Laws and Rules

Regarding the NDBDE's Ethics and Jurisprudence Examination: HUGE HINT>>> Contents of the Exam ARE found on this page. SECOND HUGE HINT >>>The JP Exam content covers current Laws and Administrative Rules and the ADA's Code of Ethics, pertaining to the practice of dentistry, dental hygiene and dental assisting in North Dakota.  

Laws - The ND Dental Practice Act (North Dakota Century Code)

Although the title of this Act implies that it is purely related to dentists, the Act contains laws which pertain to dentists, dental hygienists, and dental assistants, with each having their own chapter.  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 43-20-01 through 43-20-12 - Hygienist and Dental Assistant

Statute - North Dakota Century Code 43-28.1 - Dentists' Loan Repayment Program

Statute - North Dakota Century Code 43-28.1 - Professional and Occupational Licensing

Statute - Members of Military - License renewal. NDCC 43-51-11. 

                1. A board shall adopt rules to provide for or shall grant on a case-by-case basis exceptions to the board's license renewal requirements in order to address renewal compliance hardships that may result from:    a. Activation of more than thirty days of a licensee who is a member of the national guard or a military member.   b. Service in the theater or area of armed conflict by a licensee who is a military member.

                2. For purposes of this section, the term board includes the state board of accountancy, state electrical board, North Dakota real estate appraiser qualifications and ethics board, state real estate commission, secretary of state with respect to contractor licensing, North Dakota board of medicine, and state board of dental examiners.

Statute - North Dakota Century Code 43-51-11.1 Military spouses and military members - Licensure

               1. A board shall adopt rules regarding licensure of a military spouse or a military member or shall grant on a case-by-case basis exceptions to the board's licensing standards to allow a military spouse or military member to practice the occupation or profession in the state if upon application to the board: a. The military spouse or military member demonstrates competency in the occupation or profession through methods or standards determined by the board; and b. The board determines the issuance of the license will not substantially increase the risk of harm to the public. A board with 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. A board shall issue a provisional license or temporary permit to a military spouse or military member for which the licensure requirements under subsection 1 have been substantially met. A board may not charge a military spouse or military member 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 or military member is making progress toward satisfying the unmet licensure requirements. A military spouse or military member 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 or military member 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 or military member 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. A 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 or military member 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 or military member 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.

             6. For purposes of this section, the term "board" includes the state board of accountancy, state electrical board, North Dakota real estate appraiser qualifications and ethics board, state real estate commission, secretary of state with respect to contractor licensing, North Dakota board of medicine, and state board of dental examiners.   

Statute - Members of the military and military spouses - Licensure applications. 43-51-11.2

             1. On each licensure application and renewal form, a board shall inquire and maintain a record of whether an applicant or licensee is a military member or military spouse. If an applicant self-identifies as and provides the board with satisfactory proof of being a military spouse or military member, the board immediately shall commence the process to issue a license, provisional license, or temporary permit under section 43-51-11.1.

             2. Annually, on forms developed by the department of commerce, each board shall report to the department of commerce regarding military member and military spouse data.

             3. For purposes of this section, the term "board" includes the state board of accountancy, state electrical board, North Dakota real estate appraiser qualifications and ethics board, state real estate commission, secretary of state with respect to contractor licensing, North Dakota board of medicine, and state board of dental examiners. 

Administrative Rules (North Dakota Administrative Code)

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. Administrative rules have the force of law.  

Chapter 20-01-01         ORGANIZATION OF THE BOARD

Chapter 20-01-02         DEFINITIONS

Chapter 20-02-01         DENTISTS  - GENERAL REQUIREMENTS

Chapter 20-03-01         DENTAL ASSISTANTS  -  DUTIES 

Chapter 20-04-01         DENTAL HYGIENISTS  -  DUTIES

Chapter 20-05-01         FEES

PRESCRIBERS: Register for the Prescription Drug Monitoring Program [PDMP]: 

Patient Records Retention

ND Administrative Code 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 and records kept by any other means.
 

 PRINCIPLES OF ETHICS & CODE OF PROFESSIONAL CONDUCT

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 are required for renewal of license and registration. 

Other Laws Governing Dentistry:

Pharmacy Laws | Pharmacy Guidelines | Medical Records | Professional Organizations | 

Board of Pharmacy Administrative Code 61-12-01-02. Dispenser Reporting - North Dakota Administrative Code - Title 61, Article, 12 Chapter 1 (ndlegis.gov)

N.D.C.C. 43-15-31.3. Oral transmission of prescriptions - North Dakota Century Code t43c15 (ndlegis.gov)

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 § 23-12-14.

Record definition: 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:

  1. Medical/dental history.
  2. Written progress notes.
  3. Radiographs.
  4. Models.
  5. Billing information
  6. Insurance claims

A patient record should not include:

  1. Care related to another patient.
  2. Peer review/quality assurance information/documents.
  3. Correspondence/notes from attorneys.
  4. 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 supersedes the confidentiality requirements outlined in the Health Insurance Portability and Accountability Act.  Further these statements do 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 ND 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

Laws outlining transfer of patient dental records and retention of  dental records  exist in Administrative Rules (Chapters 20-02-01-08 and 20-02-01-09). Recent laws require transfer of the record within ten 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 NDSBDE during its administrative processes with licensees include:

  • Failure to obtain patient consent for treatment or refusal of treatment (i.e. x-rays)
  • 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, abscess 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