CHAPTER 8 GUAM BOARD OF DENTAL EXAMINER · teeth and from the gingival sulcus; performance of root planning and curettage; exposure of dental X-ray films; application of topical preventive

25 GAR - PROFESSIONAL & VOCATIONAL REGULATIONS

CH. 8 - BOARD OF DENTAL EXAMINER - 1997 - P. 1

CHAPTER 8GUAM BOARD OF DENTAL EXAMINER

§8101. Definitions§8102. Requirements for Dental Licensure.§8103. Professional Conduct.§8104. Dental Hygienists.§8105. Ancillary Personnel.§8106. Visiting Clinicians; Courses; Seminars. Prior Approval

Required.§8107. Conditional Dental Licensure.§1808. Guidelines for the Elective Use of Conscious sedation, Deep

Sedation, and General Anesthesia.§8109. Recommendations for Preventing the Transmission of Diseases

Within the Dental Practices.§8110. Dental Specialists.

§8101. Definitions. As used in these Rules andRegulations:

(a) Bed means the Board of Examiners forDentistry.

(b) Dental Ancillary Personnel includes DentalAuxiliaries, Dental Assistants, and Dental LaboratoryTechnicians.

(c) Dental Hygiene means the rendering ofeducational, preventive, and therapeutic dentalservices, including the removal of calculus deposits,accretions and stains from exposed surfaces of theteeth and from the gingival sulcus; performance ofroot planning and curettage; exposure of dental X-rayfilms; application of topical preventive or prophylacticagents; and performance of all tasks delegable by thedentist in accordance with PL 16-123 and the rules andregulations of the BED.

(d) Dental Hygienist means a person licensed bythe BED to practice Dental Hygiene.

(e) Dental Auxiliary means person registered withand certified by the BED as a Dental auxiliary who,under the direct supervision and authorization of adentist, may provide dental care services directly to apatient. This person must have completed a Dentalauxiliary Training Program approved by the BED'.

(f) Dental Assistant means a person registered withand certified by the BED as a Dental Assistant who,under the direct supervision and authorization of adentist, assists the Dentist or provides dental careservices directly to a patient.



(g) Dental Lab Technician means a personregistered with and certified by the BED whoperforms for a fee of any kind, gratuitously orotherwise, directly or through an agent or employee,by any means or method, or who in any way suppliesor manufactures artificial substitutes for the naturalteeth, or who furnishes, supplies, constructs, orreproduces or repairs any prosthetic denture, bridge,or appliance to be worn in the mouth or who in anyway holds himself out as a dental laboratorytechnician; Such persons may create or alter dentalappliances only on the written authorization of alicensed dentist and may not see patients directly forany purpose whatsoever.

(h) Resident Dentist means ' Dentist who haspresented evidence satisfactory to the BED of either (1)his or her intention to reside on Guam indefinitely, or(2) his or her intention to practice dentistry on Guamimmediately upon licensure, either for a fixed periodof time or indefinitely.

(i) Direct Supervision means supervision whereby adentist diagnoses the condition to be treated, a dentistremains on the premises while the procedures areperformed and a dentist approves the work performedbefore dismissal of the patient.

(j) Indirect Supervision means supervision wherebya dentist authorizes the procedure and a dentist is onthe premises while the procedures are performed.

(k) General Supervision means supervisionwhereby a dentist authorizes the procedures which arebeing carried out but need not be present on thepremises or at chairside when the authorizedprocedures are being performed.

(l) Irreversible Tasks are those intra-oral treatmenttasks which, when performed, are irreversible, createunalterable changes within the oral cavity or thecontiguous structures, or which cause an increasedrisk to the patient.

(m) Reversible Tasks are those intra-oral treatmenttasks which are readily reversible, do not createunalterable changes within the oral cavity or thecontiguous structures, and which do not cause anyincreased risk to the patient.



(n) Category I Continuing Dental Education (CDE)credits are credits earned through attendance at state,national, and international dental meetings,continuing education courses accredited by theAmerican Dental Association and, other ContinuingDental Education (CDE) activities approved inadvance by the BED'. The BED will determine the CDEcredits earned for these other CDE activities.

(o) Category II Continuing Dental Education (CDE)credits are credits earned by attendance at regularlyscheduled monthly meetings of the Guam DentalSociety only. Two CDE credits will be awarded foreach Guam Dental Society meeting attended.

(p) Advertise means to communicate informationabout a licensee's professional services orqualifications to another person or to the public.

(q) Dental Specialist means a dentist who islicensed as a dental specialist by the Board ofExaminers for Dentistry.

(r) Dental Specialty means any of the dentalspecialties which are currently recognized by theAmerican Dental Association.

(s) Reside means to maintain a principal home; aprincipal home may be maintained in only one (1)jurisdiction.

§8102. Requirements for Dental Licensure. (a) Repealand Reenactment. The rules and regulations of the BEDrelative to the requirements for Dental licensure whichwere submitted to the Legislative Secretary on March 8,1985 are hereby repealed and the rules and regulations inSection 2 through 55 below are enacted in their place.

(b) Application for Licensure. Any person whodesires to practice Dentistry in Guam must apply to theBED for licensure and provide the following:

(1) Proof of good moral character. The applicantmust satisfactorily complete the BED's questionnaireon moral character and fitness.

(2) A notarized copy of applicant's diploma orevidence satisfactory to the BED of graduation from aU. S. dental school or college which has beenapproved by the BED and accredited by the AmericanDental Association (ADA); or, if a foreign dentalgraduate, applicant must present evidence of



satisfactory completion of either a Two (2) year dentalresidency through a U. S. accredited hospital oruniversity, or certified completion of an AmericanDental Association (ADA) accredited dental specialtytraining program. All graduates, including foreigndental graduates, must demonstrate to the Board thatthey have successfully passed a clinical dentalexamination in one of the Fifty (50) states.

(3) If the applicant has practiced Dentistry in anyU. S. jurisdiction, the applicant shall furnish:

(i) A notarized copy of applicant's license topractice Dentistry in that jurisdiction, and;

(ii) An affidavit from the Board of DentalExaminers of that jurisdiction verifying thatapplicant has been engaged in the legal andreputable practice of Dentistry in that jurisdiction,and for how many years.

(4) A detailed 'Practice Plan' outlining the type ofpractice applicant will establish, where this practicewill be conducted, and in what way the practice willbenefit the community and meet a need in the dentalcare delivery system.

(5) Payment of required non-refundable fees:

Service: Fee:(i) New application $500(ii) Clinical examination $2000(iii) Renewal of license $ 40(iv) Late renewal filing fee $200/each month late(v) License verification $15(vi) Re-issuance of license certificate $25(vii) Copy of Dental Practice Act $5(viii) Copy of Dental Board Rules and

Regulations $15(ix) Photocopy per page $.50

(6) Verification of all information required on theapplication by both verbal and written oath.

(7) It is the responsibility of each applicant toensure that the BED Secretary receives all necessarydocuments and the application is incomplete until allnecessary documents, including a recent photograph,are presented to the BED and all applicable fees havebeen paid. With the exception of original documents,all credentials must be notarized. In makingapplication for licensure as a Dentist, the applicantauthorizes the BED to verify any or all information



contained in the application, and to seek whateveradditional information pertinent to the applicant'squalifications or character that the BED may deemproper. A completed application must be filed at leastSixty (60) days prior to the proposed establishment ofpractice and the date of examination or interview.

(8) Proof that the applicant has attended a total ofSixty-five (65) hours of Category I CDE within theprevious Twenty-four (24) months. In the case of anapplicant who has graduated from Dental Schoolwithin the previous Twenty-four (24) months, the BEDwill pro-rate the above Continuing Dental Educationrequirement.

(9) Evidence of either (1) applicant's intention toreside on Guam indefinitely, or (2) applicant'sintention to practice dentistry on Guam immediatelyupon licensure, whether for a fixed period of time orindefinitely.

(10) An original copy, or a notarized copy of theoriginal, of the scores indicating successful completionof Parts I and II of the National Board of DentalExaminers Examination.

(11) A notarized copy of applicant's birthcertificate or a notarized copy of the identificationpages of applicant's U. S. or other passport, includingthe photograph.

(12) Wherever a notarized copy is requested, theapplicant's notarized signature must be under thefollowing statement: "I hereby certify this to be a trueand unaltered copy of the original document".

(c) Pending Complaints. If the BED finds that anapplicant has a complaint filed against him or her inanother jurisdiction, it may deny the application pendingfinal disposition of the complaint.

(d) Examination for Licensure. Any applicant forDental licensure in Guam is subject to the following:

(1) Successful completion of an oral examinationand interview before the BED which includes, but isnot limited to, providing the Board with informationconcerning a detailed practice plan and a site wherethe dental practice will be conducted.

