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PA Bulletin, Doc. No. 00-1384




[49 PA. CODE CH. 33]

Continuing Dental Education and Biennial Renewals

[30 Pa.B. 4245]

   The State Board of Dentistry (Board) amends §§ 33.1, 33.105 and 33.106 and adds §§ 33.401--33.404 to read as set forth in Annex A pertaining to biennial renewals and continuing education requirements.

   Section 3(j.1) and (j.2) of the Dental Law (act) (63 P. S. § 122(j.1) and (j.2)) as amended in 1996, requires two conditions of biennial license or certification renewal for dentists, dental hygienists and expanded function dental assistants:

   1.  Licensees and certificateholders must obtain current certification to administer cardiopulmonary resuscitation (CPR).

   2.  Dentists shall complete 30 hours of continuing education credit, dental hygienists shall complete 20 hours of continuing education credit and expanded function dental assistants shall complete 10 hours of continuing education credit.

   The amendments also added section 3.1 to the act (63 P. S. § 122.1) setting forth additional requirements for restoration of licenses and certificates. The CPR and continuing education requirements for the lapsed period shall be satisfied before a license or certificate may be restored. Also, licensees and certificateholders who fail to renew their licenses/certificates for more than 5 years may be required to take the licensure examination.

   The regulatory amendments implement these provisions.

   Notice of proposed rulemaking was published at 28 Pa.B. 3293 (July 11, 1998). Publication was followed by a 30-day public comment period during which the Board received comments from the Pennsylvania Dental Hygienists' Association, Inc. (PDHA), the Pennsylvania Dental Association (PDA) and a dentist, a dental hygienist and an expanded function dental assistant. Following the close of the public comment period, the Board also received comments from the House Professional Licensure Committee (HPLC) and the Independent Regulatory Review Commission (IRRC). The Senate Consumer Protection and Professional Licensure Committee offered no comments, suggestions or objections to the amendments.

   In final rulemaking, the Board considered the comments and suggestions of the commentators. In addition, the Board considered this rulemaking and its purpose under the directives of Executive Order 1996-1, Regulatory Review and Promulgation.

   For ease of reference, the Board will address the comments and the Board's responses, in the order in which the amendments appear.

§ 33.1.  Definitions.

   IRRC commented that because the definition of ''credit hour'' contains a substantive provision in the second sentence, the definition should be moved to § 33.401 upon review of both sections, the Board is of the view that the definition will get lost in § 33.401. Therefore, the definition of ''credit hour''is retained in § 33.1.

   IRRC suggested that the definition of ''individual study'' be amended to specify that the individual study course shall be administered by an approved program sponsor. The Board has followed this suggestion and amended the definition accordingly.

   IRRC commented that the definition of ''program sponsor'' lacks clarity and is not consistent with section 3(j.2)(1) of the act. IRRC further suggested that the proposed definition could be interpreted to mean that individual programs, rather than the program sponsors, are approved by the Board, and suggested the definition be amended to state that the program sponsor is approved by the Board. The Board has implemented IRRC's suggestion as it clarifies the Board's intent. The PDHA suggested that the current definition of a program sponsor be labeled a ''program provider'' and a new definition for ''program sponsor'' be established. The Board has not adopted this suggestion as the intent is to have the program sponsors oversee the individual program provider, thus freeing the Board from oversight responsibilities for numerous program providers.

Subchapter B.  Licensure of Dentists and Dental Hygienists

   IRRC pointed out that Subchapter B had ''hygienists'' misspelled. This has been corrected.

§ 33.105.  Biennial renewal of licenses and certificates.

   The HPLC requested that the Board clarify that the continuing education credits are to be earned during the 2 years preceding the 2001-2003 biennial and that both certification and CPR in continuing education credits be completed to renew a license effective for the 2001-2003 biennial period. Section 33.105(b) is amended accordingly. IRRC suggested that this section does not adequately explain how the Board intends to notify licensees and certificateholders of the new requirements for continuing education. The regulation specifies that during the 1999-2001 renewal period, the continuing education requirements in §§ 33.401--33.404 shall be satisfied. The Board has revised and added clarifying language. As written, the section tracks the amendment to the act and provides for an enforcement mechanism beginning with the 2001-2003 renewal period.

