Practice Resources

Under the Occupational Health and Safety Act (OHS) and Code, Part 35, Section 527 states that a person must not recap waste needles. Further, Section 525.2(2) states an employer must provide and ensure that any medical sharp is a safety-engineered syringe (SES) medical sharp.

For oral healthcare practitioners, this legislates the use of an SES for local anesthetic injection.

An acceptance, allowing for recapping of used dental needles, was granted by OHS, subject to several terms and conditions and general requirements. For dental hygienists who have evaluated the safety of SES and deemed recapping of waste needles to be safer, or as safe, and preferred over use of an SES, please make note of the following:

• The work procedures in a document, Policy Protocol Sharps, Syringes & Safety Engineered Syringes (SES) dated May 2018, MUST be followed by all dental and dental hygiene offices wishing to recap needles under the acceptance.
• All other requirements of the OHS Code must continue to be met.
• A copy of a signed acceptance letter must be posted at each dental or dental hygiene office and/or communicated to all affected workers. 

Yes. Dental hygienists who have completed the appropriate theoretical and clinical education may use lasers for dental hygiene procedures. Laser bleaching and laser periodontal therapy competencies can be obtained through a dental hygiene undergraduate program or a formal continuing education opportunity. Laser periodontal therapy courses must include hands-on clinical experiences using the laser on live, human clients.

1. The theoretical component should be a minimum of 7 hours in length and cover all aspects of laser therapy. If the introductory theory component is online, there must be an in-person review of the theory prior to proceeding to the hands-on component. (We recommend at least 2 hrs for this review.) This will allow the instructors to ensure that the participants have a good strong understanding of the theory and the mechanics of the laser itself. 
2. The hands-on clinical component should be at least one full day (7-8 hours). However, if you, the provider, do not feel adequately prepared to safely provide the laser therapy after the first day of a clinical course, you will need to obtain further clinical education until you feel competent to safely and effectively provide this service. The time needed to become competent will vary from dental hygienist to dental hygienist, but a full day of clinical experiences is the minimum. 

The instructor of the hands-on component must be a registered member of their respective regulatory college in Alberta — either as a General Member or a Courtesy Member. For example, if a dental hygienist is teaching this section of the course and they are not a regulated member with ACDH, they must contact the College and apply for courtesy registration prior to delivering the course. Dental hygienists must make evidence-based decisions regarding implementation of new techniques, technology or research before incorporating them into practice.

Dental hygienists must restrict their use of lasers to bleaching, treatment of herpes labialis, and periodontal therapy. Dental hygienists are not authorized to provide laser therapy for treatment of TMJ disorders. While dental hygienists are able to identify potential TMJ concerns, they must refer the client to an appropriate health care provider (e.g., a dentist who specializes in treating TMJ disorders) for treatment. Dental hygiene practice does not include use of lasers for alternative therapies such as hair removal.

Dental hygienists demonstrate competence in orofacial myology by completing the steps in the International Association of Orofacial Myology (IAOM) Certified Orofacial Myologist (COM) designation process (see How to become an IAOM Certified Orofacial Myologist (COM®) - IAOM). The process involves completing an introductory course in orofacial myology and working through case studies in practice.

The College does not restrict dental hygienists from completing case studies while working through the IAOM certification process if they:

• Self-assess their individual competency and only work within it (Professional Accountability Standard of Practice, Performance Expectation 9);
• Obtain informed consent to provide treatment, including informing the patient that they are working to obtain certification and have not yet been examined for competency (Clinical Therapy Standard of Practice, Performance Expectation 1); and
• Refer the patient if their needs for assessment, diagnosis, or treatment are best addressed in collaboration with or by another health professional (i.e., physician, dentist, certified orofacial myologist).

Dental hygienists may only provide orofacial myology services if they are (1) pursuing their COM designation by working on their case studies with a mentor after completing the introductory course, or (2) COM certified.” 