(2) Successful completion of a jurisprudenceexamination will be required of all applicants for



dental licensure in the territory of Guam. The purposeof such examination is to ensure that practicingdentists in the territory are familiar with theregulations and laws governing their practice. TheBED, or its representative, will administer thenecessary examination and a score of Seventy-fivePercent (75%) will be required to pass theexamination. The examination shall be successfullycompleted prior to the date of the oral examinationand interview.

(3) Successful completion of a clinical examinationof the applicant's diagnostic and clinical skills, ifrequired at the discretion of the BED. The BED will bethe sole agency to determine if the ClinicalExamination will be required. Circumstances underwhich a clinical examination may be required include,but are not limited to, the following:

(i) The applicant has been inactive in thepractice of dentistry for a period of Five (5) yearsor more immediately prior to application.

(ii) The applicant has suffered either physicalor mental impairment which could affect theapplicant's ability to carry out the duties of apracticing dentist.

(iii) The Board has information which leads itto reasonably believe that the examination willhelp safeguard the health of the community.

(iv) A dental specialist who indicates to theBoard that he or she may also provide generaldental services to his or her patients. The BED willbe the sole judge as to what constitutes generaldental procedures.

The clinical examination will be administeredby the BED in August and February of each year,and will consist of the following:

DAY ONE8:00 Set up8:30 Meet with the BED9:00 Crown preparation on Typodont11:00 Diagnosis Part A - due at 5:00 PM12:00 Lunch1:00 Lab work and Diagnosis Part A5:00 Hand in crown (invested) and typodont

(Hand in diagnosis Part A)



DAY TWO8:00 Complete crown9:30 Alloy Class II11:30 Oral diagnosis Part B (due at 1:00 PM)12:00 Lunch1:00 Class III resin and evaluation of Oral

diagnosis Part B3:30 Finish all parts of the exam3:30-5:00 BED evaluates applicant in executive session

The Conduct of the Examination is the following:

(i) By prior written authorization a DentalAssistant may be used; provided, the BED is notifiedat least Thirty (30) days before the examination date asto the name and certification status of the intendedassistant. The BED is the sole judge as to theacceptability of the dental assistant.

(ii) All supplies and materials must be ADAcertified dental materials and must be supplied by theexaminee.

(iii) Grading is either 'satisfactory' or'unsatisfactory'. To successfully complete theexamination, the applicant must receive a grade of'satisfactory' from at least Four (4) members of theBED on each part of the examination listed under'Quantitative Requirements' of the clinicalexamination guidelines below.

(iv) The BED may alter or augment the treatmentof any patient during the examination if, in its opinion,it is in the best interest of the patient to do so.

(v) If, due to any circumstance during theexamination, the patient receives less than satisfactoryresults, it will be the responsibility of the examinee toalter or replace said dental work so as to produce asatisfactory result at no cost whatsoever to the patient.If the examinee fails to become licensed in Guam, theexaminee shall pay a licensed dentist to complete orreplace the work on the patient to produce satisfactoryresults. The BED shall be the sole judge of theacceptability of the dental work.

(vi) All dental patients who are to participate inthe examination shall be informed prior to treatment



of the circumstances under which they are beingtreated and that the BED is the sole judge of theacceptability of the resulting treatment. The patientshall sign a release to that effect, which mustaccompany his or her dental records.

(vii) Examinees shall be notified of theexamination results by certified mail postmarkedwithin Five (5) working days of completing theexamination.

Clinical examination guidelines for dentistryare the following:

(i) Pre-Examination.

(A) The applicant must provide allmaterials (ADA certified) and patientsfor the examination. Further, for allpatients to be used on the examination,the applicant must provide a full-mouthseries of periapical x-rays which havebeen taken within Ninety (90) days of theexamination. The x-ray of the proposedarea of treatment must be not more thanThirty (30) days old. X-ray facilities willbe available at a Public Health Center forOne (1) week prior to the examinationdate. Study models may be taken inadvance, to be used in the diagnosis of apatient's oral condition, but are notrequired by the BED. For each patient,the applicant shall provide a completedental charting and recent medicalhistory, as well as the patient's writtenconsent to be treated by the applicant forpurposes of the examination.

(B) Examinees shall present theirpatients and materials to the BED, aswell as the above records, to show thedental pathology to be restored. Suchrestorations will accomplish thefollowing requirements:

(ii) Quantitative requirements.



Class III composite resin

Class II alloy

Oral diagnosis and Treatment Plan(Two parts)

Cast gold crown (on Typodont)

(iii) Procedural requirements for Class IIResin are the following:

Rubber dam is required.

Anterior teeth only.

Tooth must be vital, in function, incontact both mesial and distal.

Tooth must show caries into dentineither clinically, or radiographically; orshow an existing restoration needing tobe replaced due to marginal leakage, re-decay, gross discoloration, fracture, ordamaged enamel.

Pulpal protection must be provided.

Local anesthetics must be provided.

Acid etch and pin retentiontechniques are acceptable with BEDapproval.

Examinee will provide an exposed,undeveloped x-ray of the finishedrestoration to the BED upon completionof the restoration.

(iv) Procedural Requirements for Class IIAlloy are the following:

Rubber dam is required.

Posterior teeth only.



Tooth must show carious lesion intodentin clinically, or radiographically, onsurfaces to be restored; or an existingrestoration which requires replacementdue to recurrent decay, fractured enamel,or marginal failure.

Teeth chosen must be vital, inocclusion, and in contact both mesiallyand distally.

Final restoration must haveinterproximal contacts and be in functionwith opposing natural or prostheticteeth.

Pulpal protection shall be providedwhere indicated.

Pins for retention may be used withapproval of the BED.

An undeveloped x-ray of the finalrestoration shall be provided by theexaminee.

(v) Procedural requirements for oraldiagnosis are the following:

For Part A, the BED shall present theexaminee with complete records of anactual patient which shall include fullmouth x-rays, panorex, study models,complete medical history, intraoralphotographs, periodontal charting andcephalometric head film. From theserecords alone, the examinee shallformulate and present to the BED acomprehensive written oral diagnosisand treatment plan, in detail, todemonstrate examinee's knowledge ofcomprehensive dental care.

For Part B, of the oral diagnosissection, the examinee shall present to theBED a patient with advanced dental



needs, either restorative, periodontal, orprosthetic, along with the requiredrecords. Under supervision of the BED,the examinee shall conduct a completeper iodonta l chart ing and oralexamination, and from this data theexaminee shall formulate a complete andcomprehensive diagnosis and course oftreatment aimed at dental rehabilitationfor that patient.

(vi) Procedural requirements for crownpreparation and casting are the following:

The crown may be full, 3/4, or 7/8,and shall be prepared on a typodont atthe laboratory bench.

Only posterior teeth may be used

The typodont shall be mounted inClass I centric occlusion on a semi-adjustable articulator.

The tooth to be prepared shall haveboth mesial and distal proximal contactsand be in function with opposing teeth.

Preparation shall exhibit resistanceform, retention form, and withdrawalform.

The finished preparation will thenbe duplicated using normal impressiontechniques and a working model and dieshall be fabricated by the examinee.

Upon the working model a wax upand gold casting shall be fabricated andfinished by the examinee. Castingfacilities are provided by the BED.

Class II Alloy Procedure Grading Sheet is asfollows:

(Satisfactory = S) (Unsatisfactory = U)



I. General Neatness of the Preparation &Work Area.

Rubber dam placementPrep clean and ready to proceed

II. Patient Management.

AnesthesiaPatient comfortPatient acceptance

III. Preparation.

Outline formIsthmus widthExtension and preventionEnamel supported/unsupportedCavo-surface margins

Internal formDepth of axial and pulpal wallsGingival floorCaries removalPulpal protectionRetention form

BaseProper materialsPlacementEfficacy

MatrixPlacementContourWedgeAccess

Condensing and CarvingContours - occlusal and interproximalInterproximal contactCavo surface marginsAnatomy (marginal ridges, groves,etc.)Occlusion.

Class III Resin Procedure Grading Sheet is asfollows:




I. General Neatness of the Preparation andWork Area.

Rubber dam placementPrep clean and ready to proceed

II. Patient Management.

AnesthesiaPatient comfortPatient Acceptance

III. Preparation.

Outline formSupported enamelBulk for strengthContact

Internal formCarries removalPulpal protectionRetention form

BaseProper materialsPlacementEfficacy

MatrixPlacementEfficacy

IV. Final Restoration

ContoursProximal contactCavo-surface marginsFunctional contacts

AestheticsShade matchContours, shape, and anatomy

FinishSurface polish.

