Laws and Rules

Laws - The ND Dental Practice Act

Although the title implies the subject matter is purely related to dentists, the Act pertains to dentists, dental hygienists, and dental assistants. The Dental Practice Act therefore consists of Chapter 43-28, Chapter 43-28.1 and Chapter 43-20. Although Chapter 43-28, relates more specifically to the dentist it also applies to dental hygienists and dental assistants with equal force when applicable. Chapter 43-20 relates to dental hygienists and dental assistants. Chapter 43-28.1 is specifically the Dentists’ Loan Repayment Program.

Statute - North Dakota Century Code 43-28-01 through 43-28-27 - Dentist

Statute - North Dakota Century Code 43-28.1 - Dentist

Statute - North Dakota Century Code 43-20-01through 43-20-12 - Hygienist and Dental Assistant

Administrative Rules

How is a Rule different than the Law? Rules further clarify and define the laws contained in the Dental Practice Act. For example the laws governing a dental hygienist in Chapter 43-20 describe the dental hygiene scope of permitted practice. The Administrative Rules specifically describe what is included and excluded from the practice of dental hygiene in ND. Administrative rules have the force of law.

The Board cannot provide legal advice, however the rules and laws are straightforward leaving little room for interpretation.

NEW ADMINISTRATIVE RULES - Effective July 1, 2017 North Dakota Administrative Code 20-01 through 20-05

ND Laws and Rules Book

The Law and Rules Book contains all the law and rules mentioned above but is in one document easy to use document. You may use this to take the Jurisprudence exam or print it for your file.

Dentists' Loan Repayment Program

43-28.1. Provides funding to support dentists providing dental services in cities or surrounding areas, or both in which the state health council identifies as having a defined need for dental services. Dentist must agree to accept medical assistance patients and assignments. For further information, see http://www.ndhealth.gov/pco/main.asp

Prescribers Please Read - Laws for using the Prescription Drug Monitoring Program

20-02-01-12. Dental prescribers and use of the prescription drug monitoring program. Subject to the exceptions described in section 20-02-01-13, prior to the initial prescribing of any controlled substance, including samples, a dentist authorized by the drug enforcement administration to prescribe, administer, sign for, dispense, or procure pharmaceuticals shall authorize an employee to review or personally request and review the prescription drug monitoring program report for all available prescription drug monitoring program data on the patient within the previous twelve months, and shall do all of the following:

1. Assess a patient's drug monitoring program data every twelve months during the patient's treatment with a controlled substance.

2. Review the patient's prescription drug monitoring program data if the patient requests early refills or demonstrates a pattern of taking more than the prescribed dosage.

3. Review the patient's prescription drug monitoring program data if there is a suspicion of or a known drug overuse, diversion, or abuse by the patient.

4. Document the assessment of the patient's prescription drug monitoring program data.

5. Discuss the risks and benefits of the use of controlled substances with the patient, the patient's parent if the patient is an unemancipated minor child, or the patient's legal guardian or health care surrogate, including the risk of tolerance and drug dependence.

6. Request and review prescription drug monitoring program data on the patient if the practitioner becomes aware that a patient is receiving controlled substances from multiple prescribers.

7. Request and review the patient's prescription drug monitoring program data if the prescriber has a reasonable belief that the patient may be seeking the controlled substance, in whole or in part, for any reason other than the treatment of an existing medical condition.

20-02-01-13. Exceptions to the review requirement. A practitioner may not be required to review a patient's prescription drug monitoring program data if any of the following apply:

1. The controlled substance is prescribed or dispensed for a patient who is currently receiving hospice care.

2. The controlled substance is prescribed or dispensed to a patient of record as a nonrefillable prescription as part of treatment for a surgical procedure.

3. The dentist prescribes a controlled substance after the performance of oral surgery and no more than a seventy-two hour supply of the controlled substance is prescribed.

4. The dentist prescribes pre-appointment medication for the treatment of procedure anxiety.

5. The dentist obtains a report through a board-approved risk assessment tool for health care providers that accesses patient prescription information from prescription drug monitoring program databases, analyzes the data, and provides a risk-based score that includes prescription drug monitoring program data.

