Senate Bill 25-194 Revised

A Bill for an Act

• Page 1, Line 101Concerning the continuation of the "Dental Practice Act".

Bill Summary

(Note: This summary applies to this bill as introduced and does not reflect any amendments that may be subsequently adopted. If this bill passes third reading in the house of introduction, a bill summary that applies to the reengrossed version of this bill will be available at http://leg.colorado.gov.)

Sunset Process - Senate Health and Human Services Committee. The bill makes changes to the "Dental Practice Act" (act) by:

• Continuing the act for 9 years, until 2034;
• Updating and adding definitions;
• Changing the makeup of the Colorado dental board (board);
• Requiring the attorney general, in addition to counseling the board, to counsel and advise the board's consultants;
• Adding and updating the grounds for which the board may take disciplinary action against an applicant for licensure or a licensee;
• Allowing a licensee's submission to a mental or physical examination to satisfy the requirement to notify the board of a condition that would impair the licensee's ability to practice;
• Adding as exemptions to the act the volunteer practice of dentistry and dental hygiene under specific conditions;
• Repealing the exceptions that allow a dental therapist, dental hygienist, or dental assistant to perform certain dentistry practices and including additional tasks to the list of items included in the practice of dentistry;
• Clarifying that a dental assistant, dental hygienist, and dental therapist may perform tasks consistent with rules adopted by the board;
• Requiring providers who perform itinerant surgery to develop and maintain protocols for emergency follow-up care;
• Authorizing licensed dentists to prescribe orders electronically;
• Requiring a peer health assistance program selected as a designated provider for the dentist peer health assistance program to provide training and calibration to dentists who practice monitoring services;
• Authorizing dentists to self-refer to participate in a peer health assistance program or be referred by the board;
• Requiring an applicant for dental, dental hygienist, or dental therapy licensure to pass a jurisprudence examination that tests the applicant's knowledge of the act;
• Removing a requirement that dental education schools and programs must be accredited or approved by a specific entity;
• Requiring the board to adopt rules that allow for expedited, temporary licensure during a public health emergency;
• Repealing specific tasks that are currently authorized to be performed by a dental therapist;
• Updating procedures for the construction of dental devices by an unlicensed technician;
• Updating the list of practices that are considered to be the practice of unsupervised dental hygiene;
• Repealing the specific dosages of certain drugs that a dental hygienist may prescribe;
• Authorizing the board to adopt rules that identify safe prescribing alternatives to silver diamine fluoride as a treatment for strengthening teeth and preventing tooth decay;
• Identifying tasks that are deemed to be practicing supervised dental hygiene;
• Requiring a dental hygienist performing an interim therapeutic restoration to confirm a referral for follow-up care with a dentist;
• Limiting the number of dental hygienists that a dentist may supervise; and
• Authorizing a dental therapist to perform specific tasks.

• Page 3, Line 1Be it enacted by the General Assembly of the State of Colorado:

• Page 3, Line 2SECTION 1.  In Colorado Revised Statutes, 12-220-104, amend

• Page 3, Line 3(1), (4), (9)(a), and (10)(a); add(5.2), (10.5), and (14.5); and add with amended and relocated provisions (5.3) as follows:

• Page 3, Line 412-220-104.  Definitions - rules. As used in this article 220, unless the context otherwise requires:

• Page 3, Line 5(1)  "Accredited" means a program that is nationally recognized for

• Page 3, Line 6specialized accrediting for dental, dental therapy, dental hygiene, and

• Page 3, Line 7dental auxiliary programs by the Commission on Dental

• Page 3, Line 8Accreditation or a specialty accrediting organization

• Page 3, Line 9recognized by the United States department of education or by a successor organization of the commission.

• Page 3, Line 10(4)  "Dental hygiene" means the delivery of preventive,

• Page 3, Line 11educational, and clinical services supporting total health for the control

• Page 3, Line 12of oral disease; the impact of the disease, disorder, or condition on

• Page 3, Line 13the human body; and the promotion of oral health provided by a dental

• Page 3, Line 14hygienist within the scope of the dental hygienist's education, training, and experience and in accordance with applicable law.

• Page 3, Line 15(5.2)  "Dental hygiene laboratory work order" means the

• Page 3, Line 16documented order of a dental hygienist licensed in this state

• Page 4, Line 1authorizing another person to construct, reproduce, or repair an oral medicament carrier.

• Page 4, Line 2(5.3)  [Formerly 12-220-104 (11)] "Dental laboratory work

• Page 4, Line 3order" means the written instructions documented order of a dentist

• Page 4, Line 4licensed in Colorado authorizing another person to construct, reproduce,

• Page 4, Line 5or repair any prosthetic denture, bridge, appliance, or other structure to

• Page 4, Line 6function in the oral cavity, maxillofacial area, or adjacent and associated regions.

• Page 4, Line 7(9) (a) (I)   "Indirect supervision" means the supervision of those

• Page 4, Line 8tasks or procedures that do not require the presence of the dentist in the

• Page 4, Line 9office or on the premises at the time the tasks or procedures are being

• Page 4, Line 10performed but do require that the tasks be performed with the prior knowledge and consent of the dentist.

• Page 4, Line 11(II)  For procedures performed under indirect supervision,

• Page 4, Line 12if follow-up care is indicated, the treating provider shall

• Page 4, Line 13provide an appropriate referral for recommended follow-up care.

• Page 4, Line 14(III)  A dentist who provides indirect supervision must have an active Colorado license in good standing.

• Page 4, Line 15(10) (a)  "Interim therapeutic restoration" or "ITR" means a direct

• Page 4, Line 16provisional restoration placed to stabilize a tooth until a licensed dentist or dental therapist can assess the need for further definitive treatment.

• Page 4, Line 17 (10.5)  "Itinerant surgery" means the provision of

• Page 4, Line 18elective surgical procedures by a provider who travels between

• Page 4, Line 19multiple treatment facilities rather than operating from a

• Page 4, Line 20single, established surgical location where the provider is not

• Page 4, Line 21employed or does not hold ownership or a long-term lease.

• Page 5, Line 1"Itinerant surgery" includes specialty-level surgical care

• Page 5, Line 2performed in a facility by a provider who is not a graduate of an accredited surgical training program for that specialty.

• Page 5, Line 3(14.5)  "Teledentistry" means telehealth methodologies

• Page 5, Line 4and systems that are used in a manner that is compliant with the

• Page 5, Line 5federal "Health Insurance Portability and Accountability Act

• Page 5, Line 6of 1996", 42 U.S.C. secs. 1320d to 1320d-9, as amended, to deliver

• Page 5, Line 7oral health services in dentistry, including informational and

• Page 5, Line 8electronic communication technologies, remote monitoring

• Page 5, Line 9technologies, and store-and-forward transfers, to facilitate

• Page 5, Line 10the assessment, diagnosis, consultation, counseling, and

• Page 5, Line 11education of, or treatment planning for, a patient while the

• Page 5, Line 12patient is located at an originating site without a dental

• Page 5, Line 13practitioner, and the dental practitioner providing the service is at a distant site.

• Page 5, Line 15SECTION 2.  In Colorado Revised Statutes, 12-220-105, amend(1)(b)(II)(A) and (5) as follows:

• Page 5, Line 1612-220-105.  Colorado dental board - qualifications of board

• Page 5, Line 17members - quorum - panel - rules - review of functions - repeal of

• Page 5, Line 18article - repeal. (1) (b) (II) (A)  Effective July 1, 2031, the board consists

• Page 5, Line 19of seven dentist members, two one of whom is an oral and

• Page 5, Line 20maxillofacial surgeon unless an oral and maxillofacial

• Page 5, Line 21surgeon is not available;one dental therapist members, two member;

• Page 5, Line 22three dental hygienist members; and two members from the public at

• Page 5, Line 23large; except that the dental therapist seat shall remain open

• Page 5, Line 24and a dental therapist member shall not be appointed until

• Page 6, Line 1there are at least one hundred dental therapists actively

• Page 6, Line 2engaged in clinical practice in this state. The governor shall

• Page 6, Line 3appoint each member for a term of four years, and each member must

• Page 6, Line 4have the qualifications provided in this article 220. A member shall not

• Page 6, Line 5serve more than two consecutive terms of four years. Each board member

• Page 6, Line 6holds office until the member's term expires or until the governor appoints a successor.

• Page 6, Line 7(5) (a)   This article 220 is repealed, effective September 1,

• Page 6, Line 82034. Before the repeal, of this article 220 pursuant to subsection (5)(b)

• Page 6, Line 9of this section, all functions of the board are scheduled for review in accordance with section 24-34-104.