The Crown Restoration on Typodont GradingSheet is as follows:




I. General Neatness of the Preparation &Work Area.

Clean neat work areaPrep ready to proceed

II. Preparation Design

Retention formResistance formWithdrawal formOcclusal reductionPlacement and contour of the margins

III. Final Crown

Contours, form, embrasureOcclusion, centric, protrusive and lateralexcursionsContacts, finish and margins.

(e) Renewal of License.

(1) Every license to practice Dentistry in Guammust be renewed by September 30 of each oddnumbered year.

(2) Only a resident dentist is eligible for licenserenewal.

(3) The non-refundable Renewal of license fee ofForty Dollars ($40) is required for each license renewalperiod.

(4) An applicant for renewal must file a completedlicense renewal application with the Board secretaryon or before August 31 of each odd numbered year.This application must contain proof that the applicanthas attended a total of Sixty-five (65) hours of CDE, ofwhich at least Twenty (20) hours must be Category IICDE credits, earned within the previous Twenty-four(24) months. In the case of an applicant who hasgraduated from a Dental School in the previousTwenty-four (24) months or a dentist who has beenlicensed in the territory less than Twenty-four (24)months, the BED will pro-rate the above Continuing



Dental Education requirement. The Board reserves theright to adjust or waive this requirement forcircumstances not specifically addressed above.

(5) Grace period. The BED allows a grace periodextending to 15 October. Practice of dentistry after 15October without a valid license will constitute aviolation and the dentist will be subject to thepenalties in Chapter 3, Section 16.

(6) Late renewal application filing fee. The BEDwill assess a late filing fee of $200 for each month orpart thereof following 31 August of odd numberedyears.

(7) Any lapsed license to practice dentistry may berenewed within 5 years of the date of its issuance if theholder thereof meets all of the requirements forrenewal and pays to the BED the annual renewal feedue for each year that the license was not timelyrenewed.

(f) Expiration of Dental Licenses. Licenses to practicedentistry expire on September 30 of each odd numberedyear or upon termination of active practice of dentistry onGuam, whichever occurs earlier. The BED will be the solejudge as to what constitutes the active practice of dentistry.

§8103. Professional Conduct. (a) Violation. Violationof any of the provisions set forth in this Chapter shallconstitute unprofessional conduct and may result indisciplinary action.

(b) Professional Signs. No more than Three (3) signsshall designate the professional office where a Dentist isengaged in the practice of the profession. Such signs maycontain name of practitioner, earned dental degree ordegrees, the word(s) 'Dentist', 'Dentistry', 'GeneralDentistry', or if the practice is limited to one specialty,'Orthodontics', 'Pediatric Dentistry', 'Endodontics', 'OralSurgery' (extractions) or 'Oral and Maxillofacial Surgery','Oral Pathology', 'Periodontics', or 'Prosthodontics'.

(1) Lighting - The use of neon or movingbackground or lettering in a sign is expresslyprohibited.



(2) Size - The individual letters on such sign shallnot exceed Five (5) inches in height and shall be onlyin One (1) color. The entire sign shall not exceedNinety-six inches (96") in length. The BED mayauthorize exceptions to this requirement, upon writtenapplication by a dentist, on an individual basis, aslong as the sign remains professional in itspresentation and message.

(3) Practitioner's Name Required - Only the nameof the dentist or dentists who are actually engaged inthe practice of the dental profession at such addressmay be used. The name of a deceased or retiredpractitioner at such address shall not be used in anymanner from One (1) year after death or retirement.

(4) Dentist in Charge - No dentist shall practicedentistry in any office or place of practice where anyname, names, identification, directory, sign, or listingwhatsoever is used in connection therewith whichindicates, or tends to indicate, that such office or placeof practice is owned, operated, supervised, directed,staffed, or attended by other than a dentist, or by anydentist not actually present and practicing dentistrytherein; provided, however, this item 4 shall not applyto a dentist who is temporarily absent orincapacitated.

(5) Professional Corporations - Where a dentist ordentists incorporate under the laws of Guam, theremust be added, after any permitted listing, theadditional abbreviation 'Inc.' or 'P.C'.

(6) Removal of Name - If a dental licensee'sdental license has been suspended for a term of One(1) year or longer, or has been revoked or canceled,then such licensee's name and all listings, signs, andother public references to such license, his dental officeand dental practice shall be immediately removed andnot thereafter used in any manner, unless and untilsaid license is reinstated.

(7) No licensee shall permit his or her name oraddress to appear in any address at which he or she isnot practicing.



(c) Newspaper and Professional Listings.

(1) Special Announcements - Announcementsstating (i) a practitioner's first establishment of anoffice for the practice of dentistry, (ii) a change ofoffice location, (iii) the association of a new dentist insuch office and location, (iv) the original assumptionof a deceased or retired dentist's practice, or (v) thedeath or permanent retirement of an associatepractitioner, may be specially announced in thenewspapers. These announcements may be publishedTen (10) days before and Thirty (30) days immediatelyafter such an event, but may not exceed Thirty (30)days total publication.

(2) Telephone Directory Listings - A dentallicensee may have not more than Three (3)professional listings: One (1) in the white pages andTwo (2) in the yellow pages. Such listings may containthe name, the dental degree or degrees of eachlicensee, the address and the telephone numbers of thepractitioner at such address, and graphics such as aclinic logo or the logo of a Professional Association towhich the Dentist is a member. Where the practitionerlimits his or her practice to One (1) specialty, he or shemay add immediately following his or heralphabetical listing such limitation of practice orspecialty. A practitioner shall not list, or permit thelisting, of his or her name or address, under anyseparate limitation of practice or specialty headingunless he or she actually limits his or her practice tosuch specialty.

(d) Fee Splitting. No dentist shall divide, share, split,or allocate, directly or indirectly, any fee for dental serviceswith any lay person, firm, association, or corporation. Thisprohibition shall not prevent any regular employer-employee relationship and the paying for such services.

(e) Professional and Community Conduct..

(1) The dentist has special knowledge which thedental patient does not have; therefore, to avoidmisunderstanding, the dentist should advise his or herpatients in advance of beginning treatment of (i) thenature and extent of the treatment needed by suchpatient, (ii) the approximate time required to perform



the recommended treatment and services, (iii) theterms and conditions of the payment of the fee, and(iv) any further or additional service or returns by thepatient for adjustments, repair or consultation and thetime within which this shall occur.

(2) A Guam Licensee shall neither act, nor aid orabet another to act, in any manner which isreprehensible, immoral, illegal, against the publicinterest, public policy or public safety, or which tendsto degrade, destroy, or bring discredit upon thelicensee, the community, or the dental profession.

(f) Patient Records and their Transfer.

(1) Dentists shall maintain and keep adequaterecords, made in a permanent and unalterable media,of the diagnosis made and the treatment performedfor a period of time consistent with the Guam Statuteof Limitations regarding dental malpractice (§11308 ofTitle 7, Guam Code Annotated).

(2) Upon written request, original patienttreatment records shall be available for inspection bythe members of the BED, or its designated consultant,for the ascertainment of facts. Reasons for requestingrecords would include investigation of patientcomplaints, verification of dental treatments, and anyother valid reasons involving the Board's need toknow.

(3) Upon written request, copies of patientrecords, including dental x-rays, dental models, andthe treatment rendered shall be made available toanother dentist for continued treatment. A dentist isentitled to charge the patient a reasonable fee for theirduplication.

(4) If an office keeps electronic records of patienttreatment, the Board requires the following:

(i) Back up copies will be made once a weekand kept off site.

(ii) Electronic and written records will be keptfor a period of time consistent with the Guam



Statute of Limitations regarding dentalmalpractice (§11308 of Title 7, Guam CodeAnnotated).

(iii) If treatment records are not periodicallyarchived in an ROM media which is unalterable,the Board requires that a dentist print out a hardcopy at Six (6) month intervals beginning June 30,1995. This copy should be signed and dated.

(g) Termination of Relationship. No dentist shallabandon a dental patient the dentist has undertaken totreat. The dentist may discontinue treatment afterreasonable notice has been given to the patient by thedentist of the dentist's intention to discontinue treatment,and the patient has had a reasonable time to secure theservices of another dentist, or after all dental servicesactually begun have been completed and there is nocontract or agreement to provide further treatment.

(h) Unlicensed Personnel.

(1) No dentist shall employ any unlicenseddentist, nor employ any dental hygienist who is eitherunlicensed, or in possession of a temporary permit topractice dental hygiene issued by the BED.

(2) No dentist shall employ any dental ancillarypersonnel who is unregistered, or who is not inpossession of either a temporary permit or a annualcertificate issued by the BED.

