Regulations & Statutes

The Connecticut Department of Public Health (DPH) requires all Connecticut dental offices to have backflow prevention devices installed. Furthermore, those devices can (and have been) the subject of inspections by local water utility companies. It is important for you as a Connecticut dentist to understand what is required prior to being inspected.

What is a backflow prevention device? Quite simply, a backflow prevention device is used to use to prevent back-siphon age of contaminated fluids into the public water supply.

What specifically does Connecticut require? The CT DPH Fact Sheet on Backflow Prevention at Dental offices (link below) provides information on State requirements. However, it is important to note that a local water utility always has the option of having policies that are more stringent than the State's requirements.

How can I find out what's required in my area? If you are unsure about the backflow prevention device requirements in your area, please contact your local water utility company. The links to some of the larger water utilities in the State are listed below.

Useful references:

• CT DPH Cross Connection Manual (pay particular attention to pages 56 & 63)
• CT Department of Public Health Drinking Water Section
• CT DPH Drinking Water Section phone number, (860) 509-7333

DANB Infection Control Examination

In 2019, the Legislature passed a bill that requires all Connecticut dental assistants to pass the Dental Assistant National

Board’s (DANB) Infection Control Examination (ICE) or an infection control competency assessment administered by an institution accredited by the American Dental Association’s Commission on Dental Accreditation.  Dental Assistants must successfully complete the DANB ICE or a competency assessment exam by October 1, 2020.* All dental assistants must provide records demonstrating successful completion of the DANB ICE or the infection control competency assessment.

* New Connecticut dental assistants hired after July 1, 2019 have fifteen months from the start of employment to receive on-the-job training by a licensed dentist to prepare for and pass the exam or assessment, if they have not done so already.

Continuing Education

Effective January 1, 2018, upon successful completion of the Dental Assisting National Board’s infection control examination or an infection control competency assessment, all dental assistants will be required to complete not less than one hour of training or education in infection control in a dental setting every two years.

Connecticut General Statues: Chapter 379a - Dental Hygienists

CT Department of Public Health
Dental Hygiene Practice Act

Connecticut General Statutes: Chapter 379 - Dentistry

CT Department of Public Health
Dental Practice Act

During the 2016 Legislative Session, the Legislature passed Public Act 16-66 which established a new designation of dental assistants called expanded function dental assistants or EFDAs in Connecticut.

This law allows a dentist to delegate more procedures if the assistant becomes an EFDA. It also places a number of requirements on EFDAs and the dentists that hire them.

Connecticut Requirements to Earn EFDA Status:

• Pass the DANB Certified Dental Assistant or Certified Orthodontic Assistant exam and maintain current certification
• Successfully complete an EFDA education program at an institution of higher education that is accredited by the Commission on Dental Accreditation
• Pass the DANB CPFDA exams (Coronal Polish, Sealants, Topical Anesthetic and Topical Fluoride)
• Pass the DANB CRFDA exams (Anatomy, Morphology and Physiology; Impressions; Isolation; Sealants; Temporaries; and Restorative Functions)
• A dental assistant must meet all the state requirements to earn EFDA status.

The State of Connecticut does not issue a state certificate or certification to dental assistants who have met all EFDA requirements. It is the supervising dentist’s responsibility, before delegating any EFDA functions to any dental assistant, to verify that the dental assistant has met ALL of the state’s EFDA requirements.

CT Department of Public Health developed a "Best Practices for Dental Offices Considering Expanding Operations Beyond Emergency Care to Include Non-Urgent and Elective Procedures During the COVID-19 Pandemic."

Download the CT Best Practices Document

The Department of Public Health is authorized under Connecticut General Statutes, 19a-14(10)(11) to investigate complaints against health care practitioners. The Dental Practice Act which is defined in Chapter 379 of the Connecticut General Statutes allows the Department and the Board to seek disciplinary action under Section 20-114 for "incompetence or negligent conduct toward a patient".