• Page 6, Line 10(b)  This article 220 is repealed, effective September 1, 2025.

• Page 6, Line 11SECTION 3.  In Colorado Revised Statutes, 12-220-106, amend

• Page 6, Line 12(1)(a) introductory portion and (2); and add (1)(a)(VI) and (1)(a)(VII) as follows:

• Page 6, Line 1312-220-106.  Powers and duties of board - rules - limitation on

• Page 6, Line 14authority. (1)  The board shall exercise, in accordance with this article 220, the following powers and duties:

• Page 6, Line 15(a)  Make Adopt, publish, declare, and periodically review reasonable rules pursuant to section 12-20-204, including rules regarding:

• Page 6, Line 16(VI)  Requirements for jurisprudence education prior to initial licensure;

• Page 6, Line 17(VII)  Definitions for the terms "in good standing" and "patient representative" for the purposes of this article 220;

• Page 6, Line 18(2)  The board may recognize those dental specialties defined by

• Page 6, Line 19the American Dental Association National Commission on

• Page 6, Line 20Recognition of Dental Specialties and Certifying Boards or the United States department of education.

• Page 7, Line 1SECTION 4.  In Colorado Revised Statutes, amend 12-220-108 as follows:

• Page 7, Line 212-220-108.  Attorney general shall represent board and

• Page 7, Line 3members.(1)  The attorney general of the state of Colorado shall counsel

• Page 7, Line 4with and advise the board in connection with its the board's duties

• Page 7, Line 5and responsibilities under described in this article 220. If litigation is

• Page 7, Line 6brought against the board or any of its individual members in

• Page 7, Line 7connection with actions taken by the board or any of its members under

• Page 7, Line 8this article 220 and the actions are free of malice, fraud, or willful neglect

• Page 7, Line 9of duty, the attorney general shall defend the litigation without cost to the board or to any individual member of the board.

• Page 7, Line 10(2)  A witness or consultant appearing or testifying before

• Page 7, Line 11the board, or providing expert consultation to the board, has

• Page 7, Line 12the same immunity and is subject to the same conditions for immunity as specified in section 12-20-402.

• Page 7, Line 13SECTION 5.  In Colorado Revised Statutes, 12-220-201, amend (1)(n), (1)(s), (1)(ii), and (1)(oo); and add(1)(qq) and (1)(rr) as follows:

• Page 7, Line 1412-220-201.  Grounds for disciplinary action - definition.

• Page 7, Line 15(1)  The board may take disciplinary action against an applicant or

• Page 7, Line 16licensee in accordance with sections 12-20-404 and 12-220-202 for any of the following causes:

• Page 7, Line 17(n)  Refusing to make patient records available to a patient,

• Page 7, Line 18patient representative, or previous or current treatment

• Page 7, Line 19provider within seven calendar days after a written requestpursuant to a written authorization request under section 25-1-802;

• Page 7, Line 20(s)  Failing to furnish unlicensed persons with dental laboratory work orders pursuant to section 12-220-502;

• Page 8, Line 1(ii)  Advertising or otherwise holding oneself out to the public as

• Page 8, Line 2practicing a dental specialty in which the dentist has not successfully

• Page 8, Line 3completed the education specified for the dental specialty as defined by

• Page 8, Line 4the American Dental Association National Commission on

• Page 8, Line 5Recognition of Dental Specialties and Certifying Boards or the United States department of education;

• Page 8, Line 6(oo)  Failing to comply with sections 12-220-501 (1)(a)(II)(C) and

• Page 8, Line 712-220-503 (1)(g) section 12-220-503 (1)(g) and rules adopted pursuant

• Page 8, Line 8to those sections that section regarding the application of silver diamine fluoride; or

• Page 8, Line 9(qq)  Practicing outside the scope of an articulated plan

• Page 8, Line 10developed in accordance with section 12-220-503 (1)(g)(V) or 12-220-508 (1)(b), (1)(c)(VII), or (2);or

• Page 8, Line 11(rr)  The failure of the provider performing itinerant

• Page 8, Line 12surgery to provide necessary follow-up care, including the

• Page 8, Line 13failure to provide a post-procedure care plan outlining

• Page 8, Line 14follow-up care in a facility or to be performed by a licensed

• Page 8, Line 15surgical specialist who is located within a reasonable distance

• Page 8, Line 16from the office where the initial care was provided if the

• Page 8, Line 17original itinerant care provider is unavailable to provide the

• Page 8, Line 18necessary follow-up care. The post-procedure care plan shall

• Page 8, Line 19notidentify an urgent care center or a hospital emergency

• Page 8, Line 20department as the provider or the treatment facility for follow-up care.

• Page 8, Line 21SECTION 6.  In Colorado Revised Statutes, 12-220-206, add (4)

• Page 8, Line 22and (5) as follows:

• Page 9, Line 112-220-206.  Mental and physical examinations. (4)  A

• Page 9, Line 2licensee's voluntary submission to a mental or physical

• Page 9, Line 3examination and completion of any requirements given by the

• Page 9, Line 4qualified professional designated by the board satisfies any

• Page 9, Line 5requirement to notify the board of a physical or mental health

• Page 9, Line 6condition that may impact the licensee's ability to practice with

• Page 9, Line 7reasonable skill and safety pursuant to section 12-30-108 (1),

• Page 9, Line 812-220-201 (1)(j)(I), or 12-220-310 (3), unless the qualified

• Page 9, Line 9professional notifies the licensee that the licensee must notify the board of the condition.

• Page 9, Line 10(5)  Notification requirements described in section

• Page 9, Line 1112-30-108 (1), 12-220-201 (1)(j)(I), or 12-220-310 (3) begin upon

• Page 9, Line 12discharge of a licensee enrolled in inpatient treatment for a serious mental health or physical condition.

• Page 9, Line 13SECTION 7.  In Colorado Revised Statutes, 12-220-302, amend (1)(b), (1)(f), (1)(g), and (1)(j); and add (1)(k) and (1)(l) as follows:

• Page 9, Line 1412-220-302.  Persons exempt from operation of this article.

• Page 9, Line 15(1)  This article 220 does not apply to the following practices, acts, and operations:

• Page 9, Line 16(b)  The administration of an anesthetic for a dental operation

• Page 9, Line 17by a qualified anesthetist licensed pursuant to article 240 of this

• Page 9, Line 18title 12 or registered a nurse for a dental operation licensed or registered pursuant to article 255 of this title 12;

• Page 9, Line 19(f)  The practice of dentistry, dental therapy, or dental hygiene by

• Page 9, Line 20dentists, dental therapists, or dental hygienists licensed in good standing

• Page 9, Line 21by other states or countries while appearing in accredited or

• Page 9, Line 22board-approved programs of dental education or research, at the

• Page 10, Line 1invitation of any group of licensed dentists, dental therapists, or dental

• Page 10, Line 2hygienists in this state who are in good standing, so long as the practice

• Page 10, Line 3is limited to five consecutive days in a twelve-month period and the name

• Page 10, Line 4of each person engaging in the practice is submitted to the board, in

• Page 10, Line 5writing and on a form a format approved by the board, at least ten days before the person performs the practice;

• Page 10, Line 6(g)  The filling of dental laboratory work orders of a licensed

• Page 10, Line 7dentist, as provided by section 12-220-502, by any person, association,

• Page 10, Line 8corporation, or other entity for the construction, reproduction, or repair

• Page 10, Line 9of prosthetic dentures, bridges, plates, or appliances to be used or worn

• Page 10, Line 10as substitutes for natural teeth or for restoration of natural teeth, or

• Page 10, Line 11replacement of structures relating to the jaws, maxillofacial area, or adjacent and associated structures;

• Page 10, Line 12(j)  The practice of dentistry dental therapy, or dental hygiene by

• Page 10, Line 13dentists dental therapists, or dental hygienists licensed in good standing

• Page 10, Line 14by other states while providing care as a volunteer, at the invitation of any

• Page 10, Line 15group of licensed dentists, dental therapists, or dental hygienists in this

• Page 10, Line 16state who are in good standing, so long as the practice is limited to five

• Page 10, Line 17consecutive days in a twelve-month period and the name of each person

• Page 10, Line 18engaging in the practice is submitted to the board, in writing and on a

• Page 10, Line 19form a format approved by the board, at least ten days before the person performs the practice;

• Page 10, Line 20(k)  The practice of dental therapy by dental therapists

• Page 10, Line 21licensed in good standing by other states while providing care

• Page 10, Line 22as a volunteer, at the invitation of any group of licensed

• Page 10, Line 23dentists, dental therapists, or dental hygienists in this state

• Page 10, Line 24who are in good standing, so long as the practice is limited to

• Page 11, Line 1five consecutive days in a twelve-month period and the name of

• Page 11, Line 2each person engaging in the practice is submitted to the board,

• Page 11, Line 3in a format approved by the board, at least ten days before the

• Page 11, Line 4person performs the practice, and the dental therapists treat

• Page 11, Line 5patients only under direct supervision of a licensed dentist in compliance with section 12-220-508; or

• Page 11, Line 6(l)  The practice of dental hygiene by dental hygienists

• Page 11, Line 7licensed in good standing by other states while providing care

• Page 11, Line 8as a volunteer, at the invitation of any group of licensed

• Page 11, Line 9dentists, dental therapists, or dental hygienists in this state

• Page 11, Line 10who are in good standing, so long as the practice is limited to

• Page 11, Line 11five consecutive days in a twelve-month period and the name of

• Page 11, Line 12each person engaging in the practice is submitted to the board,

• Page 11, Line 13in a format approved by the board, at least ten days before the

• Page 11, Line 14person performs the practice, and the dental hygienists treat patients only under direct supervision of a licensed dentist.