PRESCRIBERS: Register for the Prescription Drug Monitoring Program [PDMP]: https://www.nodakpharmacy.com/pdfs/NDPMP_AWARxE_UserSupportManual.pdf

Patient Records Retention

ND Administrative Rules 20-02-01-09 - Retention of records: A dentist shall retain a patient's dental record for a minimum of six years after the patient's last examination, prescription, or treatment. Records for minors shall be retained for a minimum of either one year after the patient reaches the age of eighteen or six years after the patient's last examination, prescription, or treatment, whichever is longer. Proper safeguards shall be maintained to ensure safety of records from destructive elements. The requirements of this rule apply to electronic records as well as to records kept by any other means.
History: Effective April 1, 2006; amended effective January 1, 2011.
General Authority: NDCC 43-28-06 Law Implemented: NDCC 43-28-06

Ethics

The Code of Ethics as defined in the Administrative Rules means the April 2016 version of the American Dental Association's Principles of Ethics and Code of Professional Conduct . A violation of the Code of Ethics adopted by the Board by rule is grounds for disciplinary action. Two continuing education hours pertaining to Ethics and Jurisprudence is required for renewal of license and registration.

Other Laws Governing Dentistry

Board of Pharmacy 61-12-01-02. Dispenser Reporting.

Each dispenser licensed by a regulatory agency in the state of North Dakota who dispenses a controlled substance to a patient shall submit to the central repository by electronic means information regarding each prescription dispensed for a controlled substance. The information submitted for each prescription shall include all of the data elements in the American society for automation in pharmacy rules-based standard implementation guide for prescription monitoring programs issued September 2011, version 4, release 2.
Each dispenser shall submit the information required by this chapter to the central repository at least once every day unless the board waives this requirement for good cause shown by the dispenser.
An extension of the time in which a dispenser must report the information required by this chapter may be granted to a dispenser that is unable to submit prescription information by electronic means if:

a. The dispenser suffers a mechanical or electronic failure or cannot report within the required time for other reasons beyond the dispenser’s control; or

b. The central repository is unable to receive electronic submissions. [effective October 1, 2014]

61-12-01-04. Required use for certain dispensing situations.

Prior to dispensing a prescription, each dispenser licensed by a regulatory agency in the state of North Dakota who dispenses a controlled substance to a patient, for the treatment of pain or anxiety shall, at a minimum, request and review a prescription drug monitoring report covering at least a one-year time period or another state’s report, or both reports, when applicable and available, if the dispenser becomes aware of a person currently:

a. Receiving reported drugs from multiple prescribers;

b. Receiving reported drugs for more than twelve consecutive weeks;

c. Abusing or misusing reported drugs (i.e., over-utilization; early refills; appears overly sedated or intoxicated upon presenting a prescription for a reported drug; or an unfamiliar patient requesting a reported drug by specific name, street name, color, or identifying marks);

d. Requesting the dispensing of a reported drug from a prescription issued by a prescriber with whom the dispenser is unfamiliar (i.e., the prescriber is located out-of-state or the prescriber is outside the usual pharmacy geographic prescriber care area); or

e. Presenting a prescription for reported drugs when the patient resides outside the usual pharmacy geographic patient population.

After obtaining an initial prescription drug monitoring report on a patient, a dispenser shall use professional judgment based on prevailing standards of practice in deciding the frequency of requesting and reviewing further prescription drug monitoring reports or other state’s reports, or both reports, for that patient.
In the rare event a report is not immediately available, the dispenser shall use professional judgment in determining whether it is appropriate and in the patient’s best interest to dispense the prescription prior to receiving and reviewing a report.
For the purpose of compliance with subsection 1, a report could be obtained through a prescription drug monitoring program integration with software or also a board-approved aggregate tool, for which the NARxCHECK will be an approved tool. The national association of boards of pharmacy foundation's NARxCHECK service is a risk assessment tool for health care providers and pharmacists that accesses patient prescription information from prescription drug monitoring databases, analyzes the data, and provides a risk-based score that includes prescription drug monitoring program data and graphical analysis to assist in prescribing and dispensing decisions. [effective October 1, 2014]

43-15-31.3. Oral transmission of prescriptions.

An oral transmission of a prescription drug may be accepted and dispensed by a pharmacist or licensed pharmacist intern if received from a practitioner, or a nurse licensed under Chapter 43-12.1 who is authorized by the practitioner to orally transmit the prescription, or a registered dental hygienist or a registered dental assistant who is authorized by the supervised dentist to orally transmit the prescription. The practitioner shall document the order for oral transmission in the patient's records. Only a licensed pharmacist or a licensed pharmacist intern or a registered pharmacy technician may receive an orally transmitted new or refill prescription.

43-51-11.1. Military spouses - Licensure.

1. The NDBDE (the board) shall grant on a case-by-case basis exceptions to the board's licensing standards to allow a military spouse to practice the occupation or profession in the state if upon application to the board:

a. The military spouse demonstrates competency in the occupation or profession through methods or standards determined by the board which must include experience in the occupation or profession for at least two of the four years preceding the date of application under this section; and

b. The board determines the issuance of the license will not substantially increase the risk of harm to the public. The board has authority to require an applicant to submit to a statewide and national criminal history record check under section 12-60-24 may order such a record check under this subdivision.

