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HPA Frequently Asked Questions

Supervision


Does Alberta’s Health Professions Act (the "HPA") require that I work under the supervision of a dentist or have an "order" to perform certain dental hygiene therapies?

No. The HPA does not require supervision of dental hygiene practitioners, other than students performing restricted activities. Unlike legislation in other provinces, the HPA does not require an order to provide services, and does not require that a dentist examine a client prior to dental hygiene treatment.

Restricted Activities


What are restricted activities?

Restricted activities are regulated health services that involve a significant degree of risk to the public, can only be performed by individuals with specific competencies, and are identified in the Government Organization Act. Although the Regulation authorizes regulated members to perform a number of restricted activities, this does not mean that a regulated member is automatically authorized to perform any restricted activity in any situation in any practice setting. Members must always restrict themselves to performing only those restricted activities they are competent to perform and those that are appropriate to the members' area of practice and the procedure being performed. The question/answers below and the information in the Restricted Activities Authorization Table Newpdficon should help you understand the restricted activities that form part of the practice of dental hygiene.

How does authorization to perform restricted activities affect my practice?

Most of the restricted activities authorized in the Dental Hygienists Profession Regulation are taught in the basic curriculum of accredited dental hygiene programs and have been a part of the practice of dental hygiene for many years (i.e., probing, scaling, root planing, curettage, ordering, and exposing radiographs). You do not require any special authorization to perform these activities once you have been placed on the General register and have been issued a Practice Permit. Competencies related to the following restricted activities are not inclusive in all dental hygiene educational programs:

  • administration of local anaesthesia by injection;
  • prescribing and administering nitrous oxide/oxygen for the purpose of conscious sedation;
  • restorative procedures of a permanent nature in collaboration with a dentist;
  • orthodontic procedures specific to preliminary fitting of appliances in collaboration with a dentist;
  • preliminary fitting of periodontal appliances in collaboration with a dentist; and
  • signing prescriptions for the Schedule 1 drugs used in dental hygiene practice.


You are not authorized to perform the activities listed as (a) to (f) above until you:

  1. Successfully complete a Council-approved course specific to performance of these activities;
  2. Submit an application for authorization to perform the restricted activity, and;
  3. Receive written notification from CRDHA that you are authorized to perform the activity.
Where can I access the courses required for authorization to perform the restricted activities listed as (a) to (f) in the previous section?

The University of Alberta (U of A) offers continuing education courses that provide theoretical and clinical experience in administration of local anaesthesia, administration of nitrous oxide/oxygen for the purpose of conscious sedation, and orthodontic procedures including preliminary fitting of orthodontic and periodontal appliances (e.g., holding arches, palatal expansion devices, and splints). The U of A Continuing Dental Education Department can be contacted at (780) 492-5391.

Members who are considering taking courses other than those delivered through the U of A should contact the CRDHA office for information on course requirements and recognition of courses delivered by other providers.

I often complete the prescription forms for chlorhexidine and other Schedule 1 drugs I use in my practice but have always had a dentist sign the form. Does this mean I can now sign the prescriptions myself?
No. First, you will have to decide whether you want to be authorized to perform the restricted activity of prescribing. If such authorization would be useful in your practice situation, you must apply to the CRDHA for a prescriber’s identification (ID) number in order to sign prescriptions. Members who apply for a prescriber’s ID number must successfully complete a Council-approved pharmacy refresher course prior to a prescriber’s ID number being issued. The refresher course, entitled Elements of Prescribing: A Pharmacy Refresher Course for Dental Hygienists, is accessible to members in all regions of the province and is typically offered once per year. Course registration information is sent to Registered members prior to each course intake.

You do not have to hold a prescriber’s ID number to administer or apply Schedule 1 drugs as part of the treatment protocol in your practice of dental hygiene.
Are dental hygienists who are not authorized prescribers allowed to administer products like chlorhexidine, Oraqix®, ArestinTM, and Atridox®?
ALL dental hygienists registered to provide dental hygiene services in Alberta can administer drug therapies such as chlorhexidine, Oraqix®, ArestinTM, and Atridox®. As with any new product that dental hygienists may be incorporating into their practice, dental hygienists must ensure they are educated in the appropriate administration techniques and are familiar with the complete product information – including mechanism of action, potential indications and contraindications for use, common side effects, etc. In addition, they must know how to effectively manage adverse reactions to the product. Dental hygienists must make evidence-based decisions regarding when it is appropriate to use a product for a client. Each case is client-specific.