• Page 11, Line 15SECTION 8.  In Colorado Revised Statutes, 12-220-303, amend (2)(a) and (3)(d) as follows:

• Page 11, Line 1612-220-303.  Ownership of dental or dental hygiene practice -

• Page 11, Line 17information to be posted - heir to serve as temporary proprietor -

• Page 11, Line 18limitations - definitions. (2) (a)  The name, license number, ownership

• Page 11, Line 19percentage, and other information, as required by the board, of each

• Page 11, Line 20proprietor of a dental or dental hygiene practice, including an unlicensed

• Page 11, Line 21heir who is the temporary proprietor of the practice, as specified in

• Page 11, Line 22subsection (3) of this section, must be immediately and publicly

• Page 11, Line 23available at the reception desk of the dental or dental hygiene practice

• Page 11, Line 24during the practice's hours of operation. The information required by this subsection (2)(a) must be available in a format approved by the board.

• Page 12, Line 1(3) (d)  The temporary proprietorship of a dental or dental hygiene

• Page 12, Line 2practice by an unlicensed heir does must not affect the exercise of the

• Page 12, Line 3independent professional judgment of the licensed dentist or dental hygienist providing care to patients on behalf of the practice.

• Page 12, Line 4SECTION 9.  In Colorado Revised Statutes, 12-220-304, amend (3) as follows:

• Page 12, Line 512-220-304.  Names and status under which dental practice

• Page 12, Line 6may be conducted. (3)  The practice of dentistry, dental therapy, or

• Page 12, Line 7dental hygiene by a professional service corporation, limited

• Page 12, Line 8liability company of licensees, or by a limited liability partnership of

• Page 12, Line 9licensees is permitted subject to the limitations and requirements, insofar

• Page 12, Line 10as are applicable, set forth in section 12-240-138 relating to a

• Page 12, Line 11professional service corporation, limited liability company, or limited liability partnership for the practice of medicine.

• Page 12, Line 12SECTION 10.  In Colorado Revised Statutes, 12-220-305, amend

• Page 12, Line 13(1)(a), (1)(b), (1)(c), (1)(d), (1)(j), (1)(k), (1)(l), (1)(m), (1)(n), (1)(p), (1)(q), (1)(r), and (2); and add (1)(s), (1)(t), (1)(u), and (3) as follows:

• Page 12, Line 1412-220-305.  What constitutes practicing dentistry - rules. (1)  A person is practicing dentistry if the person:

• Page 12, Line 15(a)  Performs or attempts or professes to perform any dental

• Page 12, Line 16operation, oral surgery, or dental diagnostic or therapeutic services of any

• Page 12, Line 17kind; except that nothing in this subsection (1)(a) prohibits a dental

• Page 12, Line 18therapist, dental hygienist, or dental assistant from providing preventive dental or nutritional counseling, education, or instruction services;

• Page 12, Line 19(b)  Is a proprietor of a place where dental operation, oral surgery,

• Page 12, Line 20or dental diagnostic or therapeutic services are performed; except that

• Page 13, Line 1nothing in this subsection (1)(b) prohibits a dental therapist, dental

• Page 13, Line 2hygienist, or dental assistant from performing those tasks and procedures consistent with section 12-220-501;

• Page 13, Line 3(c)  Directly or indirectly, by any means or method, takes a

• Page 13, Line 4physical or digital impression or scan of the human tooth, teeth,

• Page 13, Line 5jaws, maxillofacial area, or adjacent and associated structures; performs

• Page 13, Line 6any phase of any operation incident to the replacement of a part of a

• Page 13, Line 7tooth; or supplies artificial substitutes for the natural teeth, jaws, or

• Page 13, Line 8adjacent and associated structures; except that nothing in this subsection

• Page 13, Line 9(1)(c) prohibits a dental therapist, dental hygienist, or dental assistant

• Page 13, Line 10from performing tasks and procedures consistent with sections 12-220-501 (3)(b)(III), 12-220-503 (1)(d), and 12-220-508;

• Page 13, Line 11(d)  Furnishes, supplies, constructs, reproduces, or repairs any a

• Page 13, Line 12prosthetic denture, bridge, appliance, or other structure to be worn in the

• Page 13, Line 13human mouth or upon the jaws, maxillofacial area, or adjacent and

• Page 13, Line 14associated structures other than on the written dental laboratory work order of a duly licensed and practicing dentist;

• Page 13, Line 15(j)  Extracts or attempts to extract human teeth or corrects, or

• Page 13, Line 16attempts to correct, malformations of human teeth or jaws; except that

• Page 13, Line 17this subsection (1)(j) does not prohibit a dental therapist from performing tasks and procedures consistent with section 12-220-508;

• Page 13, Line 18(k)  Repairs or fills cavities in human teeth; except that this

• Page 13, Line 19subsection (1)(k) does not prohibit a dental therapist from performing tasks and procedures consistent with section 12-220-508;

• Page 13, Line 20(l)  Prescribes ionizing radiation or the use of an X ray for the

• Page 13, Line 21purpose of taking dental X rays; or roentgenograms; except that nothing

• Page 13, Line 22in this subsection (1)(l) prohibits these procedures from being delegated

• Page 14, Line 1to appropriately trained personnel in accordance with this article 220 and rules of the board;

• Page 14, Line 2(m)  Gives or professes to give interpretations or readings of dental

• Page 14, Line 3X rays, or roentgenograms, CT scans, or other diagnostic methodologies;

• Page 14, Line 4except that nothing in this subsection (1)(m) prohibits a dental hygienist

• Page 14, Line 5from performing tasks and procedures consistent with sections

• Page 14, Line 612-220-503 and 12-220-504 or a dental therapist from performing tasks consistent with section 12-220-508;

• Page 14, Line 7(n)  Represents himself or herself themself to an individual or the

• Page 14, Line 8general public as practicing dentistry by using the words "dentist" or

• Page 14, Line 9"dental surgeon" or by using the letters "D.D.S.", "D.M.D.",

• Page 14, Line 10"D.D.S./M.D.", or "D.M.D./M.D."; Nothing in this subsection (1)(n)

• Page 14, Line 11prohibits a dental therapist, dental hygienist, or dental assistant from

• Page 14, Line 12performing tasks and procedures consistent with section 12-220-501 (2), (2.5), or (3)(b).

• Page 14, Line 13(p)  Prescribes drugs or medications and administers local

• Page 14, Line 14anesthesia, analgesia including nitrous oxide/oxygen inhalation,

• Page 14, Line 15medication prescribed or administered for the relief of anxiety or

• Page 14, Line 16apprehension, minimal sedation, moderate sedation, deep sedation, or

• Page 14, Line 17general anesthesia as necessary for the proper practice of dentistry; except that nothing in this subsection (1)(p) prohibits:

• Page 14, Line 18(I)  A dental hygienist from performing those tasks and procedures

• Page 14, Line 19consistent with sections 12-220-501, 12-220-503 (1)(e) and (1)(g), and

• Page 14, Line 2012-220-504 (1)(c), and in accordance with rules promulgated by the board; or

• Page 14, Line 21(II)  A dental therapist from performing those tasks and procedures

• Page 14, Line 22consistent with sections 12-220-501 (2.5) and 12-220-508 and in accordance with rules promulgated by the board.