   As proposed, the CPR requirement would be met by current certification from the American Heart Association or the American Red Cross. The HPLC suggested that the language of section 3(j.1) of the act should be broadly, rather than narrowly, construed. Accordingly, the Board has revised the requirement, so that any organization, charitable or for-profit, may provide qualifying courses. The Board has added a new sentence which provides that the content of certification courses be substantially similar to those offered by the American Heart Association and the American Red Cross, which the Board believes furthers the statutory intent in referencing certification by a bona fide charitable organization in section 3(j.1) of the act.

   The Board also believes that this language will assure minimum standards and consistency among organizations which provide CPR certification courses.

   IRRC suggested that the Board add the National Safety Council as an approved entity. Because the Board adopted the HPLC statutory interpretation, this change has not been adopted. IRRC also suggested that the Board should specify the minimum level of CPR certification acceptable. The Board has amended the proposal to provide that the certification shall include infant, child and adult CPR. The Board believes that this requirement furthers the legislative intent of the language ''CPR or basic life support.''

   The PDHA recommended that basic cardiac life support for the health care provider be the required form of CPR certification, as it is more extensive and covers infant, child and adult CPR, as opposed to basic CPR, which includes only resuscitation on adults. The Board concurred and amended § 33.105.

   The PDHA objected to subsection (b), providing that applicants for reactivation who have failed to renew for more than 5 years may be subject to reexamination. The objection was based upon allowing the Board the authority to determine who is subject to reexamination. The Board notes that the General Assembly has provided the Board with this discretion in section 3.1(b) of the act wherein these persons ''may be required to submit to a reexamination in accordance with Section 3.''

§ 33.401.  Credit-hour requirements.

   A commentator and the PDHA suggested that the Board allow credit hours to be carried over from a previous biennial period. Because of the minimal number of credit hours required and the administrative cost of tracking carryover hours, the Board has determined not to allow carryover.

   The PDHA recommended that subsection (b) be amended to read ''the required hours shall be taken from a program approved by a program sponsor.'' The Board believes that this change is not warranted in a section outlining subject areas.

   IRRC and the PDHA questioned the need for the requirement in subsection (c) that at least 50% of the required credit hours be taken in lecture or clinical presentation. The Board believes that this requirement is necessary and that the opportunity to interact with the instructor and other participants is crucial to learning clinical subject matter whether in didactic or ''hands-on'' learning experiences.

   IRRC suggested that subsection (d)(1) be amended to require that additional credit hours for instructors are subject to the limitations of subsection (e). Subsection (d)(1) has been amended accordingly.

   The PDHA suggested that the term ''instructor'' be defined. The Board prefers not to limit the definition of ''instructor,'' to include instructors at educational institutions and allow them to receive credit for teaching.

   The PDHA recommended that subsection (d)(1) be amended to ''instructors will be awarded two hours of preparation time plus one hour of instruction time for each hour spent instructing.'' Subsection (d)(1) has been amended to clarify that actual instruction would be covered.

   IRRC commented that subsection (d)(2) is vague regarding what standard authors' work would have to meet to qualify for additional credit up to 50%. In response, the Board has amended this subsection.

   A commentator suggested that ''instructors'' in subsection (d) should have the same license or certificate as those they teach. The Board believes that such a requirement is unnecessarily restrictive and would prohibit physicians, dentists and others from providing qualified instructors.

   A commentator suggested that subsection (d) be amended to reference § 33.402. The Board does not believe a cross-reference in this case is necessary.

§ 33.402.  Continuing education subject hours.

   IRRC suggested that subsection (a)(3) be amended to clarify that CPR certification training hours would not be included as continuing education credit hours. This section has been revised accordingly.

   IRRC, the PDHA and a commentator suggested that subsection (b)(5), wherein credit hours would not be awarded for communication skills, should not be excluded since dental hygienists need the ability to communicate with patients to promote changes in the patients' daily hygiene. The Board concurs with the assessment that all practitioners should work to improve their ability to communicate with patients. However, the Board believes that the continuing education requirement should be limited to substantive areas of clinical practice. By so doing, the Board believes that the regulation will more nearly track the legislative intent to ensure that practitioners keep abreast of technological and scientific developments.