All registered dental hygienists are expected to determine the need for treatment and identify the appropriate sites for treatment following the ADPIE model of assessment, diagnosis, and treatment planning. A dentist does not have to determine the need for administration of drug therapies prior to the dental hygienist administering the drug for dental hygiene therapy.
I have not completed a Council-approved nitrous oxide/oxygen conscious sedation course. Can someone in my office who has completed an approved course start the flow of gases for me and then return to treating their own clients?
No. Dental hygienists without approved advanced training must not provide treatment to a client who is receiving nitrous oxide/oxygen conscious sedation unless an authorized provider remains in the operatory with the unauthorized dental hygienist and the client for the duration of the treatment.

The bottom line is client safety. The dental hygienist must know how to respond if a client has an adverse reaction to the nitrous oxide, if there is an equipment malfunction, or if the nitrous oxide/oxygen levels need to be adjusted during the provision of services. These responses must occur in a timely manner that is not possible if the authorized provider who started the flow of gases is in the middle of providing services to another client in a different operatory.
Can registered dental hygienists place temporary restorations?

Under the Health Professions Act (Alberta) and Dental Hygienists Profession Regulation, registered dental hygienists can perform restorative procedures of a temporary nature as part of their scope of practice.  However, they must possess the competencies to perform these procedures safely and effectively.  In the case of Atraumatic Restorative Therapy (ART), these competencies include but are not limited to:

  • Understanding caries development and diagnosis
  • Indications and contraindications for ART
  • Client education
  • Risk assessment
  • Clinical competence in performance of the procedure

 

In order to acquire the competencies to perform ART safely and effectively, Alberta dental hygienists must complete the U of A’s Continuing Dental Education ART course or a course that the CRDHA deems substantially equivalent to the U of A course.

 

Because the more comprehensive temporary restorative procedure called ART is recognized as part of the scope of practice of Alberta dental hygienists, interim stabilization therapy (IST) is not a term or procedure recognized in Alberta.  CRDHA members are reminded that the CRDHA does not recognize an IST course as equivalent to an ART course.  Members who complete an IST course may apply for credit under the CRDHA Continuing Competence Program but they will not be deemed to have acquired the competencies to perform ART and will not be authorized to perform IST in Alberta.

 

The CRDHA considers the following to be restorative procedures of a temporary nature:

  1. Insertion of zinc oxide eugenol or other medicated cements in primary or permanent teeth when:

1.1.     a dentist is not on-site or readily available to treat the client,

1.2.     there is no evidence of abscess, and

1.3.     the client is experiencing any of the following symptoms as the result of an untreated carious lesion, a fracture of the tooth or loss of a filling:

  • discomfort from gingival or mucosal irritation
  • tooth sensitivity or pain
  • impaired ability to eat

 

  1. Atraumatic Restorative Treatment (ART) on primary or permanent teeth using glass ionomer or resin based materials when:

2.1.     a dentist is not on-site or readily available to treat the client,

2.2.     there is no evidence of abscess, and

2.3.     the client is experiencing any of the following symptoms as the result of an untreated carious lesion, a fracture of the tooth or loss of a filling:

  • discomfort from gingival/mucosal irritation
  • tooth sensitivity or pain
  • impaired ability to eat, or

2.4.     the client meets the criteria for ART as part of an early childhood caries prevention program in a community health setting

Dental hygienists placing temporary restorations of any type must ensure that the client is aware of the temporary nature of the restorations and must advise clients or the client’s guardian to obtain further dental care from a dentist.

The registered dental assistants I work with tell me that I can provide "direction" to them in the performance of authorized restricted activities, but I can’t find reference to this in the Dental Hygiene Regulation.