• Page 15, Line 1(q)  Prescribes, induces, and sets dosage levels for inhalation

• Page 15, Line 2anesthesia; except that nothing in this subsection (1)(q) prohibits the

• Page 15, Line 3delegation of monitoring and administration to dental hygienists and

• Page 15, Line 4appropriately trained unlicensed personnel in accordance with this article 220 and rules of the board, including requiring training;

• Page 15, Line 5(r)  Gives or professes to give interpretations or readings of dental

• Page 15, Line 6charts or records or gives treatment plans or interpretations of treatment

• Page 15, Line 7plans derived from examinations, patient records, or dental X rays; or

• Page 15, Line 8roentgenograms; except that nothing in this subsection (1)(r) prohibits a

• Page 15, Line 9dental therapist, dental hygienist, or dental assistant from performing

• Page 15, Line 10tasks and procedures consistent with sections 12-220-501 (2), (2.5) and (3), 12-220-503, 12-220-504, and 12-220-508;

• Page 15, Line 11(s)  Maintains patient clinical records, dental charts,

• Page 15, Line 12images, treatment plans, interpretations, or other

• Page 15, Line 13documentation, except when undergoing a transition in practice ownership as permitted in section 12-220-303 (2);

• Page 15, Line 14(t) (I)  Pursuant to rules adopted by the board, orders and

• Page 15, Line 15administers immunizations to patients six years of age or older.

• Page 15, Line 16The board shall adopt rules regarding delegation of

• Page 15, Line 17immunization administration by a licensed dentist to a dental

• Page 15, Line 18therapist or dental hygienist and may adopt rules specifying the

• Page 15, Line 19minimum training requirements for dentists to administer immunizations.

• Page 15, Line 20(II)  A dentist who administers immunizations shall:

• Page 15, Line 21(A)  Not provide medical or nonmedical exemptions for any

• Page 15, Line 22required immunizations;

• Page 16, Line 1(B)  Enter all immunization-related administration

• Page 16, Line 2information into the Colorado immunization information system created pursuant to part 24 of article 4 of title 25;

• Page 16, Line 3(C)  Disclose their medical training related to pediatric

• Page 16, Line 4administration, including the ability to manage side effects or

• Page 16, Line 5adverse outcomes, to patients as part of the patient consent process;

• Page 16, Line 6(D)  Administer only respiratory and oral health, including human papillomavirus, immunizations; and

• Page 16, Line 7(E)  Distribute immunization educational materials and

• Page 16, Line 8recommendations developed by the department of public health and environment to their patients.

• Page 16, Line 9(u)  Orders and administers neuromodulators and dermal

• Page 16, Line 10fillers to dental patients of record for therapeutic and

• Page 16, Line 11cosmetic purposes pursuant to rules adopted by the board

• Page 16, Line 12regarding required training, ongoing competency, record keeping, and delegation to dental hygienists.

• Page 16, Line 13(2)  A licensed dentist may prescribe orders electronically. This section does not prohibit:

• Page 16, Line 14(a)  A dental assistant from performing tasks and

• Page 16, Line 15procedures consistent with section 12-220-501 and in accordance with rules adopted by the board;

• Page 16, Line 16(b)  A dental hygienist from performing tasks and

• Page 16, Line 17procedures consistent with sections 12-220-501, 12-220-503, and

• Page 16, Line 1812-220-504 and in accordance with rules adopted by the board; or

• Page 16, Line 19(c)  A dental therapist from performing tasks and

• Page 17, Line 1procedures consistent with sections 12-220-501 and 12-220-508 and in accordance with rules adopted by the board.

• Page 17, Line 2(3)  A provider performing itinerant surgery shall develop

• Page 17, Line 3and maintain a written protocol for emergency follow-up care

• Page 17, Line 4with appropriately trained practitioners for all patients

• Page 17, Line 5treated. The plan shall be provided to each patient undergoing

• Page 17, Line 6treatment and must be available immediately at the request of

• Page 17, Line 7the board. The written protocol must include a provision that

• Page 17, Line 8requires the provider to include in a plan of care follow-up

• Page 17, Line 9treatment in a permanently established treatment facility

• Page 17, Line 10within a reasonable proximity of the location where itinerant

• Page 17, Line 11surgical treatment was performed. This follow-up treatment

• Page 17, Line 12shall be provided by the itinerant surgical treatment operator

• Page 17, Line 13or an appropriately trained practitioner who has agreed in

• Page 17, Line 14writing to participate in the emergency follow-up care plan for

• Page 17, Line 15the itinerant surgical treatment operator. The appropriately

• Page 17, Line 16trained practitioner must be available when the itinerant surgical operator is not available.

• Page 17, Line 17SECTION 11.  In Colorado Revised Statutes, 12-220-306, amend (1)(a)(III) and (1)(b); and add (3) and (4) as follows:

• Page 17, Line 1812-220-306.  Dentists may prescribe drugs - surgical operations

• Page 17, Line 19- anesthesia - limits on prescriptions - rules. (1) (a)  A licensed dentist is authorized to:

• Page 17, Line 20(III)  Administer, pursuant to a permit required by section

• Page 17, Line 2112-220-411 and pursuant to board rules, local anesthesia, analgesia

• Page 17, Line 22including nitrous oxide/oxygen inhalation, medication prescribed or

• Page 17, Line 23administered for the relief of anxiety or apprehension, minimal sedation, moderate sedation, deep sedation, or general anesthesia; and

• Page 18, Line 1(b)  A dentist shall not prescribe, distribute, or give to any person,

• Page 18, Line 2including the dentist themself, any habit-forming drug or any controlled

• Page 18, Line 3substance, as defined in section 18-18-102 (5) or as contained in schedule

• Page 18, Line 4II of 21 U.S.C. sec. 812, other than in the course of legitimate dental

• Page 18, Line 5practice and pursuant to the rules promulgated adopted by the board

• Page 18, Line 6regarding controlled substance record keeping and in compliance with

• Page 18, Line 7the electronic prescribing of controlled substances as required by section 12-30-111.

• Page 18, Line 8(3)  A licensed dentist may prescribe orders electronically.

• Page 18, Line 9(4)  A licensed dentist is strongly encouraged to purchase

• Page 18, Line 10or utilize an electronic health product that includes

• Page 18, Line 11integration of a tool that facilitates dentists' compliance with

• Page 18, Line 12prescription drug monitoring standards required by section 12-30-114 (1)(a)(IV).

• Page 18, Line 13SECTION 12.  In Colorado Revised Statutes, 12-220-310, amend

• Page 18, Line 14(1)(a), (1)(b) introductory portion, (1)(b)(IV), (2)(b), and (5); and add (2)(d) as follows:

• Page 18, Line 1512-220-310.  Dentist peer health assistance program - fees -

• Page 18, Line 16rules. (1) (a)  Effective July 1, 2004, as a condition of renewal in this

• Page 18, Line 17state, every An applicant for a dentist license or a dentist applying

• Page 18, Line 18to renew or reinstate the dentist's license must, at the time of

• Page 18, Line 19application, pay to the administering entity that has been selected by the

• Page 18, Line 20board pursuant to subsection (1)(b) of this section an amount a fee not to

• Page 18, Line 21exceed fifty-nine dollars per year, which maximum amount may be

• Page 18, Line 22adjusted on January 1, 2005, and annually thereafter by the board to

• Page 19, Line 1reflect changes in the United States department of labor, labor's bureau

• Page 19, Line 2of labor statistics consumer price index, or a successor index, for

• Page 19, Line 3Denver-Aurora-Lakewood for all urban consumers or goods. or its

• Page 19, Line 4successor index. The fee shall be used to support designated providers

• Page 19, Line 5that have been selected by the board to provide assistance to dentists

• Page 19, Line 6needing help in dealing with physical, emotional, or psychological

• Page 19, Line 7problems that may be detrimental to their ability to practice dentistry. The fee shall must not exceed one hundred dollars per year per licensee.

• Page 19, Line 8(b)  The board shall select one or more peer health assistance

• Page 19, Line 9programs as designated providers. The board or the department must

• Page 19, Line 10provide public notice when a peer health assistance program is

• Page 19, Line 11being considered for selection as a designated provider and

• Page 19, Line 12shall provide a process for stakeholders and the public to

• Page 19, Line 13provide input to the board regarding the selection of a

• Page 19, Line 14designated provider. To be eligible for designation by the board, a peer health assistance program must:

• Page 19, Line 15(IV)  Monitor the status of a dentist who has been referred for

• Page 19, Line 16treatment, including providing training to dentists providing practice monitoring services;

• Page 19, Line 17(2) (b)  Notwithstanding sections 12-220-201 and 24-4-104, the

• Page 19, Line 18board may immediately suspend the license of any a dentist who is

• Page 19, Line 19referred to a peer health assistance program by the board and who fails to

• Page 19, Line 20attend or complete the program. If the dentist objects to the suspension,

• Page 19, Line 21the dentist may submit a written request to the board, in a format

• Page 19, Line 22approved by the board, for a formal hearing on the suspension within

• Page 19, Line 23ten days after receiving notice of the suspension, and the board shall grant

• Page 19, Line 24the request. In the hearing, the dentist bears the burden of proving that the dentist's license should not be suspended.