Despite any orofacial myology training and education, dental hygienists are limited to the scope of practice for dental hygienists as defined by the Health Professions Act, Schedule 5, Section 3. The Health Professions Act allows dental hygienists to assess, diagnose, and treat oral health conditions through the provision of therapeutic, educational, and preventive dental hygiene procedures and strategies to promote wellness and provide restricted activities authorized by the regulations. This limits dental hygienists from assessing, diagnosing, or treating conditions that are not oral health conditions, such as sleep disorders (e.g., obstructive, sleep apnea) or breathing disorders (e.g., asthma). 

No. The HPA does not require supervision of dental hygiene practitioners, other than students performing restricted activities. Unlike legislation in other provinces, the HPA does not require an order to provide services and does not require a dentist to examine a client prior to dental hygiene treatment.

The authorization for dental hygienists to provide direction to regulated dental assistants is contained in the Health Professions Restricted Activity Authorization Regulation.

Dental hygienists may provide direction for a dental assistant to perform the following restricted activities:

• to apply any form of ionizing radiation in medical radiography.
• to cut a body tissue or to perform surgical or other invasive procedures on body tissue in or below the surface of teeth, for the purpose of performing dental probing, including periodontal screening and recording.
• to cut a body tissue or perform surgical or other invasive procedures on body tissue in or below the surface of teeth, for the purpose of scaling teeth.

A dental assistant’s practice permit will indicate if they are authorized to scale teeth under the direction of a dentist or dental hygienist.

The Health Professions Restricted Activity Authorization Regulation sets specific criteria for the performance of scaling teeth by dental assistants. As a result, authorized dental assistants may only perform scaling when the client has been recently assessed by a dentist or dental hygienist. The dental hygienist providing direction must perform an assessment to establish that the client meets all of the following criteria:

• Healthy gingival and periodontal tissues or plaque associated gingivitis;
• Pockets of 4mm or less; and
• No overt or radiographic signs of alveolar bone loss.

If you do not feel comfortable or qualified to provide direction, you are not required to do so. Any regulated health professional authorized to supervise or direct a member of another regulated health profession may decline to do so for a number of reasons. You should give careful consideration to the following questions before making your decision. If you cannot answer yes to any of the following questions, you must not consent to give direction.

1. Are you qualified (competent) and authorized to perform the restricted activity yourself and is it appropriate to your practice?
2. Do you have sufficient practice experience in the restricted activity to be directing another provider?
3. Does your assessment of the client lead you to believe that it is appropriate to direct someone else to provide the service?
4. Has the provider who is asking for direction completed any advanced training that may be required by their college?
5. Are you confident that the provider you will be directing has the level of competence required to perform the procedure?

Yes. There are other things that would prevent you from providing direction. If you have conditions on your own practice permit that prevent you from performing, supervising, or directing a restricted activity, you cannot provide direction to another health care provider.

Secondly, a dental hygienist may only provide direction to members of other regulated health professions in the provision of restricted activities if the restricted activity is authorized for both professions. As an example, you may be authorized to administer nitrous oxide/oxygen conscious sedation but you cannot direct a registered dental assistant to administer nitrous oxide/oxygen conscious sedation because the Health Professions Restricted Activity Authorization Regulation does not authorize dental assistants to perform that restricted activity.

No. Dental hygienists are unable to provide neuromodulators (e.g., Botox) or dermal fillers in their dental hygiene practice for cosmetic purposes. The legislation in Alberta restricts dental hygienists to assessing, diagnosing and treating only oral health conditions. Other health professionals may be able to provide neuromodulators or dermal fillers based on the restricted activities they are authorized to perform. 

TMJ disorders are multifactorial, complex and may mimic other orofacial pain conditions. It is appropriate for dental hygienists to assess for these conditions, but dental hygienists are not the appropriate health professional to diagnose or treat TMJ disorders. Clients can be referred to an appropriately trained health professional.  

The lists of service codes define the service and provide explanations for the use of each code, including how long a unit of time is and what is included within the code.

Typically, an office will bill under one of these two systems:

• Canadian Dental Association’s Uniform System of Codes and List of Services where the Alberta Dental Association establishes a fee guide for the use of these service codes;

OR

• Canadian Dental Hygienists Association’s National List of Service Codes.

If you have questions about whether a code is appropriate for the service you are providing, you should contact the administrator of the service codes (e.g., CDA, ADA, or CDHA).

