The Florida Senate
BILL ANALYSIS AND FISCAL IMPACT STATEMENT
(This document is based on the provisions contained in the legislation as of the latest date listed below.)
Prepared By: The Professional Staff of the Committee on Rules
BILL: CS/SB 356
INTRODUCER: Banking and Insurance Committee and Senator Boyd
SUBJECT: Practice of Dentistry
DATE: April 18, 2023 REVISED:
ANALYST STAFF DIRECTOR REFERENCE ACTION
1. Rossitto-Van
Brown HP Favorable
Winkle
2. Moody Knudson BI Fav/CS
3. Rossitto-Van
Twogood RC Favorable
Winkle
Please see Section IX. for Additional Information:
COMMITTEE SUBSTITUTE - Substantial Changes
I. Summary:
CS/SB 356 requires dentists and any individual, partnership, corporation, or other entity that
provides dental services through telehealth to make available the dentist’s name, telephone
number, after-hours contact information for emergencies, and upon request, licensure
information.
The bill requires the dentist of record to remain primarily responsible for all dental treatment for
any patient who is treated through telehealth, whether care is rendered by the dentist of record,
another dentist, dental hygienist, or dental assistant.
The bill creates a definition for advertisement and requires that if dental services are provided
through telehealth, an advertisement must include a specific disclaimer for each of the following
services, if advertised:
The taking of an impression or the digital scanning of the human tooth, teeth, or jaws,
directly or indirectly and by any means or method;
Placing an appliance or a structure in the human mouth or adjusting or attempting to adjust
the appliance or structure; and
Correcting or attempting to correct malformations of teeth or jaws.
BILL: CS/SB 356 Page 2
The bill sets supervisory standards for dental hygienists and dental assistants who take an
impression or perform digital scanning of the human tooth, teeth, or jaws, directly or indirectly
and by any means or method, for the purpose of the practice of dentistry, and provides for such
standards with respect to a dental laboratory technician who performs a digital scanning of the
human tooth, teeth, or jaws in such circumstances.
The bill creates new disciplinary offenses that establish a standard that would require a dentist of
record to perform an in-person examination of a patient or obtain records from an in-person
examination within the last six months before the initial diagnosis and correction of a
malposition of human teeth or initial use of an orthodontic appliance.
The bill provides an effective date of July 1, 2023.
II. Present Situation:
The Practice of Dentistry
The Board of Dentistry (BOD) regulates the practice of dentistry in Florida, including dentists,
dental hygienists, and dental assistants under the Dental Practice Act.1 A dentist is licensed to
examine, diagnose, treat, and care for conditions within the human oral cavity and its adjacent
tissues and structures.2 A dental hygienist provides education, preventive, and delegated
therapeutic dental services.3
Dentists
The requirements for dental licensure in Florida are found in s. 466.006, F.S. An applicant must
apply to the Department of Health (DOH) to take and pass the following examinations:
The American Dental Licensing Examination (ADLEX);4 and
An exam on Florida laws and rules relating to dentistry.
To take the ADLEX clinical examination, a dental applicant must be at least 18 years of age and
must:
Be a graduate from a dental school accredited by the American Dental Association’s (ADA)
Commission on Dental Accreditation (CODA) or any other dental accrediting entity
recognized by the U.S. Department of Education (DOE); or
Be a dental student in the final year of a program at an ADA-CODA-accredited dental school
who has completed all the coursework necessary to prepare the student to perform the
clinical and diagnostic procedures required to pass the examinations; and
Have passed Parts I and II of the National Board Dental Examination (NBDE), administered
by the Joint Commission on National Dental Examinations (JCNDE).5
1 Section 466.004, F.S.
2 Section 466.003(3), F.S.
3 Section 466.003(4) and (5), F.S.
4
Section 466.006, F.S.
5
Section 466.006(2), F.S. American Dental Association, Joint Commission on National Dental Examinations, Upholding
Quality Oral Care For All, available at https://jcnde.ada.org/ (last visited Apr. 17, 2023) The Joint Commission on National
Dental Examinations (JCNDE) is the agency responsible for the development and administration of the National Board
BILL: CS/SB 356 Page 3
If an applicant fails to pass the diagnostic skills examination in three attempts, the applicant is
not eligible for reexamination unless she or he completes additional educational requirements
established by the BOD.6
Dental Hygienist
The requirements for licensure as a dental hygienist are found in s. 466.007, F.S. An applicant
must apply to the DOH to take the American Board of Dental Examiners’ Dental Hygiene
Examination (ADHLEX) and is entitled to licensure if he or she is 18 years of age or older and
has:7
Graduated from a dental hygiene college or school that is:
o BOD-approved;
o Accredited by the ADA-CODA or by any other dental accrediting entity recognized by
the U.S. DOE;
Passed the Florida Laws and Rules examination; and
Passed the ADHLEX examination.