§ 33.403.  Program sponsors.

   IRRC and the PDHA suggested that subsection (b)(1) should specify how far in advance the program sponsor is required to disclose the information. The Board believes that requiring advance notification and more specificity is not needed with this requirement.

   IRRC suggested that the last sentence in subsection (b)(3) be amended to focus on requiring the instructor to provide accurate materials rather than when errata sheets are developed. This subsection has been revised by omitting the last sentence which requires instructors, prior to developing errata sheets, to be responsible for informing participants of changes.

   IRRC requested an explanation as to why subsection (b)(6) requires attendance records and outlines to be kept for a 5-year period, when the most recent preceding biennial period should suffice to allow the Board to audit complaints. The 5-year period was selected for clarity. Program sponsors may not necessarily know exactly when a biennial period runs. In accordance with the recommendation of the House Professional Licensure Committee, the Board has changed the requirement to 4 years, which would cover the same amount of time as that suggested by IRRC, that is, the current and most recent renewal period.

   IRRC suggested that the Board should provide that if the approval of a program sponsor identified in § 33.403(a) is withdrawn, the section will be amended accordingly. The Board concurs with the suggestion and has changed this subsection to reflect the comment.

   IRRC suggested that § 33.403 should provide guidance on obtaining approval as a program sponsor and adding sponsors in rulemaking. The Board has added a subsection (d) implementing this suggestion.

   The PDHA recommended that the responsibilities of program sponsors be amended to be the responsibilities of program providers. The Board believes that these responsibilities should be those of program sponsors, as provided in the proposed regulations.

   The House Professional Licensure Committee suggested that subsection (b)(4) be amended to reference another regulation concerning the provision of adequate facilities that provide physical access to licensees in the conformance with applicable law. The subsection has been amended to clarify that physical facilities must be adequate to both the type as well as the number of participants. The Board believes that other laws and regulations adequately cover handicapped accessibility.

   The PDHA recommended that subsection (a)(2) and (5) include the equivalent nursing associations. These sections have been amended accordingly.

   The PDHA suggested that a provision be added for special, temporary or one-time program sponsors and for adding new sponsors. As previously discussed, a new subsection (d) has been added for new sponsors.

§ 33.404.  Reporting continuing education credit hours.

   IRRC suggested amending subsection (b) to use the phrase ''required credit hours'' instead of ''required hours.'' The Board has amended this section accordingly.

   IRRC suggested amending subsection (d) to require maintenance and documentation for the current and most recent preceding biennial period, which would be a maximum of 4 years. As discussed in reference to § 33.403(b)(6), the Board believes that a specific period of years is clearer and that a 4-year period is needed to cover documentation for any discrepancies or legal concerns that may later arise.

   IRRC suggested referencing the statute in subsection (e) to cover falsification by expanded function dental assistants, in case the regulations governing expanded function dental assistants are not completed prior to completion of these regulations. The Board agreed and inserted a reference to the statute.

   IRRC suggested combining subsection (a) with (e) and subsection (b) with (f) because they concern the same subject matter. The Board had structured the subsections to combine affirmative requirements and sanctions and prefers to retain the structure of the subsections as proposed to enable the requirements of subsections (e) and (f) to stand alone.

Compliance with Executive Order 1996-1, Regulatory Review and Promulgation

   The Board reviewed this rulemaking and considered its purpose and likely impact upon the public and the regulated population under the directives of Executive Order 1996-1, Regulatory Review and Promulgation. The final-form regulations address a compelling public interest as described in this Preamble and otherwise comply with Executive Order 1996-1.

Fiscal Impact and Paperwork Requirements

   1.  Commonwealth--The amendments will require the Board to assure compliance with the continuing education requirement before renewing a license or certificate. The costs associated with implementing these amendments, including an audit, will be borne by the general licensee/certificateholder population through biennial renewal fees which generate revenue for all Board activities. Additional paperwork will be incurred by the Board to amend renewal application forms.