Restricted activities are regulated health services that can only be performed by individuals with specific competencies. Although regulation authorizes regulated members to perform a number of restricted activities, this does not mean that a regulated member is authorized to perform any restricted activity in any situation in any practice setting.

Dental hygienists must always restrict themselves to performing only those restricted activities they are competent to perform and that are appropriate to the registrant's area of practice and the procedure being performed.

The FAQs and answers below plus the Health Professions Restricted Activity Authorization Regulation will assist you in understanding the restricted activities within the practice of dental hygiene care in Alberta.

Health Professions Restricted Activity Authorization Regulation

Most of the restricted activities authorized in the Dental Hygienists Profession Regulation are taught in the basic curriculum of accredited dental hygiene programs and have been a part of the practice of dental hygiene for many years (i.e., probing, scaling, root planing, curettage, ordering, and exposing radiographs). You do not require any special authorization to perform these activities once you have been placed on the ACDH General register and have been issued a Practice Permit.

Competencies related to the following restricted activities are not inclusive in all dental hygiene educational programs:

1. Administration of local anesthesia by injection
2. Prescribing and administering nitrous oxide/oxygen for the purpose of conscious sedation
3. Restorative procedures of a permanent nature in collaboration with a dentist
4. Orthodontic procedures specific to preliminary fitting of appliances in collaboration with a dentist
5. Preliminary fitting of periodontal appliances in collaboration with a dentist
6. Prescribing Schedule 1 drugs used in dental hygiene practice

You are not authorized to perform the activities listed 1 to 6 above until you complete steps 1 to 3 listed below:

1. Successfully complete a Council-approved course specific to performance of these activities
2. Submit an application for authorization to perform the restricted activity, and
3. Receive written notification from ACDH that you are authorized to perform the activity

Under the Health Professions Act and Health Professions Restricted Activity  Regulation, dental hygienists in Alberta do not have the restricted activity to prescribe oral sedatives.

To address clients who have been orally sedated, The Alberta College of Dental Hygienists (ACDH) referred to the 2011 Alberta Dental Association and College’s (ADA&C) Standard of Practice: Use of Sedation in Non-Hospital Dental Practice, which stated:

2E2.2 Patients undergoing sedation must be supervised by an appropriately trained dentist and must never be left unattended while sedated.

This previous standard would not allow for an RDH to treat the sedated client without the dentist present in the operatory.

In January 2021, ADA&C released their Standard of Practice for Minimal and Moderate Sedation in Non-Hospital Dental Practice which updated the standards for dentists. This document now states that for patients under oral sedation (12 years and older):

3.3 A regulated member must administer the sedative dose in the dental office, taking into account any pre-arrival medications (e.g., cannabis, alcohol, narcotics, prescriptions, pre-arrival anxiolytics, etc.). The regulated member or a sedation team member must be in continuous attendance and direct observation with the patient to observe level of sedation once the medication is given. A regulated member or a sedation team member must be in continuous attendance until the recovery phase commences.

The interpretation of this new wording suggests that the dentist no longer needs to be directly supervising the client under oral sedation during the intra-operative phase.

As a result of this change in the Sedation Standards, the following question is being asked:

Can a registered dental hygienist provide treatment to clients under sedation if the dentist is not present in the operatory?

ACDH is currently seeking expert and legal advice to assist in developing guidance to answer this question to address client safety and meet the Practice Standards and Code of Ethics of the profession. In the interim, registered dental hygienists are reminded that they must work within their own level of competency and are responsible for their own practice.

For more information, please see the resource below:
Oral Sedation

No. You cannot sign a prescription without a prescriber's identification (ID) number.

If you want to be authorized to perform the restricted activity of prescribing you must apply to the ACDH for a prescriber’s identification (ID) number in order to sign prescriptions. ACDH requirements for issuing a prescriber’s ID number are successful completion of a Council-approved pharmacy refresher course.

The refresher course Elements of Prescribing: A Pharmacy Refresher Course for Dental Hygienists, is available online through Continuing Dental Education at the U of A.