How does the Department of Public Health Evaluate Infection Control Practices?
During the 2016 session, the Legislature passed a bill which mandated dental offices to adhere to the most recent version of the CDC’s guidelines for infection control in dental settings. The guidelines were updated in September 2016. Of particular interest is the addition of the sterilization of hand pieces in-between patients.

National Centers for Disease Control and Prevention Guidelines
Checklists from the "CDC Summary of Infection Prevention Practices in Dental Settings: Basic Expectations for Safe Care":

• Infection Prevention Checklist: Administrative Measures (PDF)
• Infection Prevention Checklist: Hand Hygiene is Performed Correctly (PDF)

Best management practices (BMP’s) replace the October 23, 2003 BMP’s for mercury amalgam and are intended to help dental practitioners comply with the requirements of Sections 22a-616(d) and 22a-622 of the Connecticut General Statutes (CGS) concerning the management of amalgam.

• CT DEEP Best Practices
• CT DEEP - Fillings: The Choices You Have

DEEP has also developed a Certification Form on which dental practitioners certify that their practice(s) or clinic(s) is in compliance with the state adopted BMPs.

Certificate Form

Amalgam Separator Inspection Form - Dentists in Connecticut, and now across the country, are required to perform inspections and keep records of such inspections for their amalgam separators. There is no prescribed form, you can make up their own, or you can use the sample form below one, or modify it if they choose. At some point in the future, the Department of Energy and Environmental Protection may randomly ask dental practices to submit inspection records as evidence of compliance with best management practices, specifically having and maintaining an amalgam separator. Please Note: This specific form doesn’t ensure compliance with all best management practices and you should become familiar with the DEEP standards.

• Amalgam Separator Inspection Form - SAMPLE (doc)

In Connecticut, dentists are required to follow the best management practices for mercury amalgam. According to the law, every dental office must have an amalgam separator installed and well maintained. Following these best management practices will prevent mercury from being discharged into the wastewater where it can settle into the sludge. The department is exploring a program to conduct virtual inspections of dental offices for compliance with the amalgam separator requirements. The inspections would be scheduled allowing the dental offices to prepare and facilitate the inspection process. The inspections would be conducted using a phone or tablet and designed to last 10 minutes or less. The department would appreciate your feedback to determine the best way to conduct an inspection.

Link to the survey is below:
https://www.surveymonkey.com/r/CX38LN8

Additional information:
https://portal.ct.gov/DEEP/P2/Mercury/Dental/Best-Management-Practices-for-Mercury-Amalgam

https://portal.ct.gov/DEEP/P2/Mercury/Mercury-Information

In response to questions regarding the credentials of mobile dental programs offering to provide oral health services to children in school settings, the CSDA and the Department of Public Health have reissued a letter to school administrators highlighting questions to be asked in order to assess the appropriateness of protocols in place by the mobile dental program. Review the letter sent to school superintendents, principles and school nurses in Connecticut.

Read the Mobile Dental Provider Letter

During the 2019 legislative session, the Legislature passed a bill that expanded Connecticut’s Paid Family and Medical Leave Act (PFMLA). Beginning on January 1, 2021, every employer with one or more employees must participate in the plan by collecting 0.5% of each employee’s wages and remit them as a contribution to the Connecticut Paid Leave Authority Trust Fund. Connecticut employees won’t be able to access the fund until January 1, 2022.

For further information and resources about Connecticut’s PFMLA, please visit CT Paid Leave Authority’s website. In addition, you can check out Connecticut Paid Leave Frequently Asked Questions Video.

In 2011, the Connecticut General Assembly passed a non-covered services legislation that prohibits most insurance providers from dictating the rates that dentists can charge to their patients for any services or procedures that are not covered under their dental plans. While self-funded and collectively bargained (i.e. union) insurance plans were not covered under this new law, it does apply to all other dental provider contracts that are signed, renewed or amended after January 1, 2012.

The law also requires that dentists post a notice in their office to inform patients that not all dental services may be covered under their insurance plans. Click on the links below to access and print the notice for your practice.