• Page 20, Line 1(d)  A dentist may self-refer to participate in the peer

• Page 20, Line 2health assistance program or may be referred by the board. A

• Page 20, Line 3dentist who self-refers to the peer health assistance program

• Page 20, Line 4may do so confidentially and without direct notification to the

• Page 20, Line 5board. Such self-referral to the peer health assistance program

• Page 20, Line 6satisfies board notification requirements set forth in section

• Page 20, Line 712-220-207 and subsection (3) of this section; except that the peer

• Page 20, Line 8health assistance program shall report knowledge of a

• Page 20, Line 9dentist's violation of this article 220 or rules of the board,

• Page 20, Line 10excluding knowledge of violations of section 12-220-201 (1)(e) or (1)(f).

• Page 20, Line 12(5)  The board is authorized to promulgate may adopt rules necessary to implement this section.

• Page 20, Line 13SECTION 13.  In Colorado Revised Statutes, 12-220-402, amend (1)(a) as follows:

• Page 20, Line 1412-220-402.  Dentist academic license. (1) (a)  A dentist who is

• Page 20, Line 15employed at an accredited school or college of dentistry in this state and

• Page 20, Line 16who practices dentistry in the course of the dentist's employment

• Page 20, Line 17responsibilities must either make written file an application to the board

• Page 20, Line 18for an academic license in accordance with this section, in a format

• Page 20, Line 19approved by the board, or otherwise become licensed pursuant to sections 12-220-401 and 12-220-403, as applicable.

• Page 20, Line 21SECTION 14.  In Colorado Revised Statutes, 12-220-405, amend

• Page 20, Line 22(1)(a) introductory portion as follows:

• Page 21, Line 112-220-405.  Application for dental hygienist license - fee.

• Page 21, Line 2(1)  Every person who desires to qualify for practice as a dental hygienist within this state must file with the board:

• Page 21, Line 3(a)  A written An application for a license, in a format approved by the board, on which application the applicant shall list:

• Page 21, Line 5SECTION 15.  In Colorado Revised Statutes, 12-220-407.2, amend (1)(a) introductory portion and (1)(b) as follows:

• Page 21, Line 612-220-407.2.  Application for dental therapist license - fee -

• Page 21, Line 7rules. (1)  Effective May 1, 2023, every person who desires to qualify for practice as a dental therapist within this state must file with the board:

• Page 21, Line 8(a)  A written An application for a license, in a format approved by the board, on which application the applicant must list:

• Page 21, Line 9(b)  Satisfactory proof that the applicant:

• Page 21, Line 10(I)  Graduated from a school of dental therapy that, at the time of

• Page 21, Line 11the applicant's graduation, was accredited; by the American Dental

• Page 21, Line 12Association's commission on dental accreditation or its successor organization; or

• Page 21, Line 13(II)  Graduated from a dental therapy education program developed

• Page 21, Line 14prior to February 6, 2015, that, at the time of the applicant's graduation,

• Page 21, Line 15was accredited recognized by the Minnesota board of dentistry or

• Page 21, Line 16certified by the Alaska community health aide program certification board.

• Page 21, Line 18SECTION 16.  In Colorado Revised Statutes, 12-220-409, add (6) as follows:

• Page 21, Line 1912-220-409.  Inactive dental, dental therapist, or dental

• Page 22, Line 1hygienist license - rules. (6)  The board shall adopt rules that

• Page 22, Line 2allow expedited, temporary licensure during a disaster

• Page 22, Line 3emergency declared pursuant to section 24-33.5-704 (4) for a

• Page 22, Line 4dentist, dental hygienist, or dental therapist who has

• Page 22, Line 5maintained a license in good standing with no past disciplinary

• Page 22, Line 6history prior to obtaining an inactive license. The rules must address:

• Page 22, Line 7(a)  Supervision or practice monitoring requirements;

• (b)  Liability coverage requirements;

• Page 22, Line 8(c)  Other conditions of or limitation on practice; and

• Page 22, Line 9(d)  Temporary license terms, administrative approvals, timelines, and renewal options.

• Page 22, Line 10SECTION 17.  In Colorado Revised Statutes, 12-220-410, add (7) as follows:

• Page 22, Line 1112-220-410.  Retired dental, dental therapist, and dental

• Page 22, Line 12hygienist licenses - rules. (7)  The board shall adopt rules that

• Page 22, Line 13allow expedited, temporary licensure during a disaster

• Page 22, Line 14emergency declared pursuant to section 24-33.5-704 (4) for a

• Page 22, Line 15dentist, dental hygienist, or dental therapist who has

• Page 22, Line 16maintained a license in good standing with no past disciplinary

• Page 22, Line 17history prior to obtaining an inactive license. The rules must address:

• Page 22, Line 18(a)  Supervision or practice monitoring requirements;

• (b)  Liability coverage requirements;

• Page 22, Line 19(c)  Other conditions of or limitation on practice; and

• Page 22, Line 20(d)  Temporary license terms, administrative approvals,

• Page 22, Line 21timelines, and renewal options.

• Page 23, Line 1SECTION 18.  In Colorado Revised Statutes, 12-220-411, amend (1) and (5)(a) as follows:

• Page 23, Line 212-220-411.  Anesthesia and sedation permits - dentists, dental

• Page 23, Line 3therapists, and dental hygienists - training and experience

• Page 23, Line 4requirements - office inspections - rules. (1) (a)  Upon application in a

• Page 23, Line 5form and manner determined by the board and payment of the applicable

• Page 23, Line 6fees established by the board, the board may issue an anesthesia or

• Page 23, Line 7sedation permit to a licensed dentist or a local anesthesia permit to a dental therapist or dental hygienist in accordance with this section.

• Page 23, Line 8(b)  The board shall design and implement an expedited

• Page 23, Line 9application and permitting process for a dentist who has

• Page 23, Line 10completed an accredited residency program in general

• Page 23, Line 11anesthesia or a postdoctoral training program that provides

• Page 23, Line 12comprehensive and appropriate training necessary to administer

• Page 23, Line 13and manage moderate sedation or deep sedation and general anesthesia according to industry-accepted standards.

• Page 23, Line 14(5)  The board shall establish, by rule, criteria and procedures for

• Page 23, Line 15an office inspection program to be completed upon application and renewal of anesthesia or sedation permits, which must include:

• Page 23, Line 16(a)  Designation of qualified anesthesia inspectors who are

• Page 23, Line 17experts in dental outpatient deep sedation/general anesthesia and

• Page 23, Line 18moderate sedation; have more than five years of experience

• Page 23, Line 19providing anesthesia services and hold an active anesthesia

• Page 23, Line 20permit to provide either dental outpatient deep

• Page 23, Line 21sedation/general anesthesia or moderate sedation. An

• Page 23, Line 22anesthesia inspector who holds an active anesthesia permit to

• Page 23, Line 23provide moderate sedation may only provide office anesthesia

• Page 24, Line 1inspections for providers who request moderate sedation

• Page 24, Line 2privileges for both initial and renewal permit applications. An

• Page 24, Line 3anesthesia inspector who holds an active anesthesia permit to

• Page 24, Line 4provide deep sedation/general anesthesia may provide office

• Page 24, Line 5anesthesia inspections for any level of sedation for both initial

• Page 24, Line 6and renewal permit applications. An anesthesia inspector shall

• Page 24, Line 7complete an anesthesia inspector calibration program created

• Page 24, Line 8and updated by the board once every five years. The anesthesia

• Page 24, Line 9inspector recertification may be completed in conjunction with an anesthesia permit renewal.

• Page 24, Line 10SECTION 19.  In Colorado Revised Statutes, 12-220-412, amend (1) as follows:

• Page 24, Line 1112-220-412.  Change of address - duplicate licenses and

• Page 24, Line 12certificates. (1)  Every A person licensed under this article 220, upon

• Page 24, Line 13changing the licensee's place of business or contact information, shall

• Page 24, Line 14furnish to the board the licensee's new mailing address and email address within thirty days after the change.

• Page 24, Line 15SECTION 20.  In Colorado Revised Statutes, 12-220-501, amend

• Page 24, Line 16(1)(a), (3)(a)(VI), (3)(b) introductory portion, and (3)(b)(III); and repeal (2) as follows:

• Page 24, Line 1712-220-501.  Tasks authorized to be performed by dental

• Page 24, Line 18therapists, dental hygienists, or dental assistants - rules.