ALL Alberta registered dental hygienists with the appropriate competencies can administer drug therapies such as chlorhexidine, Oraqix^®, Arestin^TM, and Atridox^®.

As with any new product dental hygienists may incorporate into their practice, they must ensure they are educated in the appropriate administration techniques and are familiar with the complete product information, including mechanism of action, potential indications and contraindications for use, common side effects, etc. In addition, they must know how to effectively manage adverse reactions to the product. Dental hygienists must make evidence-based decisions regarding when it is appropriate to use a product for a client. Each case is client-specific.

All registered dental hygienists are expected to determine the need for treatment and identify the appropriate sites for treatment following the ADPIE model of assessment, diagnosis, and treatment planning.

Any Schedule 1 drug needs to be prescribed for the client by a health professional authorized to prescribe it. Click the button to learn more about National Drug Schedules.

National Drug Schedules

No.

Dental hygienists without approved advanced training must not provide treatment to a client who is receiving nitrous oxide/oxygen conscious sedation unless an authorized provider remains in the operatory with the unauthorized dental hygienist and the client for the entire duration of the treatment.

Under the Health Professions Act (Alberta) and Dental Hygienists Profession Regulation, registered dental hygienists can perform restorative procedures of a temporary nature as part of their scope of practice. However, they must possess the competencies to perform these procedures safely and effectively. In the case of Atraumatic Restorative Therapy (ART), these competencies include but are not limited to:

• Understanding caries development and diagnosis
• Indications and contraindications for ART
• Client education
• Risk assessment
• Clinical competence in performance of the procedure

Because the more comprehensive temporary restorative procedure called ART is recognized as part of the scope of practice of Alberta dental hygienists, interim stabilization therapy (IST) is not a term or procedure recognized in Alberta. ACDH registrants are reminded that the College does not recognize an IST course as equivalent to an ART course. Members who complete an IST course may apply for credit under the ACDH Continuing Competence Program but they will not be deemed to have acquired the competencies to perform ART and will not be authorized to perform IST in Alberta

The ACDH considers the following to be restorative procedures of a temporary nature:

1. Insertion of zinc oxide eugenol or other medicated cements in primary or permanent teeth when:

1.1.  a dentist is not on-site or readily available to treat the client,

1.2.   there is no evidence of abscess, and

1.3.     the client is experiencing any of the following symptoms as the result of an untreated carious lesion, a fracture of the tooth or loss of a filling:

• discomfort from gingival or mucosal irritation
• tooth sensitivity or pain
• impaired ability to eat

2.  Atraumatic Restorative Treatment (ART) on primary or permanent teeth using glass ionomer or resin based materials when:

2.1.     a dentist is not on-site or readily available to treat the client,

2.2.     there is no evidence of abscess, and

2.3.     the client is experiencing any of the following symptoms as the result of an untreated carious lesion, a fracture of the tooth or loss of a filling:

• discomfort from gingival or mucosal irritation
• tooth sensitivity or pain
• impaired ability to eat

2.4.     the client meets the criteria for ART as part of an early childhood caries prevention program in a community health setting

Dental hygienists placing temporary restorations of any type must ensure that the client is aware of the temporary nature of the restorations and must advise clients or the client’s guardian to obtain further dental care from a dentist.

Dental hygienists are expected to recognize and respond to adverse events, including medical emergencies, using appropriate emergency protocol. An appropriate response to a medical emergency may be to perform a restricted activity that is not authorized for the dental hygiene profession (e.g., administer epinephrine by autoinjector).  

Although the Health Professions Act restricts health professionals from performing unauthorized restricted activities, it still allows an unauthorized person to perform the restricted activity to provide physical comfort or to stabilize a person who is ill, injured or unconscious as a result of an accident or other emergency if there is no authorized person available (HPA s 1.6(2)). This means that if there is no authorized person available (e.g., dentist, paramedic), a dental hygienist may provide this restricted activity despite not being authorized. 

If you are going to respond to a medical emergency by providing a restricted activity, you must ensure you have appropriate training and can safely and competently perform the restricted activity (i.e., know the procedure, be able to identify contraindications, understand if any follow-up is required, etc.). Ensure you are familiar with the emergency protocols in your practice setting.