• Non-Covered Services Sign (PDF)
• Non-Covered Services Statute Language (Sec. 38a-472h)
  

Public Act 18-166 prohibits prescribing practitioners from prescribing, dispensing or administering schedule II to IV controlled substances to themselves or immediate family members.  An immediate family member is defined as a spouse; parent; child; sibling; parent-in-law; son or daughter-in-law; brother or sister-in-law; step-parent, child or sibling; or other relative residing with the prescriber.

In an emergency, the bill allows prescribers to prescribe, dispense, or administer up to a 72-hour supply of a schedule II to IV controlled substance to themselves or immediate family members, but only if there is no other qualified prescriber available. If prescribing, dispensing or administering to a family member, the prescriber must (1) perform an assessment for the patient’s care and treatment; (2) medically evaluate the patient’s need for the controlled substance; and (3) document the emergency, assessment and patient’s need in the normal course of his or her business. (Effective as of July 1, 2018)

Public Act 17-131 requires various changes to prevent and treat opioid drug abuse.  Several of these items can impact dental practices that write prescriptions for opioids, including:

• Requires prescribing practitioners to electronically transmit the controlled substance prescription to a pharmacy (effective January 1, 2018);
• To apply for a waiver, a provider must contact the CT Department of Consumer Protection Drug Control Division directly. They can be reached at (860) 713-6065 or DCP.DrugControl@ct.gov
• Requires practitioners, when prescribing opioids, to discuss with all patients, rather than only minors, the risks associated with opioid drug use;
• Anyone who does not wish to be issued a prescription for an opioid drug may file a “voluntary non-opioid directive”   form with a prescribing practitioner. Upon reviewing the form, the prescribing practitioner must document it in the patient’s medical record;
• A prescribing practitioner shall not issue a prescription of an opioid drug to a minor for more than a five-day supply of such drug; and
• By October 1, 2017, the Alcohol and Drug Policy Council (ADPC) is required to develop a one-page fact sheet on opioid drugs. The ADPC must make the fact sheet available on the Department of Mental Health and Addiction Services website. Health care providers are encouraged to disseminate the fact sheet to anyone they provide an opioid drug prescription to.
• Department of Mental Health and Addiction Services - Opioid Fact Sheet

During the November 2017 CSDA Continuing Education Course, Rodrick Marriott, Director of the Drug Control Division of the State of CT Department of Consumer Protection, spoke to Connecticut Dentists. During the talk Mr. Marriott clarified the new opioid legislation that recently passed, including the new regulation that requires prescribing practitioners to electronically transmit controlled substance prescriptions to a pharmacy (effective January 1, 2018). The video is below for your reference:

Frequently Asked Questions on Patient Access to Medical Records according to the provisions of the Connecticut General Statutes.

Learn More About Dental Records

Connecticut Department of Public Health guidelines for obtaining dental anesthesia and conscious sedation permit.

Read the Guidelines

The prescription monitoring program collects prescription data for Schedule II through Schedule V drugs into a central database, the Connecticut Prescription Monitoring and Reporting System (CPMRS), which can then be used by providers and pharmacists in the active treatment of their patients.

• Connecticut Department of Consumer Protection
• Connecticut Public Act 13-172
  

Notice: Pursuant to Executive Order 7DDD, as amended by Executive Order 10A, the Oct. 1st Sexual Harassment Prevention Training deadline has been extended to April 19, 2021 due to the Covid-19 Pandemic. This is a blanket extension and does not require a request to be made. If there are any questions, please contact CHRO.Questions@ct.gov.

A new law went into effect on October 1, 2019 that establishes new rules and requirements regarding sexual harassment training and education. Employers with three or more employees will now have to:

• Provide all existing employees with two hours of training by October 1, 2020 January 1, 2021
• Provide to a new employee a copy of information regarding the illegality of sexual harassment and remedies available to victims
• Provide two hours of training and education to new employees hired on or after October 1, 2019 within six months of their start date
• Provide periodic supplemental training not less than every ten years

Employers with fewer than three employees must provide two hours of training and education to all existing supervisory employees by October 1, 2020 January 1, 2021 or within six months to new supervisory employees.