You are correct. It is not in our Regulation. The Dental Hygienists Profession Regulation can only address dental hygiene practice. The authorization for dental hygienists to provide direction to regulated dental assistants is contained in the Dental Assistants Profession Regulation. If required, you can obtain a complete copy of the Dental Assistants Profession Regulation from the Alberta Queen’s Printer. You should be very familiar with section 12 of the Dental Assistants Profession Regulation if you are considering giving direction to a registered dental assistant in the performance of authorized restricted activities.

Section 12 (Authorized activities) of the Dental Assistants Profession Regulation states:

  1. Regulated members may, within the practice of dental assisting, perform the following restricted activities under the direction of a dentist, dental hygienist or denturist who is authorized to perform or to order the performance of the following restricted activities:
    • to apply any form of ionizing radiation in medical radiography;
    • to cut a body tissue or to perform surgical or other invasive procedures on body tissue in or below the surface of teeth, for the purpose of performing dental probing, including periodontal screening and recording;
    • to fit a fixed or removable partial or complete denture for the purpose of determining the preliminary fit of the device;
    • to fit a periodontal appliance for the purpose of determining the preliminary fit of the device;
    • to fit an orthodontic appliance for the purpose of determining the preliminary fit of the device.
  2. Subject to subsection (3), a regulated member who has advanced training approved by the Council may perform the restricted activity of cutting a body tissue or performing surgical or other invasive procedures on body tissue in or below the surface of teeth, for the purpose of scaling teeth under the direction of a dentist or a dental hygienist authorized to perform that restricted activity.
  3. The performance of the restricted activity referred to in subsection (2) is subject to the condition that the client has been recently assessed by the dentist or dental hygienist who has determined the patient has healthy gingival and periodontal tissues or plaque associated gingivitis, pockets of 4 mm or less and no overt radiographic signs of alveolar bone loss.
  4. For the purpose of this section, "direction" means a dentist, dental hygienist or denturist is on-site and able to assist. If clients do not fit the criteria in 12 (3) above, it is not appropriate to direct a registered dental assistant with advanced training to provide scaling procedures for the client. Please direct further questions regarding the practice of dental assistants to the College of Alberta Dental Assistants (CADA) at (780) 486-2526.
Is there anything else that would prevent me from providing "direction" to another regulated health care provider?

Yes. There are other things that would prevent you from providing direction. If you have conditions on your own practice permit that prevent you from performing, supervising, or directing a restricted activity, you cannot provide direction to another health care provider.

Secondly, a dental hygienist may only provide direction to members of other regulated health professions in the provision of restricted activities if the restricted activity is authorized for both professions. As an example, you may be authorized to administer nitrous oxide/oxygen conscious sedation but you cannot direct a registered dental assistant to administer nitrous oxide/oxygen conscious sedation because the Dental Assistants Profession Regulation does not authorize dental assistants to perform that restricted activity.

Does my presence in a dental practice obligate me to be responsible for providing "direction" to registered dental assistants in the practice?

The Dental Assistant Profession Regulation authorizes registered dental hygienists to provide direction to registered dental assistants. If you do not feel comfortable or qualified to provide direction, you are not required to do so. Any regulated health professional authorized to supervise or direct a member of another regulated health profession may decline to do so for a number of reasons. You should give careful consideration to the following questions before making your decision. If you cannot answer yes to any of the folowing questions, you must not consent to give direction.

  1. Are you qualified (competent) and authorized to perform the restricted activity yourself and is it appropriate to your practice?
  2. Do you have sufficient practice experience in the restricted activity to be directing another provider?
  3. Does your assessment of the client lead you to believe that it is appropriate to direct someone else to provide the service?
  4. Has the provider who is asking for direction completed any advanced training that may be required under their own Regulation?
  5. Are you confident that the provider you will be directing has the level of competence required to perform the procedure?

Laser Use


Our office is going to be purchasing a laser. Can I incorporate this into my practice of dental hygiene?

Yes. Dental hygienists who have completed the appropriate theoretical and clinical education may use lasers for dental hygiene procedures. Laser bleaching and laser periodontal therapy competencies can be obtained through a dental hygiene undergraduate program or a formal continuing education opportunity. Laser periodontal therapy courses must include hands-on clinical experiences using the laser on live, human clients.