• Page 24, Line 19(1) (a) (I)   Except as provided in subsection (1)(a)(II) of this section, The

• Page 24, Line 20responsibility for dental diagnosis, dental treatment planning, or the

• Page 24, Line 21prescription of therapeutic measures in the practice of dentistry remains

• Page 24, Line 22with a licensed dentist and may not be assigned to any a dental therapist,

• Page 24, Line 23or dental hygienist, or dental assistant.

• (II)  A dental hygienist may:

• Page 25, Line 1(A)  Perform dental hygiene assessment, dental hygiene diagnosis,

• Page 25, Line 2and dental hygiene treatment planning for dental hygiene services pursuant to section 12-220-503 (1)(f);

• Page 25, Line 3(B)  Identify dental abnormalities for immediate referral to a dentist as described in section 12-220-503 (1)(f); and

• Page 25, Line 4(C)  In collaboration with a licensed dentist, prescribe, administer,

• Page 25, Line 5and dispense, as described in section 12-220-503 (1)(g): Fluoride,

• Page 25, Line 6fluoride varnish, silver diamine fluoride, antimicrobial solutions for

• Page 25, Line 7mouth rinsing, other nonsystemic antimicrobial agents, and resorbable antimicrobial agents pursuant to rules of the board.

• Page 25, Line 8(D)  Repealed.

• Page 25, Line 9(2)  Except as provided in subsection (1) of this section, a dental

• Page 25, Line 10hygienist may perform any dental task or procedure assigned to the

• Page 25, Line 11hygienist by a licensed dentist that does not require the professional skill

• Page 25, Line 12of a licensed dentist; except that the dental hygienist may perform the task

• Page 25, Line 13or procedure only under the indirect supervision of a licensed dentist or as authorized in sections 12-220-503 and 12-220-504.

• Page 25, Line 14(3) (a)  A dental assistant shall not perform the following tasks:

• Page 25, Line 15(VI)  Scaling (supra and sub-gingival); as it pertains to the practice of dental hygiene;

• Page 25, Line 16(b)  A dental assistant may perform the following tasks under the

• Page 25, Line 17indirect supervision of a licensed dentist or the direct supervision of a licensed dental therapist or a licensed dental hygienist:

• Page 25, Line 18(III)  Gathering and assembling information, including but not

• Page 25, Line 19limited to fact-finding and patient history, oral inspection, and

• Page 25, Line 20recording of dental and periodontal charting as dictated by a licensee;

• Page 26, Line 1SECTION 21.  In Colorado Revised Statutes, amend 12-220-502 as follows:

• Page 26, Line 212-220-502.  Construction of dental devices by unlicensed

• Page 26, Line 3technician. (1) (a)  A licensed dentist who uses the services of an

• Page 26, Line 4unlicensed technician for the purpose of constructing, altering, repairing,

• Page 26, Line 5or duplicating any denture, bridge, splint, or orthodontic or prosthetic

• Page 26, Line 6appliance a laboratory-fabricated intraoral or maxillofacial

• Page 26, Line 7dental prosthesis, product, or appliance shall furnish the unlicensed

• Page 26, Line 8technician with a written or electronic dental laboratory work order in

• Page 26, Line 9a form approved by that complies with rules of the board, which form

• Page 26, Line 10shall be dated and signed by the dentist for each separate and individual

• Page 26, Line 11piece of work. The dentist shall make the dental laboratory work order

• Page 26, Line 12in a reproducible documented form, and the dentist and the unlicensed

• Page 26, Line 13technician shall each retain a copy in a permanent file for two years as a

• Page 26, Line 14permanent part of the patient record. The laboratory

• Page 26, Line 15technician shall retain a copy of the dental laboratory work

• Page 26, Line 16order in a file for a minimum of two years. The permanent files of

• Page 26, Line 17the licensed dentist and the unlicensed technician must be open to

• Page 26, Line 18inspection at any reasonable time by the board or its duly constituted

• Page 26, Line 19agent. The licensed dentist that furnishes the dental laboratory work

• Page 26, Line 20order must have appropriate training, education, and experience related

• Page 26, Line 21to the prescribed treatment and is responsible for directly supervising all intraoral treatment rendered to the patient.

• Page 26, Line 22(b)  If a patient's care requires that multiple

• Page 26, Line 23laboratory-fabricated intraoral or maxillofacial dental

• Page 26, Line 24prostheses or appliances be fabricated at the same time, it is

• Page 27, Line 1permissible to incorporate those products or appliances into a single dental laboratory work order.

• Page 27, Line 2(b)  (c)  An unlicensed technician that possesses a valid dental

• Page 27, Line 3laboratory work order may provide extraoral construction, manufacture,

• Page 27, Line 4fabrication, supply, or repair of identified dental and orthodontic devices

• Page 27, Line 5but shall not provide intraoral service in a human mouth except under the

• Page 27, Line 6direct supervision of a licensed dentist in accordance with section 12-220-501 (3)(d).

• Page 27, Line 7(2)  If the dentist fails to keep permanent records of dental

• Page 27, Line 8laboratory work orders as required in subsection (1)(a) of this section, the

• Page 27, Line 9dentist is subject to disciplinary action as deemed appropriate by the board.

• Page 27, Line 10(3)  If an unlicensed technician fails to have in the technician's

• Page 27, Line 11possession a dental laboratory work order signed by a licensed dentist

• Page 27, Line 12with each denture, bridge, splint, or orthodontic or prosthetic appliance

• Page 27, Line 13in the technician's possession, the absence of the dental laboratory work

• Page 27, Line 14order is prima facie evidence of a violation of this section and constitutes

• Page 27, Line 15the practice of dentistry without an active license in violation of, and subject to the penalties specified in, section 12-220-211.

• Page 27, Line 16SECTION 22.  In Colorado Revised Statutes, 12-220-503, amend

• Page 27, Line 17(1) introductory portion, (1)(d)(II), (1)(d)(IV), (1)(d)(V), (1)(f), (1)(g)(I),

• Page 27, Line 18(1)(g)(III)(A), (1)(g)(III)(B), (1)(g)(III)(C), (1)(g)(IV) introductory

• Page 27, Line 19portion, (2), and (4); repeal (1)(g)(II)(A); and add (1)(d)(VI), (1)(e.5), (1)(g)(V), and (1)(h) as follows:

• Page 27, Line 2012-220-503.  What constitutes practicing unsupervised dental

• Page 27, Line 21hygiene - rules. (1)  Notwithstanding subsection (3) of this

• Page 27, Line 22section, unless licensed to practice dentistry, a person an individual is

• Page 28, Line 1deemed to be practicing unsupervised dental hygiene when the person

• Page 28, Line 2individual, within the scope of the person's individual's education, training, and experience:

• Page 28, Line 3(d)  Gathers and assembles information, including but not limited to:

• Page 28, Line 4(II)  Preparation Provision of study casts for the purpose of

• Page 28, Line 5fabricating a permanent record of the patient's present condition; as a

• Page 28, Line 6visual aid for patient education, dental hygiene diagnosis, and dental

• Page 28, Line 7hygiene treatment planning; and to provide assistance during forensic examination or digital scans;

• Page 28, Line 8(IV)  Dental charting and periodontal probing and charting; and

• Page 28, Line 9(V)  Radiographic and X-ray survey for the purpose of assessing

• Page 28, Line 10and diagnosing dental hygiene-related conditions for treatment planning

• Page 28, Line 11for dental hygiene services as described in this section and identifying

• Page 28, Line 12dental hard and soft tissue abnormalities for immediate referral to a dentist or appropriate specialist; and

• Page 28, Line 13(VI)  Additional screening or screening tests for further

• Page 28, Line 14investigation of any oral or systemic health-related concern pertinent to the scope of practice for dental hygiene; and

• Page 28, Line 15(e.5)  Administers local anesthesia in compliance with

• Page 28, Line 16section 12-220-411 and rules adopted by the board, including

• Page 28, Line 17minimum education requirements and procedures for local anesthesia administration;

• Page 28, Line 18(f)  Performs dental hygiene assessment, dental hygiene diagnosis,

• Page 28, Line 19and dental hygiene treatment planning for hard and soft tissue for

• Page 28, Line 20dental hygiene services as described in this section and identifies dental

• Page 28, Line 21abnormalities for immediate referral to a dentist or appropriate specialist; or

• Page 29, Line 1(g) (I)  Prescribes, administers, and dispenses fluoride, fluoride

• Page 29, Line 2varnish, silver diamine fluoride fluorides in accordance with subsection

• Page 29, Line 3(1)(g)(IV) of this section, antimicrobial solutions for mouth rinsing, other

• Page 29, Line 4nonsystemic antimicrobial agents, and related emergency drugs and

• Page 29, Line 5reversal agents. in collaboration with a licensed dentist. The board, by

• Page 29, Line 6rule, may further define the permissible and appropriate emergency drugs

• Page 29, Line 7and reversal agents. An articulated plan with a collaborating dentist for

• Page 29, Line 8dental hygiene prescribing must describe any protocols, restrictions or

• Page 29, Line 9limitations, follow-up and referral mechanisms, notification and

• Page 29, Line 10disclosure requirements, and any other requirements established by the

• Page 29, Line 11board by rule. Dental hygienists shall maintain clear documentation in the

• Page 29, Line 12patient record of the drug or agent prescribed, administered, or dispensed;

• Page 29, Line 13the date of the action; and the rationale for prescribing, administering, or dispensing the drug or agent.