2. The board shall issue a provisional license or temporary permit to a military spouse for which the licensure requirements under subsection 1 have been substantially met. A board may not charge a military spouse any fees for a provisional license or temporary permit under this subsection. A provisional license or temporary permit issued under this subsection may not exceed two years and remains valid while the military spouse is making progress toward satisfying the unmet licensure requirements. A military spouse may practice under a provisional license or temporary permit issued under this subsection until any of the following occurs:

a. The board grants or denies the military spouse a North Dakota license under subsection 1 or grants a North Dakota license under the traditional licensure method;

b. The provisional license or temporary permit expires;

c. The military spouse fails to comply with the terms of the provisional license or temporary permit; or

d. The board revokes the provisional license or temporary permit based on a determination revocation is necessary to protect the health and safety of the residents of the state.

3. The board that may elect to subject the board to this chapter under subsection 1 of section 43-51-01 may issue a license, provisional license, or temporary permit to a military spouse in the same manner as provided under subsections 1 and 2 regardless of whether the board has adopted rules to subject the board to this chapter.

4. A military spouse issued a license under this section has the same rights and duties as a licensee issued a license under the traditional licensure method.

5. If within thirty days of receipt of a completed application under subsection 1 the board does not grant or deny a license under subsection 1 or does not issue a provisional license or temporary permit under subsection 2, the board automatically shall issue a provisional license or temporary permit. A provisional license or temporary permit issued under this subsection remains valid until the board grants or denies the application for licensure under subsection 1 or issues a provisional license or temporary permit under subsection 2.

NDCC Ch. 23-12-14. Copies of medical records and medical bills.

As used in this section, "health care provider" means a licensed individual or licensed facility providing health care services. Upon the request of a health care provider's patient or any person authorized by a patient, the provider shall provide a free copy of a patient's health care records to a health care provider designated by the patient or the person authorized by the patient if the records are requested for the purpose of transferring that patient's health care to another health care provider for the continuation of treatment.
Except as provided in subsection 1, upon the request for medical records or medical bills with the signed authorization of the patient, the health care provider shall provide medical records and any associated medical bills either in paper or facsimile format at a charge of no more than twenty dollars for the first twenty-five pages and seventy-five cents per page after twenty-five pages or in an electronic, digital, or other computerized format at a charge of thirty dollars for the first twenty-five pages and twenty-five cents per page after twenty-five pages. This charge includes any administration fee, retrieval fee, and postage expense.

A Word about Transfer of Dental Records

The Board frequently answers questions raised by consumers and dental practitioners regarding the transfer of dental records. Practitioners are confused regarding when a fee can be charged to a patient who requests a transfer of dental record. While both sections discuss transfer of record, Section (1) provides for a patient who transfers his/her record to another practitioner. In this the provider must transfer all records free of charge. Section (2) provides for the patient who authorizes a release of records to anyone other than a healthcare provider for the purpose of continuation of treatment. Examples of this scenario include transfer of record to an attorney, insurance company or other entity.

NDCC Ch. 10-31-13. Professional organizations - Annual reports - Renewal.

A professional corporation must file an annual report with the Secretary of State:

If a domestic corporation (incorporated according to North Dakota laws) on or before August 1st of each year. The first annual report is due in the year following that in which the Secretary of State initially chartered the corporation. If a foreign corporation (incorporated according to laws of another jurisdiction other than North Dakota) on or before May 15th of each year. The first annual report is due in the year following that in which the corporation was initially authorized to transact business by the Secretary of State. On the form prescribed by the Secretary of State. If the corporation did not receive an annual report form, the form can be obtained from this website, or contact the Secretary of State’s office for another form. A copy of the report filed with the Secretary of State must also be supplied to the regulatory board that issued the professional licenses to the officers and shareholders who practice in North Dakota.

NDCC Ch. 50-25.2-03. Reporting of abuse or neglect - Method of reporting.

