Chapter 4715-23 | Teledentistry

Rule 4715-23-01 | Requirements for teledentistry permit.

• Effective: May 30, 2020
• Promulgated Under: 119.03

(A) Each applicant for a teledentistry permit shall submit the statutory fee and an application to the board.

(1) On this application, the dentist applicant for a teledentistry permit shall state under oath whether:

(a) The applicant has read all laws and rules governing teledentistry in the state of Ohio, including but not limited to sections 4715.43 to 4715.437 of the Revised Code and this chapter of the Administrative Code.

(b) The applicant has the necessary equipment required to safely and securely deliver dental services through teledentistry, specifically regarding synchronous, real-time communication.

(c) The applicant has established all necessary policies, protocols, and orders to safely deliver dental services through teledentistry at all locations where dental services will be provided through teledentistry.

(d) The applicant's Ohio license to practice dentistry is in good standing.

(e) The license or registration of dental hygienists and expanded function dental auxiliaries who will provide dental services through teledentistry for the applicant are in good standing.

(f) Any dental hygienist or expanded function dental auxiliary who provides placement of interim therapeutic restorations and application of silver diamine fluoride, has completed the appropriate course prescribed by the board.

(g) The applicant understands that:

(i) The applicant retains responsibility for ensuring the safety and quality of services provided to patients through teledentistry,

(ii) Dental services delivered through teledentistry must conform to accepted standards for the profession, and

(iii) Persons involved with providing services through teledentistry must abide by laws addressing the privacy and security of the patient's dental and medical information as well as other information required to be kept confidential as required by law.

(2) The applicant shall provide on the application form the following information:

(a) Address where dental services will be provided through teledentistry.

(b) Name and license or registration number of each dental hygienist or expanded function dental auxiliary who will perform dental services through teledentistry when the dentist is not physically present and the location where they will provide these services.

(c) A description of all equipment used to establish and maintain synchronous, real-time communication during the provision of dental services through teledentistry. Any description must include manufacturer name and model number.

(B) Each holder of a teledentistry permit shall:

Before providing dental services through teledentistry, notify the Board via e-mail or regular U.S. mail within seven calendar days of:

(1) The address where dental services will be provided through teledentistry, if not included on permit application.

(2) Name and license or registration number of each dental hygienist and expanded function dental auxiliary who will perform dental services through teledentistry when the dentist is not physically present and the location where they will provide these services, if not included on permit application.

Last updated September 8, 2023 at 2:51 PM

Supplemental Information

Authorized By: 4715.03, 4715.436
Amplifies: 4715.43
Five Year Review Date: 11/30/2027

Rule 4715-23-02 | Courses on proper placement of interim therapeutic restorations and application of silver diamine fluoride.

• Effective: May 30, 2020
• Promulgated Under: 119.03

(A) Any course that meets the following criteria shall satisfy the requirements of section 4715.431 of the Revised Code for a board-approved course on either placement of interim therapeutic restorations or application of silver diamine fluoride.

(1) Each course must be:

(a) A two-hour continuing education course with at least one continuing education hour of didactic education and at least one continuing education hour of clinical hands-on training.

(b) Provided by a board-approved sponsor of continuing education under Chapter 4715-8 of the Administrative Code, and

(c) Dedicated solely to the proper placement of interim therapeutic restorations or application of silver diamine fluoride.

(2) For a course on the proper placement of interim therapeutic restorations, course content shall include:

(a) Biological background information, including, but not limited to, materials used in and the scientific basis for the proper placement of interim therapeutic restorations.

(b) Proper isolation and placement technique, including, but not limited to, the use of cotton rolls and iso-vac.

(c) Knowledge of poor seal with interim restorations, including, but not limited to, the consequences of a poor seal, leakage, and re-cavitation.

(d) Detection of arresting dental caries and the use of a periodontal probe.

(e) Replacement of treatment, including, but not limited to, the necessity of a new diagnosis by a dentist before reapplication.