   2.  Political subdivisions--There will be no adverse fiscal impact or paperwork requirements imposed.

   3.  Private sector--There will be no adverse fiscal impact or paperwork requirements imposed.

Statutory Authority

   The amendments for continuing education, certification in CPR and restoration are governed by sections 3(j.1) and (j.2) and 3.1 of the act.

Sunset Date

   The Board continually monitors the effectiveness of its regulations through communications with the regulated population; accordingly, no sunset date has been set.

Regulatory Review

   Under section 5(a) of the Regulatory Review Act (71 P. S. § 745.5(a)), on May 22, 2000, the Board submitted a copy of the notice of proposed rulemaking, published at 28 Pa.B. 3293 to IRRC and the Chairpersons of the House Professional Licensure Committee and the Senate Consumer Protection and Professional Licensure Committee for review and comment. In compliance with section 5(c) of the Regulatory Review Act, the Board also provided IRRC and the Committees with copies of the comments received, as well as other documentation. In preparing these final-form regulations, the Board has considered the comments received from IRRC and the public.

   Under section 5.1(d) of the Regulatory Review Act, these final-form regulations were approved by the House Committee on June 6, 2000, and approved by the Senate Committee on June 12, 2000. IRRC met on June 22, 2000, and approved the final-form regulations in accordance with section 5.1(e) of the Regulatory Review Act (71 P. S. § 745.5a(e)).

Contact Person

   Further information may be obtained by contacting Lisa Burns, Administrative Assistant, State Board of Dentistry, P. O. Box 2649, Harrisburg, PA 17105-2649, (717) 783-7162.


   The Board finds that:

   (1)  Public notice of proposed rulemaking was given under sections 201 and 202 of the act of July 31, 1968 (P. L. 769, No. 240) (45 P. S. §§ 1201 and 1202) and the regulations promulgated thereunder in 1 Pa. Code §§ 7.1 and 7.2.

   (2)  A public comment period was provided as required by law and all comments were considered.

   (3)  These amendments do not enlarge the purpose of proposed rulemaking published at 28 Pa.B. 3293.

   (4)  These amendments are necessary and appropriate for administration and enforcement of the Board's authorizing statute.


   The Board, acting under its authorizing statute, orders that:

   (a)  The regulations of the Board, 49 Pa. Code Chapter 33, are amended by amending §§ 33.1, 33.105 and 33.106 and by adding §§ 33.401--33.404 to read as set forth in Annex A, with ellipses referring to the existing text of the regulation.

   (b)  The Board shall submit this order and Annex A to the Office of General Counsel and to the Office of Attorney General as required by law.

   (c)  The Board shall certify this order and Annex A and deposit them with the Legislative Reference Bureau as required by law.

   (d)  This order shall take effect upon publication in the Pennsylvania Bulletin.


   (Editor's Note:  For the text of the order of the Independent Regulatory Review Commission, relating to this document, see 30 Pa.B. 3534 (July 8, 2000).)

   Fiscal Note:  Fiscal Note 16A-464 remains valid for the final adoption of the subject regulations.

Annex A






§ 33.1.  Definitions.

   The following words and terms, when used in this chapter, have the following meanings, unless the context clearly indicates otherwise:

*      *      *      *      *

   Continuing education certificate--A document prepared by the program sponsor which contains the title of the course, the dates attended or completed and the hours of education completed.

   Credit hour--A minimum unit of continuing education consisting of 60 minutes of instruction. Programs longer than 60 minutes will be credited in 30 minute increments.

*      *      *      *      *

   Individual study--A course of continuing education offered by an approved program sponsor, which permits the participant to learn without interacting with an instructor or interactive learning methodologies and which requires a passing grade on a written examination or workbook.

*      *      *      *      *

   Program sponsor--The party approved by the Board who is responsible for the development and presentation of the continuing dental education program.

*      *      *      *      *


§ 33.105.  Biennial renewal of licenses and certificates.

   (a)  Licenses and certificates are renewable for a 2-year period beginning April 1 of each odd-numbered year. The fee for the biennial renewal is set by the Board. See § 33.3 (relating to fees). Upon renewal, licensees and certificate holders receive new biennial renewal licenses or certificates, as appropriate, and wallet-size cards which include the expiration date.

