(1) (a) A licensed dentist who uses the services of an unlicensed technician for the purpose of constructing, altering, repairing, or duplicating a laboratory-fabricated intraoral or maxillofacial dental prosthesis, product, or appliance shall furnish the unlicensed technician with a dental laboratory work order in a form that complies with rules of the board, which form shall be dated and signed by the dentist for each separate and individual piece of work. The dentist shall make the dental laboratory work order in a documented form, and the dentist and the unlicensed technician shall each retain a copy as a permanent part of the patient record. The laboratory technician shall retain a copy of the dental laboratory work order in a file for a minimum of two years. The permanent files of the licensed dentist and the unlicensed technician must be open to inspection at any reasonable time by the board or its duly constituted agent. The licensed dentist that furnishes the dental laboratory work order must have appropriate training, education, and experience related to the prescribed treatment and is responsible for directly supervising all intraoral treatment rendered to the patient.
(b) If a patient's care requires that multiple laboratory-fabricated intraoral or maxillofacial dental prostheses or appliances be fabricated at the same time, it is permissible to incorporate those products or appliances into a single dental laboratory work order.
(c) An unlicensed technician that possesses a valid dental laboratory work order may provide extraoral construction, manufacture, fabrication, supply, or repair of identified dental and orthodontic devices but shall not provide intraoral service in a human mouth except under the direct supervision of a licensed dentist in accordance with section 12-220-501 (3)(d).
(2) If the dentist fails to keep permanent records of dental laboratory work orders as required in subsection (1)(a) of this section, the dentist is subject to disciplinary action as deemed appropriate by the board.
(3) If an unlicensed technician fails to have in the technician's possession a dental laboratory work order signed by a licensed dentist with each denture, bridge, splint, or orthodontic or prosthetic appliance in the technician's possession, the absence of the dental laboratory work order is prima facie evidence of a violation of this section and constitutes the practice of dentistry without an active license in violation of, and subject to the penalties specified in, section 12-220-211.
Source: L. 2020: Entire article amended with relocations, (HB 20-1056), ch. 64, p. 255, � 1, effective September 14. L. 2025: Entire section amended, (SB 25-194), ch. 171, p. 704, � 21, effective August 6.
Editor's note: This section is similar to former � 12-220-139 as it existed prior to 2020.
12-220-503. What constitutes practicing unsupervised dental hygiene - rules. (1) Notwithstanding subsection (3) of this section, unless licensed to practice dentistry, an individual is deemed to be practicing unsupervised dental hygiene when the individual, within the scope of the individual's education, training, and experience:
(a) Removes deposits, accretions, and stains by scaling with hand, ultrasonic, or other devices from all surfaces of the tooth and smooths and polishes natural and restored tooth surfaces, including root planing;
(b) Removes granulation and degenerated tissue from the gingival wall of a periodontal pocket;
(c) Provides preventive measures including the application of fluorides, sealants, and other recognized topical agents for the prevention of oral disease;
(d) Gathers and assembles information, including but not limited to:
(I) Fact-finding and patient history;
(II) Provision of study casts or digital scans;
(III) Extra- and intra-oral inspection;
(IV) Dental charting and periodontal probing and charting;
(V) Radiographic and X-ray survey for the purpose of assessing and diagnosing dental hygiene-related conditions for treatment planning for dental hygiene services as described in this section and identifying dental hard and soft tissue abnormalities for referral to a dentist or appropriate specialist; and
(VI) Additional screening or screening tests for further investigation of any oral or systemic health-related concern pertinent to the scope of practice for dental hygiene; and
(e) Administers a topical anesthetic to a patient in the course of providing dental care;
(e.5) Administers local anesthesia in compliance with section 12-220-411 and rules adopted by the board, including minimum education requirements and procedures for local anesthesia administration;
(f) Performs dental hygiene assessment, dental hygiene diagnosis, and dental hygiene treatment planning for hard and soft tissue for dental hygiene services as described in this section and identifies dental abnormalities for referral to a dentist or appropriate specialist; or
(g) (I) Prescribes, administers, and dispenses fluoride, fluoride varnish, silver fluorides in accordance with subsection (1)(g)(IV) of this section, antimicrobial solutions for mouth rinsing, nonsystemic antimicrobial agents, and related emergency drugs and reversal agents. The board, by rule, may further define the permissible and appropriate emergency drugs and reversal agents. Dental hygienists shall maintain clear documentation in the patient record of the drug or agent prescribed, administered, or dispensed; the date of the action; and the rationale for prescribing, administering, or dispensing the drug or agent.