(3) For a course on the application of silver diamine fluoride, course content shall include:

(a) Biological background information, including, but not limited to, materials used in and the scientific basis for the application of silver diamine fluoride.

(b) Proper isolation and placement technique, including, but not limited to, the use of cotton rolls and iso-vac.

(c) Knowledge of potential problems associated with silver diamine fluoride, including, but not limited to, staining, need for treatment, and failure to arrest caries.

(d) Detection of arresting dental caries and the use of periodontal probe.

(e) Reapplication of treatment, including, but not limited to, the necessity of a new diagnosis by a dentist before reapplication.

(B) To meet the course requirements for both proper placement of interim therapeutic restoration and application of silver diamine fluoride, a dental hygienist or expanded function dental auxiliary must complete both courses dedicated to each respective subject.

(C) No course shall instruct that the use of a dental explorer or sickle probe is appropriate during the application of silver diamine fluoride or placement of interim therapeutic restorations.

Last updated September 8, 2023 at 2:51 PM

Supplemental Information

Authorized By: 4715.03, 4715.436
Amplifies: 4715.43
Five Year Review Date: 11/30/2027

Rule 4715-23-03 | Requirements for obtaining informed consent.

• Effective: May 30, 2020
• Promulgated Under: 119.03

(A) When services are provided under a teledentistry permit and the patient is not examined in person by the authorizing dentist, informed consent must be obtained before the placement of interim therapeutic restorations or the application of silver diamine fluoride.

(B) To obtain informed consent, the authorizing dentist must:

(1) Determine that the patient is mentally capable of giving informed consent to the provision of the diagnosis, care, or treatment and is not subject to duress or under undue influence,

(2) Inform the patient that the authorizing dentist will perform a clinical evaluation and diagnosis of caries through teledentistry,

(3) For the application of silver diamine fluoride,

(a) Inform the patient of the potential for staining teeth by providing color photos of the result of application,

(b) Inform the patient that application is permanent and may only be reversed through loss or restoration of the tooth,

(c) Inquire whether the patient has an allergy to silver, and

(d) Inform the patient that the treatment will require active monitoring and possible reapplication.

(4) Explain alternatives to, and the capabilities and limitations of, teledentistry,

(5) Explain that the patient may decline to receive services through teledentistry,

(6) Document in the patient record any discussion with the patient about teledentistry and whether informed consent was obtained, and

(7) Comply with the requirements set forth in division (B) of section 4715.431 of the Revised Code.

(C) If the patient is less than eighteen years of age, a parent or legal guardian must provide informed consent for the patient and meet the same requirements as provided in paragraph (B) of this rule.

Last updated September 8, 2023 at 2:52 PM

Supplemental Information

Authorized By: 4715.03, 5715.436
Amplifies: 4715.43
Five Year Review Date: 11/30/2027

Rule 4715-23-04 | Procedures not permitted.

• Effective: May 30, 2020
• Promulgated Under: 119.03

No authorizing dentist shall authorize a dental hygienist or expanded function dental auxiliary to provide a dental service or any other function prohibited by law or rule, including section 4715.435 of the Revised Code.

Last updated September 8, 2023 at 2:52 PM

Supplemental Information

Authorized By: 4715.03, 4715.436
Amplifies: 4715.43
Five Year Review Date: 11/30/2027

Rule 4715-23-05 | Equipment requirements for teledentistry.

• Effective: May 30, 2020
• Promulgated Under: 119.03

(A) All equipment used to provide dental services through teledentistry must comply with the Health Insurance Portability and Accountability Act (HIPAA), Health Information Technology for Economic and Clinical Health Act (HITECH), as well as all state and federal laws and regulations.

(B) Authorizing dentists providing dental services through teledentistry

(1) Are solely responsible for securing and protecting all patient records and data related to the provision of dental services through teledentistry, and

(2) Must take reasonable steps to prevent the compromise, breach, or theft of patient records or data related to the provision of dental services through teledentistry.