The Commission on Human Rights and Opportunities has developed a free online training and education video. View the Commission on Human Rights and Opportunities for further information regarding these new regulations and the training video.

Effective August 1, 2019, retailers making sales in Connecticut of tangible personal property to the public are required to collect a 10 cent fee per single-use plastic checkout bag. "Single-use checkout bag" is defined as a plastic bag with a thickness of less than four mils and is provided by a store to a customer at the point of sale. "Store" is defined as any retailer, as defined in Conn.Gen.Stat 12-407, that maintains a retail store within the state and sells tangible personal property directly to the public. This definition includes any dental office with a sales tax permit.

For example, if a dental office is using a plastic bag to provide their patients with promotional materials or free items, such as a toothbrush and or floss, then the dental office is not required to collect a fee. If, however, a dental office has a sales tax permit and is selling items to their patients, such as an electronic toothbrush and uses a plastic bag with a thickness of less than four mils, to provide the product to the patient, then the dental office is required to collect a 10 cent fee and report that to the State.

For further information, refer to the CT Department of Revenue Services Guidance Sheet Regarding the Single-Use Plastic Bag Fee.

If you have additional questions regarding the plastic bag fee, please contact the CT Department of Revenue Services (DRS) directly. You can email DRS Legal Division at legal.division@po.state.ct.us or call DRS at (800) 382-9463.

The CT Department of Energy and Environmental Protection (DEEP) has shared this information regarding their state inspection process of dental x-ray operations. The information is provided in hopes that the DEEP, in tandem with the CSDA, can enhance mutual effectiveness, communicate regulatory requirements, and maintain low dose and high quality dental imaging. If you have any additional questions, please feel free to contact the CT DEEP Radiation Division at 860.424.3029.

• DEEP Inspection of Medical X-Ray Machines
• List CT Health Physicists (PDF)
  

Specified health insurance carriers that issue policies covering inpatient or outpatient dental services are required, at least once during the term of a contract, to permit a licensed dentist who provides covered dental services to an insured to refuse to accept reimbursement for such services by way of virtual credit card. Such refusal shall apply to all covered dental services provided by such dentist during the term of such contract. “Virtual credit card” means a single-use credit card exclusively provided in an electronic or digital format.

Effective Date: January 1, 2019

Fluoridation became a law in Connecticut on May 18, 1965, initiated by Public Act 156. Public Water Systems (PWSs) serving 50,000 or more were required to begin fluoridation on January 1, 1967, and PWSs serving 20,000 to 49,999 people were required to begin fluoridation on October 1, 1967. The amount of fluoride in many drinking water supplies is changed to a level to help reduce tooth decay and promote good oral health. Research studies have shown that water fluoridation is safe, effective and the best way to improve oral health in a community.

ADA Applauds USPHS Final Recommendations

• CT Department of Public Health Drinking Water Section
• How Fluoride Works Flyer (Printable Flyer)

Various CT Water Utility Companies (yours may not be listed):

• Regional Water Authority (serves greater New Haven area)
• MDC (serves greater Hartford area)
• Connecticut Water (serves mostly eastern CT)
• Aquarion Water Company (serves Fairfield, New Haven, Hartford, Litchfield, Middlesex and New London counties)
  

The Americans with Disabilities Act of 1990 is a wide-ranging civil rights law that prohibits, under certain circumstances, discrimination based on disability. This link will take you to the American Dental Association's Americans with Disabilities Act Q&A. It is important to note that ALL practicing dentists are affected by this law, since dental offices are considered public accommodations under the Act.

Access the JADA Q&A

The Office for Civil Rights enforces the HIPAA Privacy Rule, which protects the privacy of individually identifiable health information; the HIPAA Security Rule, which sets national standards for the security of electronic protected health information; the HIPAA Breach Notification Rule, which requires covered entities and business associates to provide notification following a breach of unsecured protected health information; and the confidentiality provisions of the Patient Safety Rule, which protect identifiable information being used to analyze patient safety events and improve patient safety.