(II) A dental hygienist shall not prescribe, administer, or dispense the following:
(A) Repealed.
(B) Dangerous drugs or controlled substances, as defined in section 18-18-102 (5).
(III) A dental hygienist may prescribe the following:
(A) Fluoride supplements;
(B) Topical anti-caries treatments, including sodium fluoride, stannous fluoride, silver diamine fluoride, other silver fluorides, hydroxyapatite regeneration medicaments used for repairing cavities, and alternatives for strengthening teeth and preventing and arresting tooth decay. The board may adopt rules that identify safe prescribing alternatives to silver diamine fluoride as a treatment for strengthening teeth and preventing tooth decay.
(C) Topical anti-infectives, including chlorhexidine gluconate rinse, periodontal chips, periodontal gels, periodontal powders, and impregnated fibers for periodontal treatment;
(D) Related emergency drugs and reversal agents as authorized by the collaborating dentist.
(IV) A dental hygienist may prescribe and apply silver diamine fluoride and other silver fluorides upon completion of a postsecondary course or continuing education course developed at the postsecondary level that satisfies the requirements established by the board and provides instructions on the use and limitations of applying silver diamine fluoride. A dental hygienist may complete the course described in this subsection (1)(g)(IV) through:
(A) A live and interactive course presentation;
(B) An on-demand webinar with a completion quiz component to verify participation prior to the issuance of a certificate; or
(C) Any other format approved by the board.
(V) A dental hygienist may prescribe, dispense, and administer nonnarcotic analgesics, anti-inflammatories, and antibiotics within the parameters of a written articulated plan, with the authorization of the supervising dentist, and upon completion of a postsecondary course or continuing education course developed at the postsecondary level that satisfies the requirements established by the board and that provides instruction on the use and limitations of nonnarcotic analgesics, anti-inflammatories, and antibiotics.
(h) Directs dental assistants to assist in activities that are within the scope of practice for a dental hygienist under direct supervision of a dental hygienist only; except that dental assistants shall not perform activities disallowed under section 12-220-501 (3)(a).
(2) A dental hygienist shall state in writing and require a patient to acknowledge by signature that any diagnosis or assessment is for the purpose of determining necessary dental hygiene services only.
(3) Unsupervised dental hygiene may be performed by licensed dental hygienists without the supervision of a licensed dentist.
(4) (a) Notwithstanding section 12-220-104 (13) or 12-220-305 (1)(b), and consistent with section 12-220-303, a dental hygienist may be the proprietor of a place where supervised or unsupervised dental hygiene is performed and may purchase, own, or lease equipment, dental materials, and supplies necessary to perform supervised or unsupervised dental hygiene.
(b) A dental hygienist proprietor, or a professional corporation, limited liability partnership, or professional limited liability corporation of dental hygienists, in addition to providing dental hygiene services, may enter into an agreement with one or more dentists for the lease or rental of equipment or office space in the same physical location as the dental hygiene practice, but only if the determination of necessary dental services provided by the dentist and professional responsibility for those services, including but not limited to dental records, appropriate medication, and patient payment, remain with the treating dentist. It is the responsibility of the dental hygienist to inform the patient as to whether there is a supervisory relationship between the dentist and the dental hygienist. An agreement under this subsection (4)(b) does not constitute employment and does not constitute cause for discipline pursuant to section 12-220-201 (1)(h).
Source: L. 2020: Entire article amended with relocations, (HB 20-1056), ch. 64, p. 255, � 1, effective September 14. L. 2021: (1)(g)(I) and (1)(g)(III)(B) amended and (1)(g)(IV) added, (SB 21-102), ch. 31, p. 127, � 6, effective September 1. L. 2025: IP(1), (1)(d)(II), (1)(d)(IV), (1)(d)(V), (1)(f), (1)(g)(I), (1)(g)(III)(A), (1)(g)(III)(B), (1)(g)(III)(C), IP(1)(g)(IV), (2), and (4) amended, (1)(d)(VI), (1)(e.5), (1)(g)(V), and (1)(h) added, and (1)(g)(II)(A) repealed, (SB 25-194), ch. 171, p. 705, � 22, effective August 6.