(C) Contingency plan - Authorizing dentists providing dental services through teledentistry must have a contingency plan established to:

(1) Refer patients to a local healthcare provider in the event of a dental emergency;

(2) Manage an interruption in connection or communication while providing dental services through teledentistry.

(D) Dedicated space - All equipment used for providing dental services through teledentistry must be utilized in a space dedicated to providing dental services through teledentistry. This space may also function as a space in which dental services are provided when the dentist is physically present.

(E) Encryption - Authorizing dentists must ensure that all data connections and storage (including cloud storage) used in the provision of dental services through teledentistry are encrypted.

(F) High definition intraoral camera High definition intraoral cameras must be used to provide dental services through teledentistry.

(G) Microphone - A microphone must be utilized to allow verbal communication between the dentist, patient, and staff during the provision of dental services through teledentistry.

(H) Digital x-ray machine - A digital x-ray machine capable of producing high definition images that can be immediately transmitted to the authorizing dentist during the patient's appointment must be available while providing dental and diagnostic services through teledentistry.

(I) Patient records - All patient records must be transmitted, transported, handled, stored, protected, and secured in compliance with HIPAA, HITECH, as well as all state and federal laws and regulations.

Last updated September 8, 2023 at 2:52 PM

Supplemental Information

Authorized By: 4715.03, 4715.436
Amplifies: 4715.43
Five Year Review Date: 11/30/2027

Rule 4715-23-06 | Authorization.

• Effective: May 30, 2020
• Promulgated Under: 119.03

(A) An authorizing dentist who is providing dental services through teledentistry may not at any time have more than a total of three dental hygienists and expanded function dental auxiliaries working under the dentist's authorization pursuant to section 4715.431 of the Revised Code. Because teledentistry requires synchronous, real-time communication, an authorizing dentist must remain attentive and available to attend to the health and safety of all patients regardless of whether the dentist is physically present or not physically present with the patient. If an authorizing dentist supervises any dental hygienist or expanded function dental auxiliary on the same day as the authorizing dentist authorizes any dental hygienist or expanded function dental auxiliary to provide dental services through teledentistry, the authorizing dentist should not have more than a total of:

(1) Four dental hygienists practicing clinical hygiene under the supervision of the authorizing dentist pursuant to section 4715.23 of the Revised Code or three dental hygienists providing dental services through teledentistry pursuant to section 4715.431 of the Revised Code.

(2) two expanded function dental auxiliaries practicing as expanded function dental auxiliaries under the supervision of the authorizing dentist pursuant to section 4715.64 of the Revised Code or three expanded function dental auxiliaries providing dental services through teledentistry pursuant to section 4715.431 of the Revised Code, except that the total number practicing under the supervision of the authorizing dentist pursuant to section 4715.64 of the Revised Code shall not exceed two.

(B) Nothing in this rule shall prohibit:

(1) Any dental hygienist to practice as a dental hygienist when the authorizing dentist is not physically present at the location where the dental hygienist is practicing, under section 4715.22 of the Revised Code,

(2) Any expanded function dental auxiliary to practice as an expanded function dental auxiliary when the authorizing dentist is not physically present at the location where the expanded function dental auxiliary is practicing, under section 4715.64 of the Revised Code,

(3) Any dental assistant or qualified personnel to practice as a dental assistant or qualified personnel when the authorizing dentist is not physically present at the location where the dental assistant or qualified personnel is practicing, under section 4715.39 of the Revised Code,

(4) Any dental x-ray machine operator to practice as a dental x-ray machine operator when the authorizing dentist is not physically present at the location where the dental x-ray machine operator is practicing, under section 4715.56 of the Revised Code, or

(5) Any dental hygienists to practice in accordance with a permit issued pursuant to section 4715.363 of the Revised Code authorizing practice under the oral health access supervision of a dentist.

Last updated September 8, 2023 at 2:52 PM

Supplemental Information

Authorized By: 4715.03, 4715.436
Amplifies: 4715.43
Five Year Review Date: 11/30/2027