(i) Display of License. All practitioners of dentistryshall post their license and keep it conspicuously displayedin each office in which they practice.

(j) Delegation of Duties. A dentist shall not delegateirreversible tasks to ancillary personnel or to dentalhygienists.

(k) Dentist of Record.

(1) Each patient shall have a dentist known as a'dentist-of-record' who is primarily responsible for alldental treatment rendered by that dentist or by anemployee dentist, dental hygienist, or dental ancillary



personnel, in conjunction with, or at the dentist'sdirection or request, or under that dentist'ssupervision.

(2) The name of a patient's dentist-of-record shallbe prominently and permanently recorded on thefront or inside cover to the patient chart in a formatwhich indicates in a column the name of the presentdentist-of-record and specifies the dates of anysubsequent change of the dentist-of-record.

(3) If treatment is rendered by a dentist other thanthe dentist-of-record, or by a dental hygienist orauxiliary, the name or initials of such person shall beplaced in the record of the patient after a descriptionof what treatment was rendered by that individual.

(4) The dentist-of-record shall be responsible forpresenting the patient with the treatment plan, alongwith the reasonable cost to be expected as part of thattreatment plan, and shall obtain approval for thattreatment plan prior to routine treatment beingrendered to that patient. Any deviation from thattreatment plan shall be under the authority andresponsibility of the dentist-of-record and it shall bethe dentist-of-record's responsibility to obtain thepatient's prior approval of any such deviation and ofany increased costs resulting therefrom.

(5) Should the dentist-of-record leave the dentaloffice where the patient is receiving treatment, a newdentist-of-record shall be entered on the patient'srecords at the first subsequent dental visit or at thefirst subsequent contact with the dental office. Beingreplaced as a dentist-of-record in no way absolves theprior dentist-of-record of responsibility for thatportion of care which was performed prior to beingreplaced as a dentist-of-record.

(6) In any disciplinary proceeding it shall bepresumed that treatment was rendered by the dentist-of-record unless otherwise noted on the patient recordpursuant to this Subsection (k).

(7) The purpose of this Subsection (k) is to assignprimary responsibility for each patient to One (1)



dentist in a multi-dentist practice of any type, and toassign primary responsibility to the dentist fortreatment rendered by a dental hygienist or auxiliaryunder the dentist's supervision. Further, it is thepurpose of this Subsection (k) to assign responsibilityfor failure to treat, or recommend for treatment, anydental condition or pathology. Such conditions wouldinclude but not be limited to periodontal, prosthetic,and orthodontic needs. Failure to indicate arecommendation in writing in a patient's dental recordcreates a presumption of failure to so recommend.

(8) This Subsection (k) shall not be construed toassign any responsibility to a dentist-of-record fortreatment rendered pursuant to a proper referral toanother dentist not in practice with the dentist-of-record, or to prohibit a patient from voluntarilyselecting a new dentist without permission of thedentist-of-record.

(9) This Subsection (k) shall not be construed so asto prevent a dentist who is not the dentist-of-recordfrom rendering emergency treatment to a patientwhen that patient's dentist-of-record is unavailable.

(l) Proprietorship.

(1) No person other than a resident dentist,domiciled on Guam and licensed according to thelaws of the territory of Guam, may:

(i) Employ a dentist or a dental hygienist inthe operation of a dental practice;

(ii) Retain the ownership or control of a dentalpractice and make the same available in anymanner for the use of a dentist, dental hygienist,or other person.

(2) The term 'person' as used in this Subsection (l),shall not in any way pertain to territorial institutionsbut shall be deemed to include any individual, firm,partnership, corporation, or other entity.



(3) Nothing in this Subsection (l) shall apply tobona fide sales of dental equipment, dental materials,or a dental practice.

(4) No person, other than a resident dentist, aprofessional corporation controlled by a residentdentist, or a professional corporation which employs aresident dentist who controls and manages its dentalfacility with full autonomy free from outside influencein all professional and business (financial) matters,may employ a dentist or dental hygienist in theoperation of a dental practice.

(5) The purpose of this Subsection (l) is to preventthe influencing or otherwise interfering with theexercise of a dentist's independent professionaljudgment. No person, other than a resident Guamlicensed dentist, shall enter into a relationship withanother resident Guam licensed dentist, in which theformer dentist exercises control over the latter in anyof the following:

(i) The selection of a course of treatment for apatient, the procedures or materials to be used aspart of such course of treatment, and the mannerin which such course of treatment is carried outby the licensee;

(ii) The patient records of a dentist;

(iii) Policies and decisions relating to pricing,credit, refunds, warranties, and advertising;

(iv) Professional decisions relating to officepersonnel and hours of practice.

(6) The resident Guam licensed dentist must be infull control of the dental practice in all phases of itsprofessional, business, and fiscal operation. Bydefinition, the dentist must be able to operate thedental practice with autonomy and without outsideinfluence.

(m) Dental Franchising. Dental franchising is notpermitted within the territory of Guam. A Guam dentistmay not own, maintain, operate, lease, or in any way



utilize more than One (1) primary and Two (2) satelliteoffices within the territory. To operate a second satelliteoffice, a dentist must petition the Board and document thedentist's intention to staff a minimum of Ten (10) hours perweek a dental office located in a village currently withoutsuch service.

(n) Advertising of Dental Services.

(1) The purpose of this Subsection (n) is toregulate the advertisement by dentists of informationwhich is intended to provide the public with sufficientknowledge upon which to make an informed selectionof a dentist. At the same time, the public must beprotected from false or misleading advertisementswhich would detract from a fair and rational selectionprocess. The following list of reasonable restrictions oncommunications in advertising by dentists areadopted. Advertising is prohibited which containscommunications that:

(i) are false, misleading, or deceptive;

(ii) contain a statement of opinion as to thequality of dental services;

(iii) appeal to an individual's anxiety in anexcessive or unfair way, or intimidate, or exertundue pressure or undue influence over aprospective patient;

(iv) create unjustified expectations concerningthe potential result of any dental treatment;

(v) promote professional superiority orperformance of professional services in a superiormanner;

(vi) refer to benefits or other attributes ofdental procedures or products that involvesignificant risks but do not include realisticassessments of the safety and efficacy of theprocedures or products;



(vii) contain statistical data, representations,or other information that is not susceptible toreasonable verification by the public;

(viii) refer to a fee or fees for dental serviceswhich do not disclose that additional fees may beinvolved in individual cases, if the possibility ofincurring such additional charges may reasonablybe foreseen;

(ix) utilize in any manner any celebrity orauthority figure;

(x) contain direct or implied guarantees ortestimonials from patients or other persons;

(xi) advertise the availability of free dentalwork, free examinations, or free consultations;

(xii) offer any rebate, refund, commission,preference, patronage, dividend, discount, orother consideration, whether in the form ofmoney or otherwise, as compensation orinducement for referring patients, clients, orcustomers to any dentist;

(xiii) offer a discount for dental serviceswithout disclosing the total fee on which thediscount will apply;

(xiv) do not make truthful disclosure of thesource and authorship of any message publishedunder a dentist's by-line.

(2) For a first violation of this Subsection (n), nodisciplinary action may be commenced until thedentist or firm involved has been given Thirty (30)days' written notice of the violation. This notice mustinclude a copy of the applicable portions of the Rulesand Regulations, describe the prohibited advertisinginvolved, and state that the violator has Thirty (30)days from the date of notice to correct the violation. Ifthe violation is not corrected, disciplinary action mayfollow. The Thirty (30) day notice and right to correctare not applicable to any subsequent violations.



(3) No disciplinary action will be taken against adentist for the acts of advertising agents that result incommunications to the public which do not complywith the restrictions adopted by the BED, if theadvertisement does not specify the name of the dentistor the name of the group, corporation, or firm underwhich the dentist practices. However, this provisiondoes not apply in situations in which: (i) theadvertising agent is owned or controlled by thedentist; (ii) the dentist provided information that doesnot comply with the restrictions adopted by the BEDto the advertising agent for distribution to the public;or (iii) the content of the advertising is determined toany extent by the dentist.

(4) A dentist may advertise in accordance with thefollowing rules:

(i) Any advertisement for dentistry or dentalservices shall contain the name, address, andtelephone number of the dentist, and of otherdentists with whom the dentist is associated, andmay contain the names of the dental hygienistsassociated with the dentist.