Editor's note: This section is similar to former � 12-220-122 as it existed prior to 2020.
12-220-504. What constitutes practicing supervised dental hygiene - rules. (1) Notwithstanding section 12-220-501 (3), unless licensed to practice dentistry, a person who performs any of the following tasks under the supervision of a licensed dentist is deemed to be practicing supervised dental hygiene:
(a) Performing a task described in section 12-220-503 (1);
(b) Administering and monitoring inhalation anesthesia under the indirect supervision of a dentist consistent with section 12-220-305 (1)(q) and pursuant to the rules of the board regarding training and minimum education requirements;
(c) Utilizing a laser for dental hygiene purposes within defined scopes of practice in accordance with rules of the board;
(d) (I) Pursuant to rules adopted by the board, administering immunizations, under the direct supervision of a licensed dentist or the delegation of a licensed professional who is authorized to administer immunizations and delegate tasks under this title 12, to patients six years of age or older. The board may adopt rules specifying the minimum training requirements for dental hygienists to administer immunizations.
(II) A dental hygienist who administers immunizations shall:
(A) Not provide medical or nonmedical exemptions for any required immunizations;
(B) Enter all immunization-related administration information into the Colorado immunization information system created pursuant to part 24 of article 4 of title 25;
(C) Disclose their medical training related to pediatric administration, including the ability to manage side effects or adverse outcomes, to patients as part of the patient consent process;
(D) Administer only respiratory and oral health, including human papillomavirus, immunizations; and
(E) Distribute immunization educational materials and recommendations developed by the department of public health and environment to their patients.
(e) Administering neuromodulators and dermal fillers for therapeutic and cosmetic purposes under the direct supervision of a licensed dentist, or the delegation of a licensed physician or other delegated professional, pursuant to rules adopted by the board. The board shall adopt rules regarding the appropriate education and training, as applicable.
(f) Placing interim therapeutic restorations pursuant to section 12-220-505.
(2) A dental hygienist may perform any dental task or procedure assigned to the dental hygienist by a licensed dentist that does not require the professional skill of a licensed dentist; except that the dental hygienist may perform the task or procedure only under the indirect supervision of a licensed dentist or as authorized in sections 12-220-503 and 12-220-504.
Source: L. 2020: Entire article amended with relocations, (HB 20-1056), ch. 64, p. 257, � 1, effective September 14. L. 2021: (1)(c) and (1)(d) amended and (1)(e) repealed, (SB 21-102), ch. 31, p. 128, � 7, effective September 1. L. 2025: Entire section amended, (SB 25-194), ch. 171, p. 708, � 23, effective August 6.
Editor's note: This section is similar to former � 12-220-123 as it existed prior to 2020.
12-220-505. Interim therapeutic restorations by dental hygienists - permitting process - rules - subject to review. (1) Upon application, accompanied by a fee in an amount determined by the director, the board shall grant a permit to place interim therapeutic restorations to any dental hygienist applicant who:
(a) Holds a license in good standing to practice dental hygiene in Colorado; and
(b) Has completed a course developed at the postsecondary educational level that complies with the rules adopted by the board. The course must be offered under the direct supervision of a member of the faculty of an accredited Colorado dental or dental hygiene school. All faculty responsible for clinical evaluation of students must be dentists with a faculty appointment at an accredited Colorado dental or dental hygiene school.
(c) and (d) Repealed.
(2) Repealed.
(3) A dental hygienist shall not use local anesthesia for the purpose of placing interim therapeutic restorations.
(4) (a) A dental hygienist may place an interim therapeutic restoration only after a dentist provides a diagnosis, treatment plan, and instruction to perform the procedure.
