HOUSE OF REPRESENTATIVES STAFF ANALYSIS
BILL #: HB 1173 Dental Therapy
SPONSOR(S): Chaney
TIED BILLS: IDEN./SIM. BILLS: SB 1254
REFERENCE ACTION ANALYST STAFF DIRECTOR or
BUDGET/POLICY CHIEF
1) Healthcare Regulation Subcommittee 14 Y, 3 N Osborne McElroy
2) Health Care Appropriations Subcommittee 9 Y, 5 N Aderibigbe Clark
3) Health & Human Services Committee
SUMMARY ANALYSIS
The Board of Dentistry (BOD) regulates dental practice in Florida, including dentists, dental hygienists, and
dental assistants under the Dental Practice Act. A dentist is licensed to examine, diagnose, treat, and care for
conditions within the human oral cavity and its adjacent tissues and structures. A dental hygienist provides
education, preventive and delegated therapeutic dental services. There are currently 17,193 dentists, 17,681
dental hygienists, and 8,371 dental radiographers with active licenses to practice in Florida. There are 41 out-
of-state registered telehealth dentists.
Dental therapists are mid-level dental care providers; the role of dental therapists has been equated to that of
physician assistants in medicine. Under dentist supervision, dental therapists provide preventative and routine
restorative care, such as filling cavities, placing temporary crowns, and extracting badly diseased or loose
teeth. There are currently 14 states in the US that authorize the practice of dental therapy to some extent.
Florida does not currently issue licenses for dental therapists.
Current law limits the use of mobile dental units in Medicaid. Medicaid reimbursement is only available for
dental services provided by mobile dental units owned or operated by, or under contract with, a county health
department, FQHC, state-approved dental educational institution, or a mobile dental unit providing adult dental
services at a nursing home.
HB 1173 establishes licensure criteria for dental therapists. The bill specifies the scope of practice for dental
therapists and requires they operate under a written collaborative management agreement with a licensed
dentist. The bill sets continuing education requirements for dental therapists.
The bill directs the BOD to establish a Council on Dental Therapy to advise the BOD on matters relating to the
practice and regulation of dental therapy. The bill directs the chair of the BOD to appoint the members of the
Council 28 months after the first dental therapy license is granted by the BOD and sets requirements for the
composition of the Council.
The bill allows Medicaid to provide reimbursement for dental services provided by a mobile dental unit owned
by, operated by, or having a contractual relationship with a health access setting or similar program serving
underserved populations.
The bill has an indeterminant, negative fiscal impact on state government, and no fiscal impact on local
governments.
The bill provides an effective date of July 1, 2024.
This docum ent does not reflect the intent or official position of the bill sponsor or House of Representatives .
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DATE: 2/6/2024
FULL ANALYSIS
I. SUBSTANTIVE ANALYSIS
A. EFFECT OF PROPOSED CHANGES:
Background
Regulation of Dental Practice in Florida
The Board of Dentistry (BOD) regulates dental practice in Florida, including dentists, dental hygienists,
and dental assistants under the Dental Practice Act. 1 Dentists and dental hygienists must receive
specified education and training to be licensed and practice in their respective professions; 2 dental
assistants are not a licensed profession and provide a narrow scope of services as authorized and
supervised by a licensed dentist.3
There are currently 17,193 dentists and 17,681 dental hygienists with active licenses to practice in
Florida. There are 41 out-of-state registered telehealth dentists.4
Dentists
A dentist is licensed to examine, diagnose, treat, and care for conditions within the human oral cavity
and its adjacent tissues and structures.5 Dentists may delegate certain tasks 6 to dental hygienists and
dental assistants, but a patient’s “dentist of record” retains primary responsibility for all dental treatment
on the patient.7
Any person wishing to practice dentistry in this state must meet specified requirements and apply to the
Department of Health (DOH) for licensure. Applicants must sit for and pass three examinations prior to
licensure:8
The National Board of Dental Examiners dental examination (NBDE);
A practical examination, which is the American Dental Licensing Examination developed by the
American Board of Dental Examiners, Inc.;9 and
A written examination on Florida laws and rules regulating the practice of dentistry and dental
hygiene.
To qualify to take the Florida dental licensure examination, an applicant must be 18 years of age or
older, be a graduate of a dental school accredited by the American Dental Association or be a student
in the final year of a program at an accredited institution, and have successfully completed the NBDE
dental examination.10
Dentists must maintain professional liability insurance or provide proof of professional responsibility. If
the dentist obtains professional liability insurance, the coverage must be at least $100,000 per claim,
with a minimum annual aggregate of at least $300,000. 11 Alternatively, a dentist may maintain an
unexpired, irrevocable letter of credit in the amount of $100,000 per claim, with a minimum aggregate
availability of credit of at least $300,000.12 The professional liability insurance must provide coverage
1
S. 466.004, F.S.
2 S. 466.003(2) and (5), F.S.
3 See, Rules 64B5-16.002 and 64B5-16.005, F.A.C.
4 See, Department of Health License Verification web search. Available at https://mqa-
internet.doh.state.fl.us/MQASearchServices/HealthCareProviders (last visited January 14, 2023).
