NEW YORK STATE ASSEMBLY MEMORANDUM IN SUPPORT OF LEGISLATION submitted in accordance with Assembly Rule III, Sec 1(f)
BILL NUMBER: A7402
SPONSOR: Peoples-Stokes TITLE OF BILL:
An act to amend the education law, in relation to permitting dental
assistants and licensed practical nurses to perform the application of
topical fluoride varnish
PURPOSE OR GENERAL IDEA OF BILL:
The purpose of this bill is to improve children's dental health outcomes
by allowing additional healthcare providers to apply fluoride varnish to
teeth when there is a prescription and under protocols of an authorized
provider.
SUMMARY OF PROVISIONS:
Section 1 amends section 6608 of the education law related to registered
dental assisting to allow for the application of topical fluoride
varnish.
Section 2 amends subdivision 2 of section 6902 of the education law
related to the practice of nursing as a licensed practical nurse to
allow for the application of topical fluoride varnish.
Section 3 provides for an immediate effective date.
JUSTIFICATION:
Applying fluoride varnish to the teeth of young children is proven to
reduce dental disease, but too few children in New York are receiving
treatments. Fluoride varnish application is a standard of care for
pediatric offices and for New York Medicaid.
Allowing additional types of health providers to perform this service
would bring New York in line with other states and create more access
points at which children and adolescents enrolled in Medicaid can
receive this preventive service.
Dental disease in children has been called a "hidden epidemic." Hidden
because dental disease is not always apparent until the pain becomes
unendurable or until it creates an inability to eat, sleep, or concen-
trate in school. It is also hidden by poverty. Most children won't expe-
rience severe dental disease. Instead, the effects are felt primarily by
low-income children because it relates to many of the same social and
economic factors that drive other health disparities.
In 2021, more than 14% of children in New York reported one or more oral
health problems. In 2021, more than 14% of children in New York reported
one or more oral health problems. In 2020, only one in every three New
York children enrolled in Medicaid (32.8%) received a preventive dental
visit (national median 41.5%) which includes fluoride varnish applica-
tion. Persistent oral health disparities remain, with children who are
Black and Hispanic/Latino and children experiencing poverty most-affect-
ed by poor-dental health.
Fluoride varnish is a topical solution used to prevent tooth decay.
Like fluoridated toothpaste, fluoride varnish is used on the surface of
teeth and helps prevent cavities by making the tooth hard and helps
prevent cavities when they are just starting or barely visible. Fluor-
ide varnish is painted onto the front and back, top and bottom of the
teeth with a tiny brush where it hardens. as soon as it is touched by
saliva in the mouth. It takes less than two minutes to apply and
requires no special equipment or extensive training to master the tech-
nique.
There is high-quality evidence that fluoride varnish is effective in
preventing tooth decay in children at moderate to high risk for decay.
Studies show that children who receive fluoride varnish every three
months have fewer cavities than those who get it less often or not at
all. Fluoride varnish should be started early, even in infancy, when the
first tooth erupts, because it is most effective when applied before
tooth decay develops. New York Medicaid reimburses for up to four appli-
cations per child per year: dental providers can bill from birth up to
age 21 and medical providers from birth to age 6.
Providers currently authorized to apply fluoride varnish in New York
include dentists, dental hygienists, physicians, nurse practitioners,
registered nurses, and physician assistants.
Allowing additional members of care teams to apply the varnish would
increase flexibility in offices and provide more opportunities to incor-
porate the service into visits. These amendments would bring New York
in line with many other states that allow a wider variety of health
professionals to perform this task.
PRIOR LEGISLATIVE HISTORY:
This is a new bill.
FISCAL IMPLICATIONS FOR STATE AND LOCAL GOVERNMENTS:
None.
EFFECTIVE DATE:
Immediately.
STATE OF NEW YORK
________________________________________________________________________
7402
2023-2024 Regular Sessions
IN ASSEMBLY
May 19, 2023
___________
Introduced by M. of A. PEOPLES-STOKES -- read once and referred to the
Committee on Higher Education
AN ACT to amend the education law, in relation to permitting dental
assistants and licensed practical nurses to perform the application of
topical fluoride varnish
The People of the State of New York, represented in Senate and Assem-bly, do enact as follows:
1 Section 1. Section 6608 of the education law, as amended by chapter
2 512 of the laws of 2022, is amended to read as follows:
3 § 6608. Definition of practice of registered dental assisting. The
4 practice of registered dental assisting is defined as providing support-
5 ive services to a dentist in his or her performance of dental services
6 authorized under this article. Such support shall include providing
7 patient education, taking preliminary medical histories and vital signs
8 to be reviewed by the dentist, placing and removing rubber dams, select-
9 ing and prefitting provisional crowns, selecting and prefitting ortho-
10 dontic bands, removing orthodontic arch wires and ligature ties, placing
11 and removing matrix bands, taking impressions for study casts or diag-
12 nostic casts, removing periodontal dressings, placing and removing
13 temporary restorations, application of topical fluoride varnish, and
14 such other dental supportive services authorized by the dentist consist-
15 ent with regulations promulgated by the commissioner, provided that such
16 functions are performed under the direct personal supervision of a
17 licensed dentist in the course of the performance of dental services.
18 Such services shall not include diagnosing and/or performing surgical
19 procedures, irreversible procedures or procedures that would alter the
20 hard or soft tissue of the oral and maxillofacial area or any other
21 procedures determined by the department. The practice of registered
22 dental assisting may be conducted in the office of any licensed dentist
23 or in any appropriately equipped school or public institution but must
24 be done under the direct personal supervision of a licensed dentist.
EXPLANATION--Matter in italics (underscored) is new; matter in brackets
[] is old law to be omitted.
LBD11382-03-3
A. 7402 2
1 Direct personal supervision, for purposes of this section, means super-
2 vision of dental procedures based on instructions given by a licensed
3 dentist in the course of a procedure who remains in the dental office
4 where the supportive services are being performed, personally diagnoses
5 the condition to be treated, personally authorizes the procedures, and
6 before dismissal of the patient, who remains the responsibility of the
7 licensed dentist, evaluates the services performed by the registered
8 dental assistant. Nothing herein authorizes a registered dental assist-
9 ant to perform any of the services or functions defined as part of the
10 practice of dental hygiene in accordance with the provisions of subdivi-
11 sion one of section sixty-six hundred six of this article, except those
12 functions authorized pursuant to this section. All dental supportive
13 services provided in this section may be performed by currently regis-
14 tered dental hygienists either under a dentist's supervision, as defined
15 in regulations of the commissioner, or, in the case of a registered
16 dental hygienist working for a hospital as defined in article twenty-
17 eight of the public health law, pursuant to a collaborative arrangement
18 with a licensed dentist in accordance with subdivision one of section
19 sixty-six hundred six of this article. Such collaborative arrangement
20 shall not obviate or supersede any law or regulation which requires
21 identified services to be performed under the personal supervision of a
22 dentist.
23 § 2. Subdivision 2 of section 6902 of the education law, as amended by
24 chapter 781 of the laws of 1990, is amended to read as follows:
25 2. The practice of nursing as a licensed practical nurse is defined as
26 performing tasks and responsibilities within the framework of casefind-
27 ing, health teaching, health counseling, the application of topical
28 fluoride varnish, and provision of supportive and restorative care under
29 the direction of a registered professional nurse or licensed physician,
30 dentist or other licensed health care provider legally authorized under
31 this title and in accordance with the commissioner's regulations.
32 § 3. This act shall take effect immediately.