A dentist who is a graduate of an accredited dental college or school or a graduate of an
unaccredited dental college or school, may also take the ADHLEX and obtain licensure as a
dental hygienist if he or she meets certain additional criteria.8
License Display Requirements
Every dentist or dental hygienist licensed in Florida must post and keep conspicuously displayed
his or her license in the office wherein she or he practices, in plain sight of patients. Any dentist
or dental hygienist who practices at more than one location shall be required to display a copy of
his or her license in each location where she or he practices.9
Dental Patient Records
Every dentist must maintain written dental records and medical history records on every patient
which must justify the dentist’s course of treatment for the patient. The records must include, but
not be limited to:
Patient history:
Examination results;
Test results; and,
X rays, if taken.10
In a multidentist practice, the owner dentist(s) must maintain either the original or duplicates of
all patient records, including dental charts, patient histories, examination and test results, study
Dental Examinations (NBDE). This 16-member Commission includes representatives from dental schools, dental practice,
state dental examining boards, dental hygiene, dental students, and the public.
6
Section 466.006(5)(a)7., F.S.
7
Section 466.007(2), F.S.
8
See s. 466.007 (2)(b)1. and (3), F.S.
9
Section 466.016, F.S.
10
Section 466.018 (3), F.S.
BILL: CS/SB 356 Page 4
models, and X rays, of any patient treated by a dentist at the owner dentist’s practice facility for
four years from the date of the last patient’s visit.11 The owner dentist(s) of a multidentist
practice may be relieved of this responsibility if, upon request of the patient or the patient’s legal
representative, the dentist transfers custody of the records to another dentist, the patient, or the
patient’s legal representative and retains, in lieu of the records, a written statement, signed by the
owner dentist, the person who received the records, and two witnesses, that lists the date, the
records that were transferred and the persons to whom the records were transferred. The owner
dentist(s) must provide reasonable access to duplicate records at cost.12
Dentist of Record
Section 466.018, F.S., requires that each dental patient shall have a dentist of record. The dentist
of record must remain primarily responsible for all dental treatment on a patient regardless of
whether the treatment is rendered by the dentist or by another dentist, dental hygienist, or dental
assistant rendering such treatment in conjunction with, at the direction or request of, or under the
supervision of such dentist of record. The dentist of record must be identified in the record of the
patient. If treatment is rendered by a dentist other than the dentist of record or by a dental
hygienist or assistant, the name or initials of such person must be placed in the record of the
patient In any disciplinary proceeding against a dentist, it is presumed as a matter of law that
treatment was rendered by the dentist of record unless otherwise noted on the patient record.13
Delegation of Duties
A dentist may not delegate irremediable tasks to a dental hygienist or dental assistant, except as
provided by law. A dentist may delegate remediable tasks to a dental hygienist or dental assistant
when such tasks pose no risk to the patient. A dentist may only delegate remediable tasks so
defined by law or BOD rule.14
The BOD designates by rule which tasks are remediable and delegable, except that the following
are found by law to be remediable and delegable:
Taking impressions for study casts but not for the purpose of fabricating any intraoral
restorations or orthodontic appliance;
Placing periodontal dressings;
Removing periodontal or surgical dressings;
Removing sutures;
Placing or removing rubber dams;
Placing or removing matrices;
Placing or removing temporary restorations;
Applying cavity liners, varnishes, or bases;
Polishing amalgam restorations;
Polishing clinical crowns of the teeth for the purpose of removing stains but not changing the
existing contour of the tooth;
Obtaining bacteriological cytological specimens not involving cutting of the tissue; and
11
Section 466.018(5), F.S.
12
Section 466.018(4), F.S.
13
Section 466.018,(1), F.S.
14
Section 466.024, (1), F.S.