(b) If a supervising dentist authorizes a dental hygienist to perform an interim therapeutic restoration placement at a location other than the dentist's practice location, the dental hygienist shall provide the patient or the patient's representative with written notification that the care was provided at the direction of the supervising dentist. The dental hygienist shall include in the written notification the dentist's name, practice location address, and telephone number.
(c) A dental hygienist who obtains a dentist's diagnosis, treatment plan, and instruction to perform an ITR utilizing telehealth shall notify the patient of the patient's right to receive interactive communication with the distant dentist upon request.
(5) A dental hygienist who obtains a permit pursuant to this section may place interim therapeutic restorations in a dental practice setting under the direct or indirect supervision of a dentist or through telehealth supervision for purposes of communication with the dentist.
(6) (a) A dentist shall not supervise more than five full-time equivalent dental hygienists who place interim therapeutic restorations under telehealth supervision unless granted a waiver by the board pursuant to subsection (6)(b) of this section. A dentist who supervises a dental hygienist who provides interim therapeutic restorations under telehealth supervision must have an active license in good standing issued by the board. Before providing interim therapeutic restorations, a dental hygienist shall confirm in communication to the supervising dentist a referral for follow-up care to a licensed dentist within reasonable physical proximity to the location where the interim therapeutic restoration is placed.
(b) The board shall promulgate rules creating a process for a dentist to seek a waiver from the supervision limit specified in subsection (6)(a) of this section. At a minimum, the rules must specify the application process and waiver requirements.
(c) A dentist shall not supervise, in aggregate, more than five full-time equivalent dental hygienists or dental therapists performing procedures pursuant to subsection (6)(a) of this section and section 12-220-508, and limits on supervision of dental therapists must remain consistent with section 12-220-508 (3).
(7) A dental hygienist shall inform the patient or the patient's legal guardian, in accordance with board rules, that the patient should follow up with a dentist as appropriate.
(8) Repealed.
Source: L. 2020: Entire article amended with relocations, (HB 20-1056), ch. 64, p. 258, � 1, effective September 14. L. 2021: (1)(a), (4)(c), (5), (6), and (7) amended and (1)(c), (1)(d), (2), and (8) repealed, (SB 21-102), ch. 31, p. 129, � 8, effective September 1. L. 2025: (1)(b) and (6)(a) amended and (6)(c) added, (SB 25-194), ch. 171, p. 709, � 24, effective August 6.
Editor's note: This section is similar to former � 12-220-128 as it existed prior to 2020.
12-220-506. Application of silver diamine fluoride by dental hygienists - authorization - limitations - rules - subject to review - repeal. (Repealed)
Source: L. 2020: Entire article amended with relocations, (HB 20-1056), ch. 64, p. 259, � 1, effective September 14. L. 2021: Entire section repealed, (SB 21-102), ch. 31, p. 130, � 9, effective September 1.
Editor's note: Prior to its repeal, this section was similar to former � 12-220-129 as it existed prior to 2020.
12-220-507. Dental hygienist peer health assistance program - fees - rules. (1) (a) (I) Effective July 1, 2023, as a condition of licensure in this state, and for the purpose of supporting a dental hygienist peer health assistance program, every applicant for initial licensure as a dental hygienist or a dental hygienist reinstating or renewing the dental hygienist's license must pay to the administering entity that has been selected by the department pursuant to subsection (1)(c) of this section an amount not to exceed fifteen dollars per year. The department may adjust this amount on January 1, 2024, and annually thereafter to reflect changes in the United States department of labor, bureau of labor statistics, consumer price index for Denver-Aurora-Lakewood for all urban consumers or goods, or its successor index; except that the amount must not exceed twenty-five dollars per year.
(II) The administering entity shall use the money collected pursuant to this subsection (1)(a) to administer a peer health assistance program for dental hygienists, including to support designated providers that the department selects pursuant to subsection (1)(b) of this section to assist dental hygienists with physical, emotional, or psychological problems that may be detrimental to dental hygienists' ability to practice dental hygiene.
