whom the employing veterinarian assigns tasks in accordance with § 31.31 (relating to scope of practice).
VETERINARY TECHNICIANS AND [NONCERTIFIED EMPLOYEES] VETERINARY ASSISTANTS § 31.31. Scope of practice.
(a) Certified veterinary technicians. A certified veterinary technician may perform the duties enumerated in this subsection under direct veterinary supervision or indirect veterinary supervision as indicated. While some of the enumerated duties may be applicable primarily to small animal practices, the intended scope of this subsection is both large and small animal practices. This subsection does not prohibit the performance by a certified veterinary technician of a service which is not listed in this subsection if the service is within the certified veterinary technician's skills, forms a usual component of the veterinarian's scope of practice, and is requested by the supervising veterinarian. The veterinarian bears ultimate responsibility for assuring that the certified veterinary technician to whom a duty is assigned is competent to perform it.
(1) A certified veterinary technician may do the following only under direct veterinary supervision:
(i) Administer anesthesia[—] ordered by the veterinarian, including induction, intubation, maintenance, extubation and recovery and intravenous sedation.
(ii) Perform dental [prophylaxis] procedures as set forth in § 31.31a(a) (relating to performing dental procedures on companion animals, excluding equines, by certified veterinary technicians, VTSs and veterinary assistants).
* * * * * (b) [Noncertified employees] Veterinary assistants. [Noncertified employees] Veterinary assistants may perform the duties enumerated in this subsection under direct veterinary supervision or immediate veterinary supervision, as indicated. While some of the enumerated duties may be applicable primarily to small animal practices, the intended scope of this subsection is both large and small animal practices. This subsection does not prohibit a [noncertified employee] veterinary assistant from administering medication or rendering auxiliary or other supporting assistance which is not listed in this subsection if the service is within the [noncertified employee's] veterinary assistant's skills and is requested by the supervising veterinarian. The veterinarian bears ultimate responsibility for assuring that the [noncertified employee] veterinary assistant to whom a duty is assigned is competent to perform it.
(1) A [noncertified employee] veterinary assistant may do the following under direct veterinary supervision:
* * * * * (ii) Perform dental [prophylaxis] procedures as set forth in § 31.31a(b).
* * * * * (2) A [noncertified employee] veterinary assistant may do the following only under immediate veterinary supervision:
* * * * * (3) Emergency treatment by [noncertified employes] veterinary assistants is permitted without veterinary supervision when an animal has been placed in a life-threatening condition and immediate treatment is necessary to sustain the animal's life. The [noncertified employe] veterinary assistant shall immediately take steps to secure the direct supervision of a veterinarian. Emergency treatment may only consist of those duties enumerated under paragraphs (1) and (2)(i)—(iv).
(c) Prohibited acts. Neither certified veterinary technicians nor [noncertified employees] veterinary assistants may do the following:
* * * * * (6) Perform any dental procedure that invades hard or soft oral tissue or that alters the shape, structure or position of teeth including malocclusions, except procedures authorized in § 31.31a.
§ 31.31a. Performance of dental procedures on companion animals, excluding equines, by certified veterinary technicians, VTSs and veterinary assistants.
(a) Certified veterinary technician. In addition to the procedures in § 31.31 (relating to scope of practice), a certified veterinary technician may, under the direct supervision of a veterinarian perform the following procedures on companion animals, excluding equines:
(1) Supragingival or subgingival tooth (root) scaling using manual, ultrasonic or high speed dental cleaning equipment; manual plaque removal; polishing; and application of fluoride or other recognized topical agents to teeth that are to be retained.
(2) Dental charting and dental radiographs.
(3) Dental extractions of a single-rooted tooth that is loose, mobile or diseased using a gauze sponge. If instrumentation is needed to free the tooth from gingival attachments, a certified veterinary technician may use an elevator or dental forceps only after consulting with the supervising veterinarian.
(4) Appropriate skin gingival closure if authorized after consultation with the supervising veterinarian.
(b) Veterinary assistant. A veterinary assistant whom the supervising veterinarian has determined is competent in providing dental care may, under the direct supervision of a veterinarian, perform the following procedures on companion animals, excluding equines:
(1) Supragingival or subgingival tooth (root) scaling using manual, ultrasonic or high speed dental cleaning equipment; manual plaque removal; polishing; and application of fluoride or other recognized topical agents to teeth that are to be retained.
(2) Dental charting and dental radiographs.
(3) Dental extractions of a single-rooted tooth that is loose, mobile or diseased using a gauze sponge. If instrumentation is needed to free thetooth from gingival attachments, a veterinary assistant may use an elevator or dental forceps only after consulting with the supervising veterinarian and after the supervising veterinarian has examined the animal and instructed the veterinary assistant to proceed.
(c) VTS. A certified veterinary technician who holds current certification as a VTS in dentistry may, under direct veterinary supervision, perform additional ancillary dental services or procedures on companion animals, excluding equines. Advanced procedures may include:
(1) Performing single-rooted tooth extractions.
(2) Performing multiple-rooted tooth extractions after consultation with and under the immediate supervision of a veterinarian.
(3) Preparing dental impressions or models, including whole-mouth alginate impressions.
(4) Assisting the supervising veterinarian with dental nerve blocks.
(5) Identifying normal dentition and eruption schedules.
(6) Identifying abnormal oral pathology.
(7) Performing subgingival scaling, root planing and curettage.
(8) Preparing instruments in sequence for use in pulpotomy, pulpectomy, surgical and nonsurgical extractions, periodontal surgery and oral surgery.
(9) Preparing dental stone laboratory models.
(10) Positioning for intra-oral radiology.
(11) Maintaining hand instruments, equipment and dental delivery systems.
(12) Assessing and managing pain in consultation with the treating veterinarian.
§ 31.39. Grounds for disciplinary proceedings.
* * * * * (b) Certified veterinary technicians, VTSs and [noncertified employees] veterinary assistants who deviate from the permitted scope of practice as set forth in § 31.31 (relating to scope of practice) or § 31.31a (relating to performance of dental procedures on companion animals, excluding equines, by certified veterinary technicians, VTSs and veterinary assistants) will be subject to prosecution and the levying of a civil penalty by the Board under section 28(c) of the act (63 P. S. § 485.28(c)). Veterinarians who permit, order or direct certified veterinary technicians, VTSs or [noncertified employees] veterinary assistants to perform duties which are not authorized by § 31.31 or § 31.31a (relating to performance of dental procedures on companion animals, excluding equines, by certified veterinary technicians, VTSs and veterinary assistants) will be subject to disciplinary action by the Board under section 21 of the act (63 P. S. § 485.21).
* * * * * [Pa.B. Doc. No. 10-1586. Filed for public inspection August 27, 2010, 9:00 a.m.]