Any medical or mental health professional or personnel, law enforcement officer, firefighter, member of the clergy, or caregiver having knowledge that a vulnerable adult has been subjected to abuse or neglect, or who observes a vulnerable adult being subjected to conditions or circumstances that reasonably would result in abuse or neglect, shall report the information to the department or the department's designee or to an appropriate law enforcement agency if the knowledge is derived from information received by that person in that person's official or professional capacity. A member of the clergy, however, is not required to report the information if the knowledge is derived from information received in the capacity of spiritual adviser. For purposes of this subsection, "medical or mental health professional or personnel" means a professional or personnel providing health care or services to a vulnerable adult, on a full-time or part-time basis, on an individual basis or at the request of a caregiver, and includes a physician, nurse, medical examiner, coroner, dentist, dental hygienist, optometrist, pharmacist, chiropractor, podiatrist, physical therapist, occupational therapist, addiction counselor, counselor, marriage and family therapist, social worker, mental health professional, emergency medical services personnel, hospital personnel, nursing home personnel, congregate care personnel, or any other person providing medical and mental health services to a vulnerable adult.

50-25.1-03. Persons required and permitted to report - To whom reported.

Any physician, nurse, dentist, optometrist, dental hygienist, medical examiner or coroner, or any other medical or mental health professional, religious practitioner of the healing arts, schoolteacher or administrator, school counselor, addiction counselor, social worker, child care worker, foster parent, police or law enforcement officer, juvenile court personnel, probation officer, division of juvenile services employee, or member of the clergy having knowledge of or reasonable cause to suspect that a child is abused or neglected, or has died as a result of abuse or neglect, shall report the circumstances to the department if the knowledge or suspicion is derived from information received by that person in that person's official or professional capacity. A member of the clergy, however, is not required to report such circumstances if the knowledge or suspicion is derived from information received in the capacity of spiritual adviser.

26.1-36-09.15(c) Coverage of telehealth services.

"Health care provider" includes an individual licensed under chapter 43-28.

Substantiated Policies

Patient Records | Laser Technology | Mercury-free Dentistry | Record Keeping | Teeth Whitening Services

Patient Records

The purpose of this policy is to clarify the Board's position and laws regarding the ownership and release of patient records. The American Dental Association calls upon dentists to follow high ethical standards who have the benefit of the patient as their primary goal. Failure to release a copy of the patient record upon request of the patient or the patient's parent/legal guardian to do so is grounds for discipline pursuant to North Dakota Century Code § 43-28-18 and NDCC § 23-12-14.

Record, defined: A patient record includes any document or combination of documents that pertains to a patient's medical/dental history, diagnosis, prognosis, or medical/dental condition, and that is generated and maintained in the process of the patient's dental treatment. Patient records include:

Medical/dental history.
Written progress notes.
Radiographs.
Models.
Billing information
Insurance claims

A patient record should not include:

Care related to another patient.
Peer review/quality assurance information/documents.
Correspondence/notes from attorneys.
Aberrant/deviant statement.

Ownership: Patient records belong to the treating practitioner; however, the patient has an absolute right to a copy of his/her patient records.

Costs: This obligation to provide a copy of records exists whether or not the patient's account is paid in full. Since the patient has an absolute right to a copy of his/her records, a dentist may not ignore a request for records due to an unpaid balance for services rendered. Further, a dentist cannot demand payment for copies up front. The dentist may add the fee ( provided the costs are provided for in NDCC 23-12-14) for copies to the unpaid balance, and include this in any claim for reimbursement, but records cannot be held hostage for payment of any kind.

Disclaimer: Nothing in this policy supercedes the confidentiality requirements outlined in the Health Insurance Portability and Accountability Act. Further these statements does not apply to records subpoenaed for the North Dakota State Board of Dental Examinations investigation/enforcement purposes as those requests are exempted from the protections under HIPPA.

Laser Technology

It is the position of the Board that any services provided by a licensee, regardless of the devise used, must be within the scope of practice for each licensee. Whenever a new treatment modality is brought forward, it is the Board’s policy that the dentist must have equal or greater proficiency and training in the technology. Licensees utilizing the new technology must maintain documentation of the satisfactory completion of the formal continuing education or training. The particular technology utilized does not alter the fact that the dentist is ultimately responsible.

Mercury-free Dentistry

There are no rules or regulations in place that would prohibit a licensee from discussing the pros and cons of specific filling materials with a patient. The Board does not regulate the filling materials used as long as the treatment rendered conforms to the standard of care and is the appropriate treatment for the diagnosis. As is the approach of this Board regarding mercury-free dentistry and other professional practice related areas, the Board makes determinations within its disciplinary jurisdiction. This is consistent with the mandated mission of the Board, which is to assure that licensees practice in an ethical and competent manner that is appropriate to preserve the health, safety, and welfare of the public.