• ADA HIPAA Privacy and Security Updates
  
• State of Connecticut Department of Public Health Notice of Privacy Practices
• Department of Health and Human Services: HIPAA Basics for Providers
  

OSHA: Dentistry Workers and Employers

This guidance is not a standard or regulation, and it creates no new legal obligations. It contains recommendations as well as descriptions of mandatory safety and health standards.

Learn More About OSHA COVID-19 Guidelines

CDC: Interim Infection Prevention and Control Guidance for Dental Settings During the COVID-19 Response

Learn More About CDC COVID-19 Response

Developed by CDC staff in collaboration with a working group of infection control experts, the document contains a review of the scientific evidence regarding dental infection control issues as well as consensus, evidence-based recommendations.

• Recommended Infection Control Practices for Dentistry

Checklists from the "CDC Summary of Infection Prevention Practices in Dental Settings: Basic Expectations for Safe Care":

• Infection Prevention Checklist: Administrative Measures (PDF)
• Infection Prevention Checklist: Hand Hygiene is Performed Correctly (PDF)

For State of Connecticut Infection Control in a Dental Practice Regulations, look under State Regulations, above.

State plans establish guidelines and standards to promote worker safety and health that apply to every workplace in the United States, including medical and dental offices. A glimpse of the most frequently found hazards in medical and dental offices.

• United States Department of Labor
  

The Office for Civil Rights has issued a final rule that prohibits health care entities that receive certain federal financial assistance, including Medicaid and CHIP, from discriminating based on race, color, national origin, sex, age or disability. According to ADA’s Health Policy Institute, 42% of dentists across the country were enrolled in Medicaid programs in 2014, and will therefore be subject to this rule.

The rule, went into effect July 18, 2016 and implements Section 1557 of the Affordable Care Act, required the affected parties by October 16, 2016 to post taglines in multiple languages and nondiscrimination notices in their offices, on their websites and in significant publications and communications. The ADA provides a number of resources, including a checklist, Q&A and sample documents for dental practices, free of charge only to ADA members to help them comply with this rule at success.ada.org. Read more in ADA News.

• Section 1557 of the Patient Protection and Affordable Care Act
• Section 1557 ADA Webinar Available

Hundreds of ADA members attended the webinar Understanding Section 1557 and it is now available for all members to view.

In December 2022, the U.S. Congress passed an omnibus spending bill that included the Medication Access and Training Expansion (MATE) Act. This new law requires prescribers of controlled substances, including dentists, to complete eight hours of one-time training on safely prescribing controlled substances (Schedules II, III, IV, and/or V) in order to receive or renew their registration with the U.S. Drug Enforcement Administration (DEA).

It’s likely that you received an email from the DEA last week notifying you of this new requirement, which goes into effect on June 27, 2023.

To help dentists comply, the ADA has created a Frequently Asked Questions document addressing common questions we have heard from members, including:

• Does this new federal training requirement affect me?
• What am I required to do?
• How much time do I have to satisfy the new training requirement?
• Do I need to maintain records showing I have completed the training?
• How will I know what courses will satisfy the requirement?
• Will training hours completed prior to the law’s passage count toward the new requirement?
• Will I have to complete the 8 hours of federally required CE on a cyclical basis?\
• Will CE credits that are accepted for state licensure count toward the new federal requirement?
• Can my state impose additional CE requirements?
• Am I required to complete training on topics that are outside of my scope of practice?
• Do I have to use a specific CE provider? Will ADA CERP credits count?
• Does the ADA offer CE on safe controlled substance prescribing?

The ADA will update the FAQ regularly to answer new questions and share additional information. Currently, our team is working to address questions about how the DEA will enforce the requirement, how the rule will affect prescribers with multiple DEA registrations, and other topics.

If you have further questions, the ADA’s Member Service Center is here to help. Contact the MSC via e-mail at msc@ada.org or call 312-440-2500. Staff are available Monday through Friday from 8 a.m. - 5 p.m. central time.