(ii) Any advertising may contain thefollowing information:

(A) Any dental specialty recognized bythe BED to which the dentist confines thedental practice if the dentist holds a certificatefor having completed a recognized specialtytraining program approved by the AmericanDental Association. For the purposes of thisrule, the BED recognizes only those nationalspecialty boards which are recognized by theAmerican Dental Association. It is misleadingadvertising for a dentist who has not acquiredthe certificate in a particular specialty area,and who was not otherwise eligible forexamination by the national specialty boardin that specialty area, to advertise that he orshe limits his or her practice to that specialtyarea.

(B) Office hours.



(C) Advertising on radio or television maycontain a person narrating the advertisement.In the case of advertisements on television,only the advertising dentist may appear andspeak on camera. If the person narrating aradio or television advertisement representshim or herself as a certain dentist, then he orshe must be the dentist represented.

(D) A licensee who authorizes anotherperson or agent to disseminate informationabout the licensee's professional services tothe public is responsible for the content ofthat information unless the licensee can proveby clear and convincing evidence that thecontent of the advertisement is contrary to thelicensee's specific directions.

(E) A Guam licensed dentist may notadvertise or promote him or herself in anymanner as a dental specialist unless the Boardrecognizes that area of dentistry as a specialtyand has licensed the dentist in that specialty.A dentist, without a specialty license, bydefinition practices as a general practitioner.Any general practitioner practicing a dentalspecialty more than Fifty Percent (50%) ofclinic hours without a specialty license issuedby the BED must include an educationaldisclaimer with his or her advertising orpromotion. This disclaimer must clearly andconspicuously state the lack of recognized oraccredited spe cialty training in any dentalspecialty recognized by the Board.

(5) This Subsection (n) applies to any advertisingdone in Guam regardless of the fact that suchadvertising is done for, or on behalf of, or contractedby any out-of-territory practice or organization.

(o) Other Acts of Unprofessional Conduct. Thefollowing acts shall also constitute unprofessional conductand may result in disciplinary action:

(1) Attempting to obtain or renew, or obtaining orrenewing a Guam Dental license by bribery ormisrepresentation.



(2) Revocation or suspension of a license or anyother disciplinary action taken against a practitioner,including the denial of licensure, by the licensingauthority of another state, territory, or country.

(3) Being convicted or found guilty of a crime inany jurisdiction. Any plea of nolo contendere shall beconsidered to be a finding of guilt for purposes of thisChapter.

(4) Advertising goods or services in a mannerwhich in form or content is contrary to the rules andregulations of the BED.

(5) Practicing or attempting to practice under anyname other than the licensed dentist's legal nameexcept when the dentist is practicing as a professionalcorporation and uses the corporation name.

(6) Being employed in the practice of dentistry byany organization, corporation or group not controlledby a dentist, or by any person other than a dentist.Along with the title of the organization on allbuildings and stationary there must follow a listing ofthe dentists providing service with the organization.Groups or organizations with more than One (1)dentist must list all dentists in a directory either on orwithin the building and also on all professionalstationary. Dentists with hospital staff privileges areexempt from this requirement when practicing in thehospital facility only.

(7) Failure to report to the BED any person whomthe licensee knows, or has reason to believe, is inviolation of the Dental Practice Act or of the rules andregulations of the BED.

(8) Aiding, assisting, procuring, or advising anyunlicensed person to practice dentistry or dentalhygiene contrary to the Dental Practice Act or the rulesand regulations of the BED.

(9) Failing to perform any statutory or legalobligation imposed upon a licensee.



(10) Making or filing a report which the licenseeknows to be false; intentionally or negligently failingto file a report or record required by state, federal, orterritorial law or willfully discouraging, impeding, orobstructing such filing, or inducing another person todo so.

(11) Sexual misconduct with a patient; committingany act which would constitute sexual battery orassault upon a patient.

(12) Making deceptive, untrue, or fraudulentrepresentations in the practice of dentistry.

(13) Failing to keep complete, permanent, andunalterable dental records and medical history recordsjustifying the course of treatment of the patientincluding, but not limited to, patient histories,examination results, dental x-rays and test results.These records must be retained for a minimum periodof time consistent with the Guam statute of limitationsregarding dental malpractice (§11308 of Title 7, GuamCode Annotated).

(14) Exercising influence on the patient or client insuch a manner as to exploit the patient or client for thefinancial gain of the licensee or of a third party, whichincludes, but is not limited to: the promotion or sale ofgoods or services, engaging in any split-feearrangement in any form whatsoever with a dentist,an organization, an agency, or a person, either directlyor indirectly, for patients referred to providers ofhealth care goods and services. The provisions of thisitem 8 shall not be construed to prevent a dentist fromreceiving a fee for legitimate, bona fide professionalconsultation services.

(15) Failing to make available for legitimate andreasonable purposes of review, to a patient or to hislegal representative, copies of documents in thepossession or under control of the licensee whichrelate to that patient.

(16) Performing professional services which havenot been authorized by the patient or patient's legalrepresentative.



(17) Fraud, deceit, or misconduct in the practice ofdentistry or dental hygiene.

(18) Being guilty of incompetence by failing tomeet the minimum standards of performance indiagnosis and treatment when measured against thegenerally prevailing peer performance, including, butnot limited to: the undertaking of diagnosis andtreatment for which the dentist is not qualified bytraining or experience. Unless established by a court oflaw, the BED will be the sole judge for establishing theminimum standards for the community.

(19) Practicing or offering to practice beyond thescope permitted by law or accepting and performingprofessional responsibilities which the licensee knowsor has reason to know that licensee is not competent toperform.

(20) Delegating professional responsibilities toany person whom the dentist knows, or has reason toknow, is not qualified by training, experience, orlicensure to perform them.

(21) Solicitation of patients who are currentlyundergoing dental treatment with another dentalpractice by the promise of superior service or reducedfees.

(22) Failing to inspect, prior to dismissal of apatient, any and all dental services performed by adental hygienist or ancillary personnel during thecourse of treatment. This will include, but not belimited to: dental prophylaxis treatments, dental x-rayseries, all completed and delivered dental prostheticappliances, and completed dental restorations.

(23) Failing to inform the Board in writing withinThirty (30) days of any change of address, status,practice site or employment condition as a dentist.

(p) Penalties for Unprofessional Conduct.

(1) When the BED finds any applicant or licenseeguilty of unprofessional conduct, it may enter a final



order imposing One (1) or more of the followingpenalties:

(i) Denial of an application for licensure orrenewal.

(ii) Revocation or suspension of a license.

(iii) Issuance of a reprimand.

(iv) Placement of the licensee on probation fora period of time and subject to such conditions asthe BED may specify, including requiring thelicensee to attend continuing education courses ordemonstrate licensee's competency through awritten or practical examination, or to work underthe supervision of another licensee.

(v) Restricting the authorized scope ofpractice.

(vi) Imposition of an administrative fine notto exceed One Thousand Dollars ($1000) for eachseparate offense.

(2) The BED may reinstate a suspended license orlift a probation of a disciplined licensee after athorough reevaluation by the BED finds that thelicensee has complied with all of the terms andconditions set forth in the final order and is capable ofpracticing in accordance with community standards.

§8104. Dental Hygienist. (a) Registration; TemporaryPermit; Licensure.

(1) Any person wishing to be employed as adental hygienist must be licensed as a dental hygienistwith the BED prior to employment with any healthcare facility or dental office. The application for dentalhygiene licensure must specify the dentist or dentistsby whom the applicant is to be employed and mustinclude a statement by the applicant that he or she isfree of any infectious disease.

It is the responsibility of each applicant to ensurethat the BED Secretary receives all necessary



documents and the application shall be considered tobe incomplete until all necessary documents,including a recent photograph, are presented to theBED and all applicable fees have been paid. With theexception of original documents all credentials mustbe notarized. In making application for licensure as adental hygienist, the applicant authorizes the BED toverify any or all information contained in theapplication and to seek whatever additionalinformation pertinent to the applicant's qualificationsor character that it may deem proper.

(2) A non-refundable fee of One Hundred Dollars($100) must accompany the application.

(3) When an applicant meets the requirementsfor licensure established by these rules andregulations, the BED may issue a license allowing theapplicant to practice dental hygiene.

(b) Penalties and Fines for Non-Registration.

(1) Any dentist who employs any dental hygienistwho is unregistered, or who is not in possession ofeither a temporary permit or a license issued by theBED, shall be fined an amount not to exceed FiftyDollars ($50) per working day.

(2) Any dental hygienist found in violation of therequirements of this Chapter shall be disciplined inaccordance with Subsection (p) of Chapter 3 of theserules regulations.

(c) Requirements for Licensure.

(1) Any person applying for licensure as a dentalhygienist must provide the Board with the followingdocuments:

(i) a notarized copy of their diploma from adental hygiene training program accredited by theAmerican Dental Association.

(ii) a notarized copy of a license to practicedental hygiene in one of the Fifty (50) states.