   (b)  As a condition of biennial renewal, commencing with the 2001-2003 renewal period, licensees and certificate holders shall maintain current certification in infant, child and adult cardiopulmonary resuscitation and continuing education requirements specified in §§ 33.401--33.404 (relating to continuing dental education). Licensees and certificate holders shall certify their compliance with this subsection when renewing their licenses on and after April 1, 2001. Courses for certification in cardiopulmonary resuscitation (CPR) shall be substantially similar in content to the CPR courses offered by the American Heart Association and the American Red Cross and have a similar renewal period.

   (c)  Dentists and dental hygienists who fail to renew their licenses and expanded function dental assistants who fail to renew their certificates are prohibited from practicing their profession in this Commonwealth.

§ 33.106.  Reactivation of licenses and certificates.

   (a)  Dentists and dental hygienists who have failed to renew their licenses and expanded function dental assistants who have failed to renew their certificates may apply for reactivation on forms prescribed by the Board. The applicant for reactivation shall pay the current biennial renewal fee, provide evidence of current certification in cardiopulmonary resuscitation, and shall submit a notarized affidavit identifying the period of time in which the applicant did not practice in this Commonwealth. Effective with the 1999-2001 renewal period, licensees and certificate holders shall also complete the continuing education requirements for the renewal periods during which the license or certificate was not renewed.

   (b)  In addition to the requirements in subsection (a), an applicant for reactivation who has failed to renew for more than 5 years may be subject to reexamination under section 3.1(b) of the act (63 P. S. § 122.1.(b)).

   (c)  An applicant for reactivation who practiced in this Commonwealth without a current license or certificate shall pay a later renewal fee of $5 for each month or part of a month during which the unauthorized practice occurred, as provided in section 225 of the Bureau of Professional and Occupational Affairs Fee Act (63 P. S. § 1401-225). In addition, the applicant shall pay the biennial renewal fee for each biennium during which unauthorized practice occurred. The payment of late fees and biennial renewal fees does not preclude the Board from taking disciplinary action against a dentist or dental hygienist who practice without a current license or an expanded function dental assistant who practice without a current certificate.



33.401.Credit-hour requirements.
33.402.Continuing education subject areas.
33.403.Program sponsors.
33.404.Reporting continuing education credit hours.

§ 33.401.  Credit-hour requirements.

   (a)  An applicant shall complete the following continuing education credit hours during the preceding biennial period:

   (1)  Dentists--30 hours.

   (2)  Dental hygienists--20 hours.

   (3)  Expanded function dental assistants--10 hours.

   (b)  The required hours shall be taken in the subject areas listed in § 33.402 (relating to continuing education subject areas) from a program sponsor listed in § 33.403 (relating to program sponsors).

   (c)  At least 50% of the required credit hours shall be taken in lecture or clinical presentations.

   (d)  A maximum of 50% of the required credit hours, listed in § 33.402, may be taken through individual study, serving as an instructor or author of a book, article or continuing education program.

   (1)  Instructors will be awarded two additional credit hours as preparation time for each credit hour of instruction, and for actual instruction, up to 50% of the required hours. Additional credit hours for instructors are subject to the limitations of subsection (e).

   (2)  Authors will be awarded 50% of the required hours for articles published in a peer-reviewed professional journal.

   (e)  Credit will not be awarded for repeating a program in the same renewal period unless the subject matter has substantially changed during that period.

   (f)  A licensee or certificate holder suspended for disciplinary reasons is not exempt from the continuing education requirements in subsection (a).

   (g)  Exceptions are as follows:

   (1)  An applicant is exempt from the continuing education requirement in subsection (a) for only the biennial period during which the applicant passed the licensure or certification examination.

   (2)  An applicant who cannot meet the continuing education requirement due to illness, emergency or hardship may apply to the Board in writing for a waiver. The request shall explain why compliance is impossible. Waiver requests will be evaluated by the Board on a case-by-case basis.

§ 33.402.  Continuing education subject areas.

   (a)  The required credit hours shall be completed in subjects which contribute directly to the maintenance of clinical competence of a dentist, dental hygienist or expanded function dental assistant. Examples of acceptable subjects include:

   (1)  Diagnosis and treatment of oral pathosis.