(b) The department shall select one or more peer health assistance programs as designated providers. To be eligible for designation by the department, a peer health assistance program must:
(I) Provide for the education of dental hygienists with respect to the recognition and prevention of physical, emotional, and psychological problems and provide for intervention when necessary or under circumstances that may be established by rules promulgated by the board;
(II) Offer assistance to a dental hygienist in identifying physical, emotional, or psychological problems;
(III) Evaluate the extent of physical, emotional, or psychological problems and refer the dental hygienist for appropriate treatment;
(IV) Monitor the status of a dental hygienist who has been referred for treatment;
(V) Provide counseling and support for a dental hygienist and for the family of any dental hygienist referred for treatment;
(VI) Agree to receive referrals from the board; and
(VII) Agree to make its services available to all licensed Colorado dental hygienists.
(c) The department shall select an administering entity to administer the peer health assistance program. The administering entity must be a qualified, nonprofit foundation that is qualified under section 501 (c)(3) of the federal Internal Revenue Code of 1986, as amended, and that is dedicated to providing support for charitable, benevolent, educational, and scientific purposes that are related to dental hygiene, oral health education, oral health research and science, and other oral health charitable purposes.
(d) The administering entity shall:
(I) Collect the required fees, directly or through the board;
(II) Verify to the board, in a manner acceptable to the board, the names of all dental hygienist applicants who have paid the fee set by the board;
(III) Distribute the money collected, less expenses, to the designated provider, as directed by the board;
(IV) Provide an annual accounting to the board of all amounts collected, expenses incurred, and amounts disbursed; and
(V) Post a surety performance bond in an amount specified by the board to secure performance under the requirements of this section. The administering entity may recover the actual administrative costs incurred in performing its duties under this section in an amount not to exceed ten percent of the total amount of fees collected.
(e) The department, on behalf of the board, may collect the required fees payable to the administering entity for the benefit of the administering entity and shall transfer the fees to the administering entity. All required fees collected or due to the department on behalf of the board for each state fiscal year are custodial funds that are not subject to appropriation by the general assembly, and the fee revenues do not constitute state fiscal year spending for purposes of section 20 of article X of the state constitution.
(2) (a) A dental hygienist may self-refer to participate in the peer health assistance program or may be referred by the board.
(b) Notwithstanding sections 12-220-201 and 24-4-104, the board may immediately suspend the license of any dental hygienist who is referred to a peer health assistance program by the board and who fails to attend or complete the program. If the dental hygienist objects to the suspension, the dental hygienist may submit a written request to the board for a formal hearing on the suspension within ten days after receiving notice of the suspension, and the board shall grant the request. In the hearing, the dental hygienist bears the burden of proving that the dental hygienist's license should not be suspended.
(c) Any dental hygienist who is accepted into a peer health assistance program in lieu of disciplinary action by the board shall affirm that, to the best of the dental hygienist's knowledge, information, and belief, the dental hygienist knows of no instance in which the dental hygienist has violated this article 220 or the rules of the board, except in those instances affected by the dental hygienist's physical, emotional, or psychological problems.
(3) If a dental hygienist is arrested for a drug- or alcohol-related offense, the dental hygienist shall self-refer to the peer health assistance program within thirty days after the arrest for an evaluation and referral for treatment as necessary. If the dental hygienist self-refers, the evaluation by the program is confidential and cannot be used as evidence in any proceeding other than before the board. If a dental hygienist fails to comply with this subsection (3), the failure alone is not grounds for discipline under sections 12-220-201 and 12-220-202 unless the dental hygienist has also committed an act or omission specified in section 12-220-201, other than an act or omission specified in section 12-220-201 (1)(e) or (1)(f).
(4) Nothing in this section creates any liability on behalf of the board or the state of Colorado for the actions of the board members in making grants to peer health assistance programs, and no civil action may be brought or maintained against the board or the state for an injury alleged to have been the result of the activities of any state-funded peer health assistance program or of an act or omission of a dental hygienist participating in or referred by a state-funded peer health assistance program. However, the state remains liable under the Colorado Governmental Immunity Act, article 10 of title 24, if an injury alleged to have been the result of an act or omission of a dental hygienist participating in or referred by a state-funded peer health assistance program occurred while the dental hygienist was performing duties as an employee of the state.
(5) The board may promulgate rules necessary to implement this section.
Source: L. 2022: Entire section added, (SB 22-058), ch. 431, p. 3039, � 1, effective August 10.