(iii) an official transcript from their dentalhygiene training program which has been maileddirectly to the Board.

(2) Examination. The BED may, upondetermination of a reasonable professional need,require an examination for licensure of any dentalhygienist. In the interest of upgrading professionalrequirements, the BED will reserve authority torequire such examination of applicants as needed.

(3) Payment of the required application fee.

(4) Verification of all information required on theapplication by written oath.

(5) Successful passing of the BED jurisprudenceexamination with a test score of Seventy-five Percent(75%) or greater.

(d) Renewal of License.

(1) Each license to practice dental hygiene must berenewed by September 30 of each odd numbered year.

(2) A non-refundable fee of Twenty Dollars ($20)is required for license renewal.

(e) Display of License. Each dental hygienist shallpost his or her license and keep it conspicuously displayedin each office in which he or she practices.

(f) Delegated Duties.

(1) A dentist may not delegate irreversible tasks todental hygienists.

(2) Not withstanding any other provision of rule,or regulation, the dentist is primarily responsible forall procedures which the dentist delegates to dentalhygienists.

(3) A dental hygienist may practice under theindirect supervision of a Guam licensed dentist.



(g) Revocation of License. The following acts shallconstitute cause for revocation of a license to practicedental hygiene:

(1) Attempting to obtain or renew, or obtaining orrenewing a Guam dental hygiene license by bribery ormisrepresentation.

(2) Revocation or suspension of a license, or anyother disciplinary action taken against a dentalhygienist, including the denial of licensure, by thelicensing authority of another state, territory, orcountry.


(4) Sexual misconduct with a patient: committingany act which would constitute sexual battery orassault upon a patient.

(5) Fraud, deceit, or misconduct in the practice ofdental hygiene.

(h) Certification of Licensed Dental Hygienists toAdminister Local Anesthesia. The BED may, onsatisfactory completion of the Board's applicationrequirements, grant certification to a Guam licensed dentalhygienist to administer local anesthesia to dental patients.Administering local anesthesia to dental patients may onlybe done under the direct supervision of a Guam licenseddentist.

(i)Certificate Required.

(1) In order to administer local anesthesia, aGuam licensed dental hygienist must possess a localanesthesia permit issued by the BED. All dentalhygienists must post his or her local anesthesia permitand keep it conspicuously displayed in each office inwhich he or she practices. The permit must berenewed every odd numbered year on or beforeSeptember 30th. In order to receive such a permit,either new or renewal, the dental hygienist must:



(i) Apply on a prescribed application form tothe BED and pay a non-refundable application feeof Twenty Dollars ($20).

(ii) Produce evidence that the dentalhygienist:

(A) holds a valid license to practice dentalhygiene in the territory of Guam.

(B) documents in a manner satisfactory tothe BED that they have completed a trainingprogram acceptable to the BED whichincludes instruction in anatomy, physiology,pharmacology, and practical clinicalexperience in local anesthetic administrationtechniques. This course must consist of notless than Thirty-two (32) instructional hoursand train the applicant in the followinginjections:

Maxilla MandibleAnterior superior Alveolar Inferior Alveolar nerve

blockPosterior Superior Alveolar Lingual nerve blockMiddle Superior Alveolar Mental nerve blockGreater Palatine Buccal infiltrationNaso-Palatine Lingual Infiltration

Mental Infiltration

(iii) Maintain a valid permit demonstratingcurrency in CPR training.

(2) Regulations for Administering LocalAnesthetics.

(i) Local Anesthetic agents may beadministered to patients by a certified Guamlicensed dental hygienist only upon the directionof a Guam licensed dentist who will accept theresponsibility for a review of the patients medicalhistory and current health status.

(ii) Anesthetic procedures can only beperformed under the direct supervision of aGuam licensed dentist. Direct supervision isdefined as having the dentist on the premises and



immediately accessible to the hygienists treatmentarea.

(iii) Local anesthetics and anestheticprocedures may only be provided to patientstreated by the dental hygienist and not to patientswho will be principally treated by another personor dentist.

(3)Renewal of Certificate. Each certificate toadminister local anesthesia must be renewed on orbefore September 30 of every odd numbered year.Documentation of current CPR certification mustaccompany the application.

(4) Revocation of Certification. The certificate foradministering local anesthetic agents may be revokedfor failure to comply with the regulations ofSubsection (h) of Chapter 4 of these rules andregulations.

§8105. Ancillary Personnel. (a) Registration;Temporary Permit; Certification.

(1) All persons wishing to perform the duties orfunctions of dental ancillary personnel must registerwith the BED and be issued a temporary permit priorto employment with any health care facility or dentaloffice. An application for registration and certificationmust be filed with the BED Secretary at theDepartment of Public Health and Social Services priorto being employed in a dental practice. Theapplication must specify the dentist or dentists bywhom the applicant is to be employed and mustinclude a statement by the applicant that he or she isfree of any infectious disease. Upon satisfactorycompletion of the application and verification by thedentist specified thereon of his or her intent to employthe applicant, a Sixty (60) day, non-renewable,temporary permit will be issued to the applicantallowing him or her to work in a dental practice.

(2) A non-refundable fee of Twenty-five Dollars($25) must accompany the application. If the applicantfails to apply prior to beginning employment, his orher application shall be considered to be late and thefee increased to Fifty Dollars ($50).



(3) If the applicant meets the requirements forcertification established by these rules and regulations,the BED may issue the applicant an annual certificateallowing the applicant to be employed in a dentalpractice after the expiration of his or her temporarypermit.

(b) Penalties and Fines for Non-Registration.

(1) Any dentist who employs a dental hygienistwho is unlicensed by the BED shall be fined anamount not to exceed Fifty Dollars ($50) per workingday.

(2) Any dental ancillary personnel found inviolation of the requirements of this Chapter shall bedisciplined in accordance with Subsection (p) ofChapter 3 of these rules and regulations.

(c) Requirements for Certification.

(1) The BED may, upon determination of areasonable professional need, require an examinationfor certification of any dental ancillary personnel. Inthe interest of upgrading professional requirementsthe BED will reserve authority to require suchexamination of applicants as needed.

(2) Payment of the required application fee.

(3) Verification of all information required on theapplication by written oath.

(4) Other Requirements:

(A) dental auxiliaries - Must have completeda dental auxiliary training program equivalent toor greater in scope than that offered by theUniversity of Guam in its most recent dentalauxiliary program.

(B) dental assistants - Requirements to be setat a future date.

(C) dental lab technicians - Requirements tobe set at a future date.



(d) Renewal of Certificate.

(1) Each biannual certificate must be renewed bySeptember 30 of each odd numbered year.

(2) A non-refundable fee of Ten Dollars ($10) isrequired for certificate renewal.

(e) Display of Certificate or Permit. Each dentalancillary personnel shall post and keep conspicuouslydisplayed his or her annual certificate or temporary permitin each office in which he or she is employed.

(f) Delegated Duties.

(1) A dentist may not delegate irreversible tasks todental ancillary personnel.

(2) Reversible tasks shall be performed byancillary personnel under the direct or indirectsupervision of a dentist, and after such formal or on-the-job-training as the BED may require.

(3) Notwithstanding any other provision of rule orregulation, the dentist is primarily responsible for allprocedures which he or she delegates to ancillarypersonnel.

(g) Revocation of Certificate. The following acts shallconstitute cause for revocation of a certificate to practice asa dental ancillary personnel:

(1) Attempting to obtain or renew, or obtaining orrenewing a certificate to practice as a dental ancillarypersonnel by bribery or misrepresentation.

(2) Revocation or suspension of a certificate orlicense, or any other disciplinary action taken against adental ancillary personnel, including the denial ofcertification or licensure, by the licensing authority ofanother state, territory, or country.




(4) Sexual misconduct with a patient; committingany act which would constitute sexual battery orassault upon a patient.

(5) Fraud, deceit, or misconduct in the renderingof any dental treatment.

§8106. Visiting clinicians; courses; seminars. PriorApproval Required. Licensees of other jurisdictions maybe permitted to demonstrate their professional technicalability at scientific and clinical meetings approved by theBED. Any and all courses, seminars, clinics ordemonstrations, including those pertaining to anesthesiaor anesthetic agents and duties of dental hygienists orancillary personnel must be approved in advance by theBED. It is the responsibility of any clinician, person ororganization sponsoring such a demonstration to requestsuch permission in a timely manner.