• Page 29, Line 14(II)  A dental hygienist shall not prescribe, administer, or dispense the following:

• Page 29, Line 15(A)  Drugs whose primary effect is systemic, with the exception of

• Page 29, Line 16fluoride supplements permitted under subsection (1)(g)(III)(A) of this section; and

• Page 29, Line 17(III)  A dental hygienist may prescribe the following:

• Page 29, Line 18(A)  Fluoride supplements; as follows, all using sodium fluoride:

• Page 29, Line 19Tablets: 0.5 mg, 1.1 mg, or 2.2 mg; lozenges: 2.21 mg; and drops: 1.1 mL;

• Page 29, Line 20(B)  Topical anti-caries treatments, as follows, all using sodium

• Page 29, Line 21fluoride unless otherwise indicated: Toothpastes: 1.1% or less (or

• Page 29, Line 22stannous fluoride 0.4%); topical gels: 1.1% or less (or stannous fluoride

• Page 30, Line 10.4%); oral rinses: 0.05%, 0.2%, 0.44%, or 0.5%; oral rinse concentrate

• Page 30, Line 2used in periodontal disease: 0.63% stannous fluoride; fluoride varnish:

• Page 30, Line 35%; silver diamine fluoride: 38%; and prophy pastes containing

• Page 30, Line 4approximately 1.23% sodium fluoride and used for polishing procedures

• Page 30, Line 5as part of professional dental prophylaxis treatment including sodium

• Page 30, Line 6fluoride, stannous fluoride, silver diamine fluoride, other

• Page 30, Line 7silver fluorides, hydroxyapatite regeneration medicaments

• Page 30, Line 8used for repairing cavities, and alternatives for strengthening

• Page 30, Line 9teeth and preventing and arresting tooth decay. The board may

• Page 30, Line 10adopt rules that identify safe prescribing alternatives to silver

• Page 30, Line 11diamine fluoride as a treatment for strengthening teeth and preventing tooth decay.

• Page 30, Line 12(C)  Topical anti-infectives, as follows: Chlorhexidine gluconate

• Page 30, Line 13rinses: 0.12%; chlorhexidine gluconate periodontal chips for subgingival

• Page 30, Line 14insertion into a periodontal pocket/sulcus; tetracycline impregnated fibers,

• Page 30, Line 15inserted subgingivally into a periodontal pocket/sulcus; doxycycline

• Page 30, Line 16hyclate periodontal gel, inserted subgingivally into a periodontal

• Page 30, Line 17pocket/sulcus; and minocycline hydrochloride periodontal powder,

• Page 30, Line 18inserted subgingivally into a periodontal pocket/sulcus including

• Page 30, Line 19chlorhexidine gluconate rinse, periodontal chips, periodontal

• Page 30, Line 20gels, periodontal powders, and impregnated fibers for periodontal treatment;and

• Page 30, Line 21(IV)  A dental hygienist may prescribe and apply silver diamine

• Page 30, Line 22fluoride and other silver fluorides upon completion of a

• Page 30, Line 23postsecondary course or continuing education course developed at the

• Page 30, Line 24postsecondary level that satisfies the requirements established by the

• Page 30, Line 25board and provides instructions on the use and limitations of applying

• Page 31, Line 1silver diamine fluoride. A dental hygienist may complete the course described in this subsection (1)(g)(IV) through:

• Page 31, Line 2(V)  A dental hygienist may prescribe, dispense, and

• Page 31, Line 3administer nonnarcotic analgesics, anti-inflammatories, and

• Page 31, Line 4antibiotics within the parameters of a written articulated plan,

• Page 31, Line 5with the authorization of the supervising dentist, and upon

• Page 31, Line 6completion of a postsecondary course or continuing education

• Page 31, Line 7course developed at the postsecondary level that satisfies the

• Page 31, Line 8requirements established by the board and that provides

• Page 31, Line 9instruction on the use and limitations of nonnarcotic analgesics, anti-inflammatories, and antibiotics.

• Page 31, Line 10(h)  Directs dental assistants to assist in activities that

• Page 31, Line 11are within the scope of practice for a dental hygienist under

• Page 31, Line 12direct supervision of a dental hygienist only; except that dental

• Page 31, Line 13assistants shall not perform activities disallowed under section 12-220-501 (3)(a).

• Page 31, Line 14(2)  A dental hygienist shall state in writing and require a patient

• Page 31, Line 15to acknowledge by signature that any diagnosis or assessment is for the

• Page 31, Line 16purpose of determining necessary dental hygiene services only. and that

• Page 31, Line 17it is recommended by the American Dental Association, or any successor

• Page 31, Line 18organizations, that a thorough dental examination be performed by a dentist twice each year.

• Page 31, Line 19(4) (a)  Notwithstanding section 12-220-104 (13) or 12-220-305

• Page 31, Line 20(1)(b), and consistent with section 12-220-303, a dental hygienist

• Page 31, Line 21may be the proprietor of a place where supervised or unsupervised dental

• Page 31, Line 22hygiene is performed and may purchase, own, or lease equipment,

• Page 31, Line 23dental materials, and supplies necessary to perform supervised or unsupervised dental hygiene.

• Page 32, Line 1(b)  A dental hygienist proprietor, or a professional corporation,

• Page 32, Line 2limited liability partnership, or professional limited liability

• Page 32, Line 3corporation of dental hygienists, in addition to providing dental hygiene

• Page 32, Line 4services, may enter into an agreement with one or more dentists for the

• Page 32, Line 5lease or rental of equipment or office space in the same physical location

• Page 32, Line 6as the dental hygiene practice, but only if the determination of necessary

• Page 32, Line 7dental services provided by the dentist and professional responsibility for

• Page 32, Line 8those services, including but not limited to dental records, appropriate

• Page 32, Line 9medication, and patient payment, remain with the treating dentist. It is the

• Page 32, Line 10responsibility of the dental hygienist to inform the patient as to whether

• Page 32, Line 11there is a supervisory relationship between the dentist and the dental

• Page 32, Line 12hygienist. An agreement under this subsection (4)(b) does not constitute

• Page 32, Line 13employment and does not constitute cause for discipline pursuant to section 12-220-201 (1)(h).

• Page 32, Line 14SECTION 23.  In Colorado Revised Statutes, amend 12-220-504, as follows:

• Page 32, Line 1512-220-504.  What constitutes practicing supervised dental

• Page 32, Line 16hygiene - rules. (1)  Notwithstanding section 12-220-501 (3), unless

• Page 32, Line 17licensed to practice dentistry, a person who performs any of the following

• Page 32, Line 18tasks under the supervision of a licensed dentist is deemed to be practicing supervised dental hygiene:

• Page 32, Line 19(a)  Performing a task described in section 12-220-503 (1);

• (b)  Preparing study casts;

• Page 32, Line 20(c)  Administering local anesthesia under the indirect supervision

• Page 32, Line 21of a licensed dentist pursuant to rules of the board, including minimum

• Page 32, Line 22education requirements and procedures for local anesthesia administration; or

• Page 33, Line 1(d)  Placing interim therapeutic restorations pursuant to section 12-220-505.

• Page 33, Line 2(e)  Repealed.

• Page 33, Line 3(b)  Administering and monitoring inhalation anesthesia

• Page 33, Line 4under the indirect supervision of a dentist consistent with

• Page 33, Line 5section 12-220-305 (1)(q) and pursuant to the rules of the board regarding training and minimum education requirements;

• Page 33, Line 6(c)  Utilizing a laser for dental hygiene purposes within defined scopes of practice in accordance with rules of the board;

• Page 33, Line 7(d) (I)  Pursuant to rules adopted by the board,

• Page 33, Line 8administering immunizations, under the direct supervision of a

• Page 33, Line 9licensed dentist or the delegation of a licensed professional

• Page 33, Line 10who is authorized to administer immunizations and delegate

• Page 33, Line 11tasks under this title 12, to patients six years of age or older.