5 S. 466.003(2)-(3), F.S.
6 S. 466.024, F.S.
7 S. 466.018, F.S.
8 S. 466.006, F.S.
9 Rule 64B5-2.013, F.A.C.
10 S. 466.006(2), F.S.
11 Rule 64B5-17.011(1), F.A.C.
12 Rule 64B5-17.011(2), F.A.C.
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for the actions of any dental hygienist supervised by the dentist. 13 However, a dentist may be exempt
from maintaining professional liability insurance if he or she:14
Practices exclusively for the federal government or the State of Florida or its agencies or
subdivisions;
Is not practicing in this state;
Practices only in conjunction with his or her teaching duties at an accredited school of dentistry
or in its main teaching hospitals; or
Demonstrates to the Board that he or she has no malpractice exposure in this state.
Dental Hygienists
A dental hygienist provides education, preventive and delegated therapeutic dental services under
varying levels of supervision by a licensed dentist.15 Any person wishing to be licensed as a dental
hygienist must apply to DOH and meet the following qualifications: 16
Be 18 years of age or older;
Be a graduate of an accredited dental hygiene college or school;17 and
Obtain a passing score on the:
o Dental Hygiene National Board Examination;
o Dental Hygiene Licensing Examination developed by the American Board of Dental
Examiners, Inc., which is graded by a Florida-licensed dentist or dental hygienist
employed by DOH for such purpose; and
o A written examination on Florida laws and rules regulating the practice of dental
hygiene.
A supervising dentist may delegate certain tasks to a dental hygienist, such as removing calculus
deposits, accretions, and stains from exposed surfaces of the teeth and from the gingival sulcus and
the task of performing root planning and curettage.18 A dental hygienist may also expose dental X-ray
films, apply topical preventive or prophylactic agents, and delegated remediable tasks.19 Remediable
tasks are intra-oral tasks which do not create an unalterable change in the oral cavity or contiguous
structures, are reversible, and do not expose a risk to the patient, including but not limited to:
Fabricating temporary crowns or bridges inter-orally;
Selecting and pre-sizing orthodontic bands;
Preparing a tooth service by applying conditioning agents for orthodontic appliances;
Removing and re-cementing properly contoured and fitting loose bands that are not
permanently attached to any appliance;
Applying bleaching solution, activating light source, and monitoring and removing in-office
bleaching solution;
Placing or removing rubber dams;
Making impressions for study casts which are not being made for the purpose of fabricating any
intra-oral appliances, restorations, or orthodontic appliances;
Taking impressions for passive appliances, occlusal guards, space maintainers, and protective
mouth guards; and
Cementing temporary crowns and bridges with temporary cement.
A dental hygienist may perform additional remediable tasks as delegated by the supervising dentist if
they have received additional training in a pre-licensure course, other formal training, or on-the-job
13 Rule 64B5-17.011(4), F.A.C.
14 Rule 64B5-17.011(3), F.A.C.
15 S. 466.003(4)-(5), F.S.
16 S. 466.007, F.S.
17 If the school is not accredited, the applicant must have completed a minimum of 4 years of postsecondary dental education and
received a dental school diploma which is comparable to a D.D.S. or D.M.
18 S. 466.023, F.S.
19 Ss. 466.023 and 466.024, F.S.
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training.20 To administer local anesthesia, a dental hygienist must obtain certification which requires the
dental hygienist completes an accredited course of 30 hours of didactic training and 30 hours of clinical
training and is certified in basic or advanced cardiac life support. Once certified, the dental hygienist
may only administer local anesthesia to a non-sedated, adult patient.21
Dental Assistants
Dental assistants provide limited dental care services under the supervision and authorization of a
licensed dentist.22 Florida does not license dental assistants; however, dental assistants may choose to
receive formal education in dental assisting and obtain a national certification. 23 Dental assistants who
have graduated from a board-approved dental assisting school are eligible for certification as dental
radiographers.24
The scope of practice for dental assistants is limited to the delegable tasks determined in Florida law
and rule. The specific tasks that may be delegated to a dental assistant are dependent on the formal
and on-the-job training the dental assistant has received.25
Supervision of Dental Hygienists and Dental Assistants
Dental hygienists and dental assistants are generally required to practice under the supervision of a
licensed dentist. There are three levels of supervision that a dental hygienist and dental assistant may
be subject to:26
Direct supervision: A licensed dentist examines the patient, diagnose a condition to be treated,
authorize the procedure to be performed, be on the premises while the procedure is performed,
and approve the work performed prior to the patient’s departure from the premises;
Indirect supervision: A licensed dentist examines the patient, diagnose a condition to be treated,
authorize the procedure to be performed, and be on the premises while the procedure is
performed; and
General supervision: A licensed dentist authorizes the procedures to be performed but need not
be present when the authorized procedures are being performed. The authorized procedures
may also be performed at a place other than the dentist’s usual place of practice.