§8107. Conditional dental licensure. Conditions ofApproval. In the event of a serious illness or anincapacitating occurrence to a Guam licensed dentist, thedentist or the dentist's representative may petition the BEDto conditionally license a dentist to operate the dentist'soffice, or offices, until such time as the dentist may eitherrecover or arrange for the disposal, transfer, or sale of thedental practice. A conditionally licensed dentist must meetall requirements for licensure in the territory except therequirement for residency and the Sixty (60) dayapplication period. Conditional licensure will be for aperiod of One Hundred Eighty (180) days and may berenewed at the discretion of the Board. The total timeallowed for conditional licensure shall not exceed ThreeHundred Sixty (360) days.

§8108. Guidelines for the elective use of conscioussedation, deep sedation, and general anesthesia. (a)Definition of Terms. As used in this Chapter, thefollowing terms have the following meanings:

(1) Must or Shall means an imperative need;mandatory'.

(2) May or Could means freedom or liberty tofollow alternatives.



(3) Should means 'the recommended manner toobtain the standard; highly desirable'.

(4) Conscious Sedation means 'the use ofpharmacological or non-pharmacological methods, ora combination thereof which results in a minimallydepressed level of consciousness that retains thepatient's ability to maintain a patent airwayindependently and continuously, and respondappropriately to physical stimulation or verbalcommand, e.g., open your eyes.

(5) Deep Sedation means 'the use of any drug,element or any other material which results in acontrolled state of depressed consciousness orunconscious from which the patient is not easilyaroused, which may be accompanied by a partial orcomplete loss of protective reflexes, including theability to maintain a patent airway independently andrespond purposefully to physical stimulation or verbalcommand'.

(6) IV/IM Sedation means the parenteral use of anydrug, element or material to produce sedation,whether conscious or deep.

(7) Oral or Rectal Sedation means the oral or rectaluse of any drug, element, or material to producesedation, whether conscious or deep.

(8) General Anesthesia means 'the use of any drug,element, or any other material which results in acontrolled state of unconsciousness accompanied by aloss of protective reflexes, including the ability tomaintain an airway independently and to respond tophysical stimulation or verbal command'

(9) Analgesia means a state of decreased sensibilityto pain produced by using inhalation nitrous oxideand oxygen gases, with or without local anesthesia.

(b) Facilities and Equipment.

(1) Facilities. A dental practitioner who wishes toutilize any type of sedation medication or generalanesthetic agents must have available the proper



facilities, personnel, and equipment to manage anyreasonably foreseeable emergency situationexperienced by the patient.

(2) Back-Up Emergency Services.

(i) Back-up emergency services should beidentified and in place.

(ii) For non-hospital facilities, an emergency-assist system should be established.

(3) Equipment.

(i) A positive pressure oxygen deliverysystem must be available that is capable ofadministering greater than Ninety Percent (90%)oxygen at a Five (5) liter per minute flow for atleast Thirty (30) minutes. All equipment must beable to accommodate persons of all ages and sizes.

(ii) Equipment must be present which isappropriate for the technique being used andwhich will monitor the physiologic state of thepatient.

(iii) An emergency cart or kit must be readilyaccessible. All emergency equipment and drugsare to be checked and maintained on a scheduledbasis.

(c) Documentation.

(1) Proper documentation must be submitted forreview along with the application permitting use ofsedation and general anesthesia. The practitioner mustdocument each sedation and general anesthesiaprocedure in the patient's chart. For deep sedation andgeneral anesthetic procedures, such documentationshould include:

(i) Instructions to the patient or, if a minor, tothe parent or legal guardian.

(ii) Dietary precautions



(iii) Vital statistics

(iv) Preoperative health evaluation whichincludes:

(A) Risk assessment (American Society ofAnesthesiology)

(B) Health history

(C) Review of systems

(D) Vital signs

(v) Name and address of patient's physician

(vi)Rationale for sedation

(vii) Vital signs during treatment

(viii) Medications given

(ix) Post-treatment information

(d) Personnel Qualifications and Requirements.

(1) Conscious Sedation.

(i) In order to administer conscious sedationon an outpatient basis, a dentist must possess apermit of authorization issued by the BED. Thepermit must be renewed every Two (2) years. Inorder to receive such a permit, either new orrenewal, the dentist must:

(A) Apply on prescribed applicationform to the BED and pay a non-refundableapplication fee of Twenty Dollars ($20).

(B) Produce evidence that he or she:

(1) Has a facility containing thefollowing properly operating equipment:an emergency drug kit with no expiredmedications, positive pressure oxygen,stethoscope, suction (high volume



evacuation), laryngoscope with trachealtubes , a t racheotomy set up,oropharyngeal airways, and bloodpressure monitoring device. The facilitymust have an operating pulse oximiter.

(2) Maintains a staff of supervisedpersonnel capable of handlingprocedures , compl ica t ions andemergency incidents thereto. The dentistand at least One (1) staff member,present during the procedure, must becertified in basic cardiac life support(Cardio-Pulmonary Resuscitation) notless than once every Two (2) years.

(3) Holds a valid license to practicedentistry in Guam.

(4) Maintains a current permit toprescribe and administer controlledsubstances in Guam issued by the UnitedStates Drug Enforcement Administration(USDEA).

(C) Meet One (1) or more of the followingcriteria:

(1) Has participated in Boardapproved undergraduate, graduate, orpost graduate education which shouldinclude Sixty (60) clock hours of trainingin basic conscious sedation, physicalevaluation, management of medicalemergencies, monitoring and the use ofmonitoring equipment and cardio-pulmonary resuscitation (CPR); or hasutilized IV/IM sedation in at least Three(3) cases per month, or oral/rectalsedation in at least Six (6) cases permonth, for the last Three (3) years;

(2) If a dental graduate within thepast Three (3) years has completed theeducational requirements, and hasutilized IV/IM sedation in at least Three



(3) cases per month or oral/rectalsedation in at least Six (6) cases permonth for the last Three (3) years sincelicensure; or,

(3) Presented an alternate set ofqualifications acceptable to the BED.

(ii) The BED may conduct an on-siteevaluation of the facility where the dentist shallsuccessfully demonstrate the availability of allrequired equipment and personnel.

(iii) A dentist, certified under these rules toadminister conscious sedation, may employ anurse anesthetist to administer conscious sedationunder the direct supervision of the dentist or mayutilize a third person to monitor the physicalstatus of the patient undergoing dental treatment.

(2) General Anesthesia and Deep Sedation.

(i) In order to administer general anesthesiaby any means, or deep sedation byintravenous/intramuscular means, on an out-patient basis, a dentist must possess a permit ofauthorization issued by the BED. Such permitmust be renewed every Two (2) years. In order toreceive such a permit, either new or renewal, thedentist must:

(A) Apply on prescribed applicationform to the BED and pay a non- refundableapplication fee of Twenty Dollars ($20).

(B) Produce evidence that he or she:

(1) Has completed a minimum ofOne (1) year's advanced training inanesthesiology or related academicsubjects; or has successfully completedan approved residency training programin oral and maxillofacial surgery; or is adiplomate of the American Board of Oraland Maxillofacial Surgery; or is a fellowor member of the American Association



of Oral and Maxillofacial Surgeons; or isa fellow of the American Dental Societyof Anesthesiology; or

(2) When administering generalanesthesia, employs or works inconjunction with a licensed medical orosteopathic physician who is a memberof the anesthesiology staff of a hospital inGuam and who will remain on thepremises of the dental facility until anypatient given general anesthetic regainsconsciousness and is discharged. A thirdperson not involved with the dentalprocedure must monitor the patient'svital signs during dental treatment.

(3) When administering deepsedation, employs or works inconjunction with a third person notinvolved with the dental procedure whowill be present to monitor the patient'sphysical status during dental treatment.

(4) Holds a valid license to practicedentistry in Guam.

(5) Maintains a current permit toprescribe and administer controlledsubstances in Guam issued by the UnitedStates Drug Enforcement Administration(USDEA).

(6) Has a facility containing thefollowing properly operating equipment:anesthesia or analgesia machine,emergency drugs, EKG monitor(recommended but not required),positive pressure oxygen, suctionlaryngoscope and blades, endotrachealtubes, Magill forceps, oral airways,stethoscope and blood pressuremonitoring device.

(7) Has a supervised team ofauxiliary personnel capable of handling



procedures, problems, and emergencyincidents, at least One (1) of whom iscertified in basic cardio-pulmonaryresuscitation (CPR) every Two (2) years.

(ii) A dentist certified under these rules andregulations to administer general anesthesia anddeep sedation may employ a nurse anesthetist toadminister general anesthesia and deep sedationunder the direct supervision of the dentist.

(iii) Each dentist who has been approved bythe BED to use general anesthesia or deepsedation prior to the effective date of these rulesshall make application on the prescribed form tothe BED to continue to use and employ generalanesthesia and deep sedation. If he or she meetsthe requirements of this item (2) of Subsection (d)of Chapter 8 of these rules and regulations, apermit will be issued.