BILL: CS/SB 356 Page 5
Administering local anesthesia.15
All other remediable tasks must be performed under the direct, indirect, or general supervision of
a dentist, after such additional training as required by BOD rule.16
A dentist may not delegate to anyone other than another licensed dentist:
Any prescription of drugs or medications requiring the written order or prescription of a
licensed dentist or physician; or
Any diagnosis for treatment or treatment planning.17
According to the DOH, a direct-to-consumer teeth aligner business model currently exists for
consumers. Dental impressions are being taken by the consumer using a dental impression kit
mailed by the aligner company, or the consumer visits a location for a digital scan by a
technician. The impression or image is then reviewed by a dentist to create custom aligners,
which are shipped back to the consumer for use. This business model does not include an in-
person examination by a licensed dentist or direct supervision by a licensed dentist when digital
scanning is performed.18
Dental Advertising
A licensed dentist’s advertisements may not contain any false, fraudulent, misleading, or
deceptive statement or claim or any statement or claim which:
Contains misrepresentations of fact;
Is likely to mislead or deceive because, in context, it makes only a partial disclosure of
relevant facts;
Contains laudatory statements about the dentist or group of dentists;
Is intended or is likely to create false, unjustified expectations of favorable results;
Relates to the quality of dental services provided as compared to other available dental
services;
Is intended or is likely to appeal primarily to a layperson’s fears;
Contains fee information without a disclaimer that such is a minimum fee only; or
Contains other representations or implications that in reasonable probability will cause an
ordinary, prudent person to misunderstand or to be deceived.19
15
Id.
16
Section 466.024(7), F.S.
17
Section 466.024(8), F.S.
18
Florida Department of Health, 2023 Agency Legislative Bill Analysis, Senate Bill 356, Jan. 25, 2023 (on file with the
Senate Committee on Health Policy).
19
Section 466.019, F.S.
BILL: CS/SB 356 Page 6
Telehealth
Section 456.47, F.S., defines the term “telehealth” as the use of synchronous or asynchronous
telecommunications technology by a telehealth provider to provide health care services,
including, but not limited to, assessment, diagnosis, consultation, treatment, and monitoring of a
patient; transfer of medical data; patient and professional health-related education; public health
services; and health administration. The term does not include audio-only telephone calls, e-mail
messages, or facsimile transmissions.
In a general sense, “synchronous” telehealth happens in live, real-time settings where the patient
interacts with a provider, usually via phone or video. Providers and patients communicate
directly, often resulting in a diagnosis, treatment plan, or prescription. Synchronous
telehealth can include additional at-home devices such as a blood pressure or heart rate monitors,
thermometers, oximeters, cameras, or scales to help the provider more accurately assess the
patient’s health status.20
“Asynchronous” telehealth, also known as “store-and-forward,” is often used for patient intake
or follow-up care. For example, a patient sends a photo of a skin condition that is later reviewed
by a dermatologist who recommends treatment.21
Section 456.47, F.S., also authorizes out-of-state health care providers to use telehealth to deliver
health care services to Florida patients if they register with the DOH or the applicable board22
and meet certain eligibility requirements.23 A registered out-of-state telehealth provider may use
telehealth, within the relevant scope of practice established by Florida law and rule, to provide
health care services to Florida patients but is prohibited from opening an office in Florida and
from providing in-person health care services to patients located in Florida without first
becoming licensed by the state of Florida.
A telehealth provider may not use telehealth to prescribe a controlled substance listed in
Schedule II24 or s. 893.03, F.S., unless the controlled substance is prescribed for the following:
The treatment of a psychiatric disorder;
Inpatient treatment at a hospital licensed under ch. 395, F.S.;
20
TELEHEALTH.HHS.GOV, “Synchronous direct-to-consumer telehealth,” available at
https://telehealth.hhs.gov/providers/direct-to-consumer/synchronous-direct-to-consumer-telehealth/ (last visited Apr. 17,
2023).
21
TELEHEALTH.HHS.GOV, “Asynchronous direct-to-consumer telehealth,” available at
https://telehealth.hhs.gov/providers/direct-to-consumer/asynchronous-direct-to-consumer-telehealth/ (last visited Apr. 17,
2023).
22
Under s. 456.001(1), F.S., the term “board” is defined as any board, commission, or other statutorily created entity, to the
extent such entity is authorized to exercise regulatory or rulemaking functions within DOH or, in some cases, within DOH’s
Division of Medical Quality Assurance (MQA).
23
Section 456.47(4), F.S.
24
Schedule II drugs, substances, or chemicals are defined as drugs with a high potential for abuse, with use potentially
leading to severe psychological or physical dependence. These drugs are also considered dangerous. Some examples of
Schedule II drugs are: combination products with less than 15 milligrams of hydrocodone per dosage unit (Vicodin), cocaine,
methamphetamine, methadone, hydromorphone (Dilaudid), meperidine (Demerol), oxycodone (OxyContin), fentanyl,
Dexedrine, Adderall, and Ritalin. United States Drug Enforcement Administration, Drug Scheduling, Schedule II, available at
https://www.dea.gov/drug-information/drug-scheduling (last visited Apr. 17, 2023).
BILL: CS/SB 356