   (2)  Clinical and technological subjects.

   (3)  Emergency procedures excluding hours required for cardiopulmonary resuscitation (CPR) certification.

   (4)  Infection control.

   (5)  Abuse and neglect.

   (6)  Medical and scientific subjects.

   (7)  Laws and regulations pertaining to dentists, dental hygienists and expanded function dental assistants.

   (b)  Credit hours will not be awarded in nonclinical subjects, including:

   (1)  Billing.

   (2)  Office management.

   (3)  Practice building.

   (4)  Insurance reimbursement.

   (5)  Communication skills.

§ 33.403.  Program sponsors.

   (a)  The Board has approved the following as program sponsors:

   (1)  An accredited dental, dental hygiene or expanded function dental assisting school or program.

   (2)  The medical or osteopathic medical school or college accredited by an accrediting body recognized by the State Board of Medicine, State Board of Osteopathic Medicine or State Board of Nursing.

   (3)  The American Dental Association Continuing Education Review Program, the American Dental Association's speciality associations, the American Dental Hygienists Association and the American Dental Assistants Association.

   (4)  The National Dental Association and its speciality societies and the National Dental Hygienists Association.

   (5)  The American Medical Association, American Osteopathic Medical Association and the American Nursing Association.

   (6)  The Pennsylvania Academy of Dental Hygiene Studies.

   (7)  The Academy of General Dentistry National Sponsor Approval Program.

   (8)  The Veterans' Administration.

   (9)  The United States military services.

   (10)  The National Institutes of Health.

   (11)  The United States Public Health Services.

   (b)  Program sponsors shall:

   (1)  Disclose in advance to prospective participants the objectives, prerequisites, experience level, content, required advanced preparation, teaching method and number of continuing education credits involved in the program.

   (2)  Conduct programs in subjects which contribute directly to the maintenance of clinical competence of a dentist, dental hygienist or expanded function dental assistant.

   (3)  Provide program materials which are accurate and consistent with currently accepted standards relating to the program's subject matter.

   (4)  Provide sufficient and adequate physical facilities for the number and type of participants and the teaching methods to be utilized.

   (5)  Evaluate the program, through questionnaires of the participants and instructors, to determine its effectiveness.

   (6)  Retain accurate attendance records and written outlines for a 4-year period.

   (7)  Provide participants with a continuing education certificate after assuring satisfactory completion and attendance of the program.

   (c)  The Board may, following notice and hearing under 2 Pa.C.S. §§ 501--508 (relating to practice and procedure of Commonwealth agencies), withdraw the approval of a program sponsor for cause and amend subsection (a) accordingly.

   (d)  A party desiring to be an approved program sponsor shall file a written petition with the Board outlining the party's qualifications and experience. Upon Board approval, subsection (a) will be amended accordingly.

§ 33.404.  Reporting continuing education credit hours.

   (a)  The applicant shall provide the requested information concerning the required hours on an application for biennial renewal.

   (b)  The applicant shall provide a copy of the documentation supporting the completion of the required credit hours when requested to do so by the Board.

   (c) Acceptable documentation consists of any one of the following:

   (1)  A continuing education certificate or sponsor-generated printouts.

   (2)  A certified transcript of courses taken for credit in an accredited university or college. For noncredit courses taken, a statement of hours of attendance, signed by the instructor.

   (3)  Evidence of publication for published articles, books or continuing education programs.

   (4)  Evidence obtained from the program sponsor of having been an instructor, including an agenda.

   (d)  The responsibility for documenting the continuing education requirements rests with the applicant. The documentation shall be maintained for 4 years after the completion of the program.

   (e)  Falsification of information required under subsection (a) constitutes a violation of § 33.212(1) (relating to misleading, deceptive, untrue or fraudulent representations) and section 4.1 of the act (63 P. S. § 123.1(a)(2)).

   (f)  Failure to comply with subsection (b) may result in disciplinary or corrective action.

[Pa.B. Doc. No. 00-1384. Filed for public inspection August 11, 2000, 9:00 a.m.]

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