(iv) The BED shall conduct an on-siteevaluation of the facility where the dentist mustsuccessfully demonstrate the availability ofequipment and personnel required. The BED mayrequire the licensed dentist to demonstrate theadministration of general anesthesia in Two (2) ormore actual clinical cases in the presence of theevaluation team. The on-site evaluation team willbe comprised of Two (2) dentists who aremembers of the BED or are its designees and willbe done during the month of initial licensure andduring the month of renewal of the certificate.

(3) Analgesia. In order to administer inhalationanalgesia with Nitrous Oxide/Oxygen in the dentaloffice, a dentist must possess a permit of authorizationissued by the BED. The permit must be renewed everyTwo (2) years. In order to receive such a permit, eithernew or renewal, the dentist must:

(i) Apply on prescribed application form tothe BED and pay a non-refundable application feeof Twenty Dollars ($20).

(ii) Produce evidence that he or she:



(A) Has a facility containing thefollowing properly operating equipment:emergency drug kit, positive pressureoxygen, stethoscope, high-volume evacuation(suction), oropharyngeal airways, and bloodpressure monitoring device.

(B) Maintains a staff of supervisedpersonnel capable of handling procedures,complications, and emergency incidents. Thedentist and at least One (1) staff member,present during the procedure, must becertified in basic cardiac life support (CPR)every Two (2) years.

(C) Holds a valid license to practicedentistry in Guam.

(D) Utilizes an analgesia machinecapable of delivering One Hundred Percent(100%) oxygen and capable of providing notless than Twenty Percent (20%) oxygenconcentration. It is recommended that suchequipment be provided with an alarmindicating oxygen flow of less than a TwentyPercent (20%) minimum or a fail safemechanism to maintain oxygen flow atTwenty Percent (20%) or greater.

(E) Has successfully completed aminimum of Fourteen (14) hours instructionin the use of analgesia (relative analgesia,nitrous oxide-oxygen conscious sedation,inhalation analgesia etc.) or proof of usesatisfactory to the Board of Nine (9) patientsper month during the past year, or proofsatisfactory to the Board of documented safeuse of analgesia within the past year.

(e) Reports of Adverse Occurrences. If a mortality orother incident in a dental outpatient facility occurs as adirect result of the administration of general anesthesia,deep sedation or conscious sedation and causes atemporary or permanent physical or mental injury of thepatient, or results in the calling of a paramedic unit or thetransport of the patient to any hospital or emergencymedical facility the dentist involved must submit a



complete report of the incident to the BED within Ten (10)days of its occurrence.

(f) Facility Inspection. Facility inspection may becarried out by not less than Two (2) members of the BED orits designees at any time. Failure to comply with therequirements of the BED will result in an immediatesuspension of the dentist's license to utilize sedationprocedures until such time as the facility or dentist canonce again prove compliance. Inspections may beconducted on a yearly basis or at the discretion of theBoard.

§8109 Recommendations for preventing thetransmission of diseases within the dental practice. (a)Introduction. Acquired Immunodeficiency Syndrome(AIDS) has emerged as a major threat to public health sincecases were first reported in 1981. This disease, which isnearly always fatal, joins Hepatitis B, and nowTuberculosis, in requiring special and in many cases newsterilization procedures in the dental office. These areimplemented as a preventive measure for the safety of thedoctor and the doctor's staff and also to prevent thetransmission of disease from One (1) patient to another.

(b) The BED requires that all dental offices complywith the infection control guidelines required by theCenter for Disease Control (CDC), American DentalAssociation (ADA), and Occupational Safety and HazardAdministration (OSHA) so that they will effectivelyprevent the transmission of AIDS, Hepatitis B,tuberculosis, and other communicable diseases.

(b) Patient Management.

(1) Each dentist is responsible for a currentmedical history and oral examination. Each patientmust be questioned about current medications,illnesses and past medical history. Each patient mustalso be questioned about signs and symptoms ofAIDS, AIDS related illnesses, Hepatitis B, andtuberculosis.

(2) Most patients with these diseases will not beidentified before treatment. Therefore, appropriateinfection precautions must be used at all times.



(3) The HIV antibody test result of any patient isconfidential and must be treated as such. Frequentlywritten consent must be given before such informationmay be released to anyone except the patient'spersonal physician and a limited number of otherhealth care providers, including dentists.

(c) Professional Responsibility and Dental Personnelwith HIV Infection.

(1) In the coming years, dental providers will beasked to treat an increasing number of patients withHIV infection or AIDS. The dental care system shouldrespond to this need by ensuring that all high riskindividuals have access to humane and competentcare without discrimination.

(2) Dental providers who have HIV infectionshould pose no risk to patients if they carefully followthe infection control precautions as recommended bythe Center for Disease Control and summarized here.Infected dental personnel should consult aknowledgeable physician or public health official inorder to review the infection control procedures intheir own practice setting and ensure that the controlprocedures are adequate.

(3) If there is an accident in which a dentalprovider who is believed to have HIV infectionexposes the mucous membrane of a patient to bloodfrom the dental provider, that provider should informthe patient of the exposure and suggest referral to aphysician for advice regarding follow-up and testing.If the dental provider involved in such an incident isat high risk for HIV infection but has not been tested,the dental provider should be encouraged to be testedand inform the patient of the test result.

§8110.Dental Specialists. (a) License to Practice as aSpecialist Required. A Guam licensed dentist may nothold him or herself out to the public as being especiallyqualified in a branch of dentistry by announcing throughthe press, sign, card, letterhead, printed matter, or anymeans of public advertising, using such terms as 'specialist'or inserting the name of the specialty, or using otherphrases used by qualified specialists that would imply to



the public that the dentist is so qualified, without firstsecuring a specialist's license as provided in this Chapter.

The fact that any Guam licensed dentist shallannounce by card, letterhead, or any other form ofcommunication using such terms as 'Specialist', 'PracticeLimited to...', 'Limited to Specialty of....', or shall useequivalent words or phrases to announce the same, shallbe prima facie evidence that such dentist is holding him orherself out to the public as a specialist.

(b) General Provisions.

(1) Each license as a dental specialist shall beissued by the BED upon an applicant's proof ofqualification and shall be in effect until September 30of each odd numbered year.

(2) The fee for initial licensure as a dentalspecialist will be Twenty Dollars ($20).

(3) A dentist may not state or imply that he or sheis a specialist in a field of dentistry unless thefollowing Two (2) requirements are met:

(i) The area of dental practice is either One (1)of the Eight (8) areas recognized by the ADA asdental specialties or a bona fide certifying bodyrecognized by the BED.

(ii) The dentist has met the ADA'seducational standards for the specialty, is adiplomate of an ADA-recognized certifyingBoard, or is credentialed by a certifying bodyrecognized by the BED.

(4) A dentist licensed as a dental specialist shallnot provide general dental services to patients. TheBED will be the sole judge as to what constitutesproviding general dental services to patients.

(c) Requirements for Licensure.

(1) The Board may license a Guam licenseddentist as a dental specialist if the applicant presents



proof satisfactory to the Board that the applicant isqualified by reason of the following:

(i) The dentist is a diplomate of or a fellow ina specialty Board recognized by the AmericanDental Association: or

(ii) The dentist has completed a post-graduatedental specialty training program approved bythe Commission on Dental Accreditation of theAmerican Dental Association.

(2) The applicant must submit notarizeddocuments satisfactory to the Board, certified by thedirector of the training program, showing that theapplicant successfully completed a course of study in aprogram approved by the ADA.

(3) The Board may require that an applicant forlicensure as a dental specialist successfully complete adental specialty examination consisting of either aclinical examination or a written examination or both.

(d) Renewal of Dental Specialty Licensure.

(1) Every license to practice as a dental specialistin Guam must be renewed by September 30 of eachodd numbered year.

(2) A non-refundable fee of Twenty Dollars ($20)is required for license renewal.

(3) Any dental specialty license may be renewedwithin Five (5) years of the date of issuance if theholder thereof meets all of the requirements forrenewal and pays to the BED the annual renewal feedue for each year that the license was not timelyrenewed.

(e) Penalty for Violation of the Provisions of Chapter10. When the BED finds a dentist guilty of violating therequirements of this Chapter, the dentist will be subject tothe penalties of Subsection (p) of Chapter 3 of these rulesand regulations, as well as other applicable penalties.

Documents

CHAPTER 8 GUAM BOARD OF DENTAL EXAMINER · teeth and from the gingival sulcus; performance of root planning and curettage; exposure of dental X-ray films; application of topical preventive