The level of supervision required is dependent upon the specific task being performed, the education
and training of the dental professional, and the discretion of the supervising dentist. Supervisory
standards are outlined in current law and rule prescribed by the BOD.27
Dental hygienists are authorized to perform dental charting without dentist supervision. Dental charting
includes the recording of visual observations of clinical conditions of the oral cavity without the use of
X-rays, laboratory tests, or other diagnostic methods or equipment, except the instruments necessary
to record visual restorations, missing teeth, suspicious areas, and periodontal pockets. 28 Dental
charting is not a substitute for a comprehensive dental examination, and each patient who receives
dental charting by a dental hygienist must be informed of the limitations of dental charting. 29 Dental
20 See, ss. 466.023, 466.0235, and 466.024, F.S.; and Rule 64B5-16, F.A.C.
21
S. 466.017(5), F.S.
22 S. 466.003(6), F.S.
23 See, Dental Assisting National Board, Earn Dental Assistant Certification. Available at https://www.danb.org/certification/earn-dental-
assistant-certification (last visited January 18, 2024).
24 Rule 64B5-9.011, F.A.C.; A dental assistant may also become eligible for certification as a dental radiographer through three
continuous months of on-the-job training under the direct supervision of a dentist.
25 For more information on the specific tasks which may be delegated to a dental assista nt, and the required training for each task, see,
rules 64B5-16.002 and 64B5-16.005, F.A.C.
26 Rule 64B5-16.001, F.A.C.
27 S. 466.024, F.S.; and ch. 64B5-16, F.A.C.
28 S. 466.0235, F.S.; Dental hygienists may only perform periodontal probing as a part of dental charting if the patient has received
medical clearance from a physician or dentist.
29 Rule 64B5-16.0075, F.A.C
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hygienists performing dental charting without dentist supervision are required to maintain their own
medical malpractice insurance or other proof of financial responsibility.30
Dental hygienists are not required to maintain professional liability insurance and must be covered by
the supervising dentist’s liability insurance,31 unless they are providing services without dental
supervision, in which case they must maintain their own medical malpractice insurance or other proof of
financial responsibility.32
Access to Dental Care in Florida
Lack of dental care can lead to poor oral health and poor overall health outcomes. Poor oral health is
associated with a variety of poor health outcomes including diabetes, heart and lung disease, as well as
increased stroke risk and adverse birth outcomes including pre-term deliveries and low birth-weight.33
The US Department of Health and Human Services’ Health Resources and Services Administration
(HRSA) designates Health Professional Shortage Areas (HPSAs). A HPSA is a geographic area,
population group, or health care facility that has been designated by the HRSA as having a shortage of
health professionals. There are three categories of HPSA: primary care, dental health, and mental
health.34 HPSAs can be designated as geographic areas; areas with a specific group of people such as
low-income populations, homeless populations, and migrant farmworker populations; or as a specific
facility that serves a population or geographic area with a shortage of providers. 35
As of September 30, 2023, there are 266 dental HPSAs designated within the state. It would take 1,317
dentists distributed accordingly to eliminate these shortage areas.36 Most dentists are disproportionately
concentrated in the more populous areas of the state. Two counties, Dixie and Glades, do not have any
licensed dentists, while other counties have over 150 dentists per 100,000 residents. 37
Dental Therapy
Dental therapists are mid-level dental care providers; the role of dental therapists has been equated to
that of physician assistants in medicine. Under dentist supervision, dental therapists provide
preventative and routine restorative care, such as filling cavities, placing temporary crowns, and
extracting badly diseased or loose teeth. Dental therapists are part of a larger dental team, and allow
dentists to be able to perform more advanced care and treat a larger number of patients. 38
In 2015, the Commission on Dental Accreditations (CODA) established accreditation standards for
dental therapy education programs.39 To be accredited programs must, among other things: 40
30
Rule 64B5-17.011(4), F.A.C.
31 Rule 64B5-17.011(4), F.A.C.
32 Id., see also, s. 466.024(5), F.S.
33 Mayo Clinic. Oral Health: A Window to Your Overall Health (2021). Available at https://www.mayoclinic.org/healt