• Page 33, Line 12The board may adopt rules specifying the minimum training requirements fordentalhygienists to administer immunizations.

• Page 33, Line 13(II)  Adentalhygienist who administers immunizations shall:

• Page 33, Line 14(A)  Not provide medical or nonmedical exemptions for any required immunizations;

• Page 33, Line 15(B)  Enter all immunization-related administration

• Page 33, Line 16information into the Colorado immunization information system created pursuant to part 24 of article 4 of title 25;

• Page 33, Line 17(C)  Disclose their medical training related to pediatric

• Page 33, Line 18administration, including the ability to manage side effects or

• Page 33, Line 19adverse outcomes, to patients as part of the patient consent process;

• Page 34, Line 1(D)  Administer only respiratory and oral health, including human papillomavirus, immunizations; and

• Page 34, Line 2(E)  Distribute immunization educational materials and

• Page 34, Line 3recommendations developed by the department of public health and environment to their patients.

• Page 34, Line 4(e)  Administering neuromodulators and dermal fillers

• Page 34, Line 5for therapeutic and cosmetic purposes under the direct

• Page 34, Line 6supervision of a licensed dentist, or the delegation of a licensed

• Page 34, Line 7physician or other delegated professional, pursuant to rules

• Page 34, Line 8adopted by the board. The board shall adopt rules regarding the appropriate education and training, as applicable.

• Page 34, Line 10(f)  Placing interim therapeutic restorations pursuant to section 12-220-505.

• Page 34, Line 11(2)  A dental hygienist may perform any dental task or

• Page 34, Line 12procedure assigned to the dental hygienist by a licensed dentist

• Page 34, Line 13that does not require the professional skill of a licensed

• Page 34, Line 14dentist; except that the dental hygienist may perform the task

• Page 34, Line 15or procedure only under the indirect supervision of a licensed dentist or as authorized in sections 12-220-503 and 12-220-504.

• Page 34, Line 16SECTION 24.  In Colorado Revised Statutes, 12-220-505, amend (1)(b), (1)(d), and (6)(a); and add (6)(c) as follows:

• Page 34, Line 1712-220-505.  Interim therapeutic restorations by dental

• Page 34, Line 18hygienists - permitting process - rules - subject to review. (1)  Upon

• Page 34, Line 19application, accompanied by a fee in an amount determined by the

• Page 34, Line 20director, the board shall grant a permit to place interim therapeutic restorations to any dental hygienist applicant who:

• Page 35, Line 1(b)  Has completed a course developed at the postsecondary

• Page 35, Line 2educational level that complies with the rules adopted by the board. The

• Page 35, Line 3course must be offered under the direct supervision of a member of the

• Page 35, Line 4faculty of a an accredited Colorado dental or dental hygiene school.

• Page 35, Line 5accredited by the Commission on Dental Accreditation or its successor

• Page 35, Line 6agency. All faculty responsible for clinical evaluation of students must be

• Page 35, Line 7dentists with a faculty appointment at an accredited Colorado dental or dental hygiene school.

• Page 35, Line 8(d)  Furnishes, supplies, constructs, reproduces, or repairs any

• Page 35, Line 9prosthetic denture, bridge, appliance, or other structure to be worn in the

• Page 35, Line 10human mouth or upon the jaws, maxillofacial area, or adjacent and

• Page 35, Line 11associated structures other than on the written dental laboratory work order of a duly licensed and practicing dentist;

• Page 35, Line 12(6) (a)  A dentist shall not supervise more than five full-time

• Page 35, Line 13equivalent dental hygienists who place interim therapeutic restorations

• Page 35, Line 14under telehealth supervision unless granted a waiver by the board

• Page 35, Line 15pursuant to subsection (6)(b) of this section. For purposes of patient

• Page 35, Line 16referral for follow-up care, A dentist who supervises a dental hygienist

• Page 35, Line 17who provides interim therapeutic restorations under telehealth supervision

• Page 35, Line 18must have an active license in good standing issued by the board. and a

• Page 35, Line 19physical practice location in Colorado or within reasonable proximity of

• Page 35, Line 20the location where the interim therapeutic restoration is placed Before

• Page 35, Line 21providing interim therapeutic restorations, a dental hygienist

• Page 35, Line 22shall confirm in communication to the supervising dentist a

• Page 35, Line 23referral for follow-up care to a licensed dentist within

• Page 35, Line 24reasonable physical proximity to the location where the interim therapeutic restoration is placed.

• Page 36, Line 1(c)  A dentist shall not supervise, in aggregate, more than

• Page 36, Line 2five full-time equivalent dental hygienists or dental therapists

• Page 36, Line 3performing procedures pursuant to subsection (6)(a) of this

• Page 36, Line 4section and section 12-220-508, and limits on supervision of

• Page 36, Line 5dental therapists must remain consistent with section 12-220-508 (3).

• Page 36, Line 6SECTION 25.  In Colorado Revised Statutes, 12-220-508, amend

• Page 36, Line 7(1)(a) introductory portion, (1)(a)(VIII), (2)(a)(VI), and (3)(a); and add (1)(c)(IX) and (3)(d) as follows:

• Page 36, Line 812-220-508.  Practice of dental therapy - supervision

• Page 36, Line 9requirement - rules. (1) (a)  A dental therapist may perform the

• Page 36, Line 10following tasks and procedures under the direct supervision of a licensed dentist with an active license in good standing:

• Page 36, Line 11(VIII)  Repair defective prosthetic devices.

• Page 36, Line 12(c)  A dental therapist licensed pursuant to this article 220 may

• Page 36, Line 13perform the following tasks under the indirect supervision of a licensed

• Page 36, Line 14dentist, regardless of the number of hours the dental therapist has practiced:

• Page 36, Line 15(IX)  Directing dental assistants to assist in activities

• Page 36, Line 16that are within the scope of practice for a dental therapist

• Page 36, Line 17under direct and indirect supervision of the dental therapist

• Page 36, Line 18only; except that dental assistants shall not perform activities disallowed under section 12-220-501 (3)(a).

• Page 36, Line 19(2) (a)  An articulated plan between a dental therapist and a dentist must include:

• Page 36, Line 20(VI)  Consistent with dental assistants' scope of practice,

• Page 37, Line 1policies for supervising dental assistants and working with dental hygienists and other dental practitioners and staff.

• Page 37, Line 2(3) (a)  Except as provided in subsection (3)(b), or (3)(c), or (3)(d)

• Page 37, Line 3of this section, a dentist may not simultaneously supervise more than three full-time or full-time-equivalent dental therapists.

• Page 37, Line 4(d)  A dentist shall not supervise in aggregate more than

• Page 37, Line 5five full-time equivalent dental hygienists or dental therapists

• Page 37, Line 6pursuant to this section and section 12-220-505 (6)(a), and limits

• Page 37, Line 7on supervision of dental therapists must remain consistent with this subsection (3).

• Page 37, Line 8SECTION 26.  In Colorado Revised Statutes, 24-34-104, repeal (26)(a)(I); and add (35)(a)(VI) as follows:

• Page 37, Line 924-34-104.  General assembly review of regulatory agencies

• Page 37, Line 10and functions for repeal, continuation, or reestablishment - legislative

• Page 37, Line 11declaration - repeal. (26) (a)  The following agencies, functions, or both, are scheduled for repeal on September 1, 2025:

• Page 37, Line 12(I)  The Colorado dental board created in article 220 of title 12;

• Page 37, Line 13(35) (a)  The following agencies, functions, or both, are scheduled for repeal on September 1, 2034:

• Page 37, Line 14(VI)  The Colorado dental board created in article 220 of title 12.

• Page 37, Line 15SECTION 27.  Repeal of relocated provisions. In Colorado Revised Statutes, repeal 12-220-104 (11).

• Page 37, Line 16SECTION 28.  Act subject to petition - effective date. This act

• Page 37, Line 17takes effect at 12:01 a.m. on the day following the expiration of the

• Page 37, Line 18ninety-day period after final adjournment of the general assembly; except

• Page 37, Line 19that, if a referendum petition is filed pursuant to section 1 (3) of article V

• Page 38, Line 1of the state constitution against this act or an item, section, or part of this

• Page 38, Line 2act within such period, then the act, item, section, or part will not take

• Page 38, Line 3effect unless approved by the people at the general election to be held in

• Page 38, Line 4November 2026 and, in such case, will take effect on the date of the official declaration of the vote thereon by the governor.