  1. The theoretical component should be a minimum of 7 hours in length and cover all aspects of laser therapy. If the introductory theory component is online, there must be an in-person review of the theory prior to proceeding to the hands-on component. (We recommend at least 2 hrs for this review.) This will allow the instructors to ensure that the participants have a good strong understanding of the theory and the mechanics of the laser itself. 
  2. The hands-on clinical component should be at least one full day (7-8 hours). However, if you, the provider, do not feel adequately prepared to safely provide the laser therapy after the first day of a clinical course, you will need to obtain further clinical education until you feel competent to safely and effectively provide this service.  The time needed to become competent will vary from dental hygienist to dental hygienist, but a full day of clinical experiences is the minimum. 


The instructor of the hands-on component must be a registered member of their respective regulatory college in Alberta — either as a General Member or a Courtesy Member. For example, if a dental hygienist is teaching this section of the course and he/she is not a regulated member with CRDHA, he/she must contact CRDHA and apply for courtesy registration prior to delivering the course. Dental hygienists must make evidence-based decisions regarding implementation of new techniques, technology or research before incorporating them into practice.

Dental hygienists must restrict their use of lasers to bleaching and periodontal therapy. Dental hygienists are not authorized to provide laser therapy for treatment of TMJ disorders. While dental hygienists are able to identify potential TMJ concerns, they must refer the client to an appropriate health care provider (e.g., a dentist who specializes in treating TMJ disorders) for treatment. Dental hygiene practice does not include use of lasers for hair removal, treatment of gout, or other alternative therapies that may be promoted by laser manufacturers or distributors.

I’ve heard that lasers can be used to treat cold sores. Can I use lasers for this purpose?
No. If your office decides to incorporate lasers into the practice, you must restrict yourself to using the laser for periodontal therapy and bleaching. Currently, there is insufficient evidence or research that supports the use of lasers for treatment of cold sores, aphthous ulcers, other dental sores, and coated or geographic tongue. Viral infections, like cold sores, typically heal within 7-10 days. There are already good therapeutic options available for viral infections which offer less risk to the client and operator.

There is preliminary research indicating that the operators are getting viral outbreaks beyond the borders of their face mask (due to laser plumes). For more information, please refer to the USA Center for Disease Control’s (CDC) 2003 Guidelines for Infection Control in Dental Health-Care Settings Internal Link Image and Canada’s National Occupational Health & Safety (CCOHS) Resources on Laser Plumes Internal Link Image.

Independent Practice


I would like to establish an independent practice. Does CRDHA have any resources about planning and operating an independent dental hygiene practice?

Yes. A business primer called The Informed Entrepreneur is available for purchase from the CRDHA. The order form is available on this website. Members only login is required. CRDHA Practice Standards, Code of Ethics and Advertising Rules are also available on the website and must be adhered to by all members regardless of practice setting. Contact CRDHA’s Practice Advisor by phone at 1-877-465-1756 or by email practiceadvisor@crdha.ca once you have done your initial research about opening a practice.

CRDHA advises that a member have at least five years experience in dental hygiene practice before establishing an independent dental hygiene practice.

If you are opening an independent dental hygiene practice, contact CRDHA one month prior to opening to schedule an inspection.

If I establish an independent practice, can I own radiation equipment?

Yes. Dental hygienists can own dental radiation equipment, including lasers. Dental x-ray equipment, including digital radiography systems, and any Class 3B or Class 4 lasers used for periodontal therapies or bleaching procedures must be installed, registered, and inspected in accordance with Alberta’s Radiation Protection Act and Regulation. Registration and inspection must be completed prior to use of the equipment. Please contact the CRDHA office for further details. Failure to be in possession of a valid registration certificate prior to operation of radiation equipment is a contravention of the Radiation Protection Act. The penalty for this offence is a maximum fine of $15,000 and/or six months imprisonment. Operation of unregistered radiation equipment would also be considered unprofessional conduct under the HPA. You must have a written Quality Assurance Program in place that is consistent with the legislation and Safety Code 30 Internal Link Image. This includes policies and procedures that:

  • Ensure the dental X-ray equipment produces quality radigrams reliably with minimal doses to clients and staff
  • Test the radiography equipment for quality control