Section 51. Any person of good moral character, nineteen years old or over, who is a graduate of a school for dental hygienists accredited or recognized as accredited by the Commission on Accreditation of Dental and Dental Auxiliary Educational Programs of the American Dental Association requiring a course of not less than one academic year and approved by the board, or who is a full time dental student who has satisfactorily completed at least four full semesters in an accredited dental college or a graduate from any accredited dental college who has not previously been examined by the board in subjects considered essential by it for a dental hygienist may, upon the payment of a fee determined annually by the commissioner of administration under the provisions of section three B of chapter seven, be examined by the board in said subjects, and, if his examination is satisfactory, shall be registered as a dental hygienist and be given a certificate allowing him to practice dental hygiene. Upon receipt of a certificate of registration pursuant to section forty-five, any certificate issued hereunder shall be revoked.

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A dental hygienist may perform all acts which may be performed by a dental assistant and may under the appropriate supervision of a dentist perform acts or services on teeth and related structures that are educational, therapeutic, prophylactic and preventive in nature, but may not perform acts or services which require the knowledge and skill of a dentist such as diagnosis, treatment planning, surgical or cutting procedures on hard or soft tissue, and the prescription of medications; provided, however, that the term ”therapeutic”, as used in this section, shall include gingival curettage and rootplaning as well as the administration of local anesthesia agents in accordance with rules and regulations adopted by the board.

A registered dental hygienist practicing as a public health dental hygienist may perform in a public health setting, without the supervision or direction of a dentist, any procedure or provide any service that is within the scope of his practice and that has been authorized and adopted by the board as a delegable procedure for dental hygienists in private practice under general supervision and may conduct minor emergency denture adjustments to eliminate pain and discomfort in nursing homes and other long-term care facilities under general supervision. Public health settings shall include, but not be limited to, residences of the homebound, schools, nursing homes and long-term care facilities, clinics, hospitals, medical facilities, community health centers licensed or certified by the department of public health, mobile and portable dental health programs licensed or certified by the department of public health and operated by a local or state agency, Head Start programs and any other facilities or programs deemed appropriate by the department of public health. Before performing a procedure or providing a service under this paragraph, a public health dental hygienist shall enter into a written collaborative agreement with a local or state government agency or institution or with a licensed dentist who states that he shall be able to provide the appropriate level of communication and consultation with the dental hygienist to ensure patient health and safety. The board shall establish appropriate guidelines for this written collaborative agreement. Public health dental hygienists shall provide to the patient or to the patient’s legal guardian a written referral to a dentist and an assessment of further dental needs. Public health dental hygienists shall also provide to each patient or to the patient’s legal guardian a consent form to be signed by the patient or legal guardian, which form shall be consistent with current department of public health policies, that describes services to be rendered, explains that the services are not a substitute for a dental examination by a dentist and informs the patient or legal guardian that the patient should obtain a dental examination by a dentist within 90 days. Public health dental hygienists shall be directly reimbursed for services administered in a public health setting by Medicaid but except as required by federal Medicaid law, shall not seek reimbursement from any other insurance or third party payor. A public health dental hygienist shall not operate independently of a dentist, except for a dental hygienist working for a local or state government agency or institution or practicing in a mobile or portable prevention program licensed or certified by the department of public health. In such cases, the local or state government agency or institution, or mobile or portable prevention program licensed or certified by the department of public health may seek reimbursement from any other insurance or third party payor.

Nothing in sections forty-three to fifty-three, inclusive, or rules and regulations adopted thereunder shall prohibit research, including educational research, conducted under the direct supervision of a licensed dentist and done by nonprofit dental research institutions chartered by the commonwealth and by dental schools accredited by the Commission on Accreditation of Dental and Dental Auxiliary Educational Programs of the American Dental Association, whether such research is preformed within or without such institutions; provided, however, if such research involves treatment of dental patients and is to be conducted in the private office of one or more private practices, the board shall be notified in writing of the intent to conduct such research and the practice or practices shall be selected in consultation with the board.

The board may adopt rules and regulations in the public interest defining those acts and services performed by a dental hygienist. If any educational institution in the commonwealth, which is accredited by the Commission on Accreditation of Dental and Dental Auxiliary Educational Programs of the American Dental Association, wishes to undertake an educational program for dental hygienists or dental assistants which program would involve delegated procedures not in accordance with existing rules and regulations of the board, such educational institution must petition the board in writing, detailing the contemplated program for the board’s written approval. The program may be undertaken if the board so approves and shall be subject to periodic review and approval by the board.

An applicant failing to pass a satisfactory examination shall be entitled to re-examination at any meeting of the board upon payment of a fee determined under the aforementioned chapter seven provision.

Each dental hygienist shall register biennially and in the year not so designated for the registration of dentists and shall pay a biennial registration fee determined under the aforementioned provision, in default of which the board may revoke said registration as a hygienist, after a hearing as provided for by section sixty-one; but payment of said fee at once or before the time of hearing, with an additional sum determined under the aforementioned provision, shall remove the default.