What should a dentist do if a patient asks him or her to remove their serviceable amalgams?
A dentist is not ethically obligated to remove serviceable dental amalgams from the non-allergic patient at the patient’s request or even the recommendation of the patient’s physician. The dentist has the professional obligation to use his or her independent judgment about the dental treatment that is best for the patient. The dentist is free to suggest that the patient seek dental care elsewhere.
If a dentist agrees to remove serviceable amalgam restorations from the non-allergic patient at the patient’s request:
The dentist should clearly state that he or she promises no health benefits to the patient by removing serviceable amalgam restorations. The dentist should take special care to obtain the patient’s informed consent to the procedure and thoroughly document that consent in the patient’s records. The patient should be informed of the risks involved in replacing amalgam restorations, including potential damage to healthy tooth structure and the loss of sound tissue in the process and the costs.

Review with the patient the current scientific data on the safety of dental amalgams – that there is no evidence that amalgams pose a significant health risk to non-allergic patients and that no known health benefits result from the removal of dental amalgams. Provide the same data for the alternative materials suggested for use.

Although the State Board of Dental Examiners recognizes the right of the patient to request removal of amalgam dental fillings by a licensed dentist, the dentist may not make a diagnosis of mercury toxicity nor make a claim that removal of amalgam dental fillings will result in a cure, alleviation, or improvement, of any systemic medical condition. If a dentist believes that amalgam dental materials may be detrimental to a patient's medical health, it is incumbent upon the dentist to make a referral to a licensed physician for examination and evaluation of the suspected medical condition.

Record Keeping/Transfer of Patient Record

Although no statute or rule is currently in place for record keeping, laws outlining transferring of records and retention of records do exist in the Administrative Rules (Chapters 20-02-01-08 and 20-02-01-09). Recent laws require transfer of the record within 10 business days. A good record protects the patient and the provider. A dentist’s recollection of events is not likely to be adequate for a subsequent provider, review by the NDSBDE, insurance claims, or a jury. Common record keeping errors seen by the NDBDE during its administrative processes with licensees include:

Failure to obtain patient consent for treatment or refusal of treatment (i.e. xrays)
Failure to document anesthetics or other medications dispensed or administered during treatment, after treatment, or sent with patient.
Failure to update medical history
Improper correction of treatment record (i.e. using white out or erasing rather than crossing out the documentation)
Failure to document patients concern/complaint or reason for appointment
Failure to document result of examination, radiographs and tests
Failure to document options, benefits and risks of treatment of lack of.
Failure to document reason for treatment, i.e. caries, broken tooth, abcess etc.
Failure to sign off or initial entrée in progress notes
Failure to legibly document
Failure to make records considered to be the standard of care.

Teeth Whitening Services

Pursuant to the North Dakota Century Code "Practice of dentistry" means examination, diagnosis, treatment, repair, administration of local or general anesthetics, prescriptions, or surgery of or for any disease, disorder, deficiency, deformity, discoloration, condition, lesion, injury, or pain of the human oral cavity, teeth, gingivae, and soft tissues, and the diagnosis, surgical, and adjunctive treatment of the diseases, injuries, and defects of the upper and lower human jaw and associated structures.” [See N.D.C.C. 43-28-01(7) https://www.legis.nd.gov/cencode/t43c28.pdf?20130906111204 ].

The Board (North Dakota Board of Dental Examiners) interprets the law as it pertains to the teeth whitening services to mean treatment or repair of the discoloration of teeth, as the practice of dentistry. The law is not broadly interpreted by the Board, therefore, an individual who purchases products for personal home use (e.g., Crest Whitestrips®) would not be in violation of the North Dakota Century Code. Likewise, the purchase of products such as hair coloring, etc. for personal home use is not prohibited.

Although teeth whitening services are similar to products available for purchase in drug stores or online, the Board, whose role is to protect the public, contends that it is reasonable to require a level of training for teeth whitening, which might include adverse reactions and for which infection control and sterilization procedures are imperative.

The Board of Dental Examiners jurisdiction lies specifically with the regulation of those who hold a dental license, dental hygiene license or dental assisting registration. Therefore a complaint received by the Board against an individual who is not licensed by or regulated by the Board, who provides teeth whitening services to the public (or the unlawful practice of dentistry), is referred to the ND States Attorney’s Office.

Federal Regulatory Agencies Links

Bloodborne Infectious Disease Resources including Post-Exposure Procedures
Occupational Health and Safety Administration (OSHA)

Bloodborne infectious Disease Resources including Post-Exposure Guidelines
Centers for Disease Control and Prevention (CDC)

Environmental Protection Agency (EPA) 
Medical Waste

Sharps Waste and other Mailable Regulated Medical Waste
United States Postal Service

OSHA Safety and Health Topics for Healthcare Facilities
OSHA Safety - Healthcare Facilities

Healthcare Infection Control Practices Advisory Committee General Guidelines
HICPAC