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HB1671
HOUSE OF REPRESENTATIVES
H.B. NO.
1671
THIRTY-THIRD LEGISLATURE, 2026
STATE OF HAWAII
A BILL FOR AN ACT
Relating
to Health
.
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF HAWAII:
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SECTION 1.
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The legislature finds that states are not
doing enough to prevent and address tooth decay, unnecessarily driving up
health care costs for families and taxpayers.
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The legislature further finds that the State has continually failed to
support proper oral health amongst its population.
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Hawaii residents on neighbor islands and
those with lower incomes face greater barriers to accessing preventive dental
care and treatment.
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According to the Hawaii
Smiles 2015 report, seventy-one per cent of third-grade children in Hawaii
experience tooth decay, with those on neighbor islands and those with lower
incomes having higher risk due to barriers in access to care.
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The report recommended expansion of dental
services that target high-risk populations.
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Recent studies have shown that lower-income
and neighbor island residents disproportionately use hospital emergency
departments to treat preventable dental conditions.
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The legislature also finds that in 2013,
Hawaii was one of only five states to receive a grade of "F" by the
PEW Charitable Trusts, an indication that Hawaii lagged behind other states' oral
health prevention efforts.
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In a 2015
follow-up report, some states made improvements to their oral health programs,
yet Hawaii remained one of three states to still receive a grade of "F".
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In 2022, PEW reported that racial and
ethnic inequities in children's oral health persist throughout the country,
with the prevalence of treated and untreated tooth decay considerably higher
among certain groups, including Native Hawaiians.
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The legislature additionally finds
that the American Dental Association and the American Academy of Pediatric
Dentistry cite interim therapeutic restoration as an effective strategy in
addressing tooth decay when dental restoration in a traditional setting is not
feasible.
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This procedure effectively
addresses cavities in individuals without the need for drills and helps improve
the capacity of the dental team while expanding their reach in the community.
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The legislature further finds that research
shows that allowing dental hygienists to perform interim therapeutic
restoration in public health settings under the general supervision of a
dentist is a cost-effective way to reach at-risk children and adults, address
tooth decay in its early stages, and prevent worsening dental conditions and
their associated costs.
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As of January
2026, at least nine states allow dental hygienists to perform interim
therapeutic restoration.
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Removing
unnecessary restrictions on dental hygienists is an effective way to mitigate
expensive and unnecessary barriers to serving those Hawaii communities that are
at greatest risk for untreated dental conditions.
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The legislature therefore finds that
the State must take proactive steps to implement measures to strengthen
community-based oral health programs, which will support the prevention of
advanced tooth decay, as well as its associated physical and financial burdens,
among Hawaii residents.
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Accordingly, the purpose of this Act
is to permit licensed dental hygienists to perform interim therapeutic
restorations under the general supervision of a licensed dentist in public
health settings.
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SECTION
2
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Section 447-3,
Hawaii Revised Statutes, is amended to read as follows:
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�447-3
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Employment of and
practice by dental hygienists.
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(a)
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Any licensed dentist, legally
incorporated eleemosynary dental dispensary or infirmary, private school,
welfare center, hospital, nursing home, adult day care center or assisted
living facility, mental institution, nonprofit health clinic, or the State or
any county, may employ licensed dental hygienists.
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(b)
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Clinical dental hygiene may be practiced by a licensed dental
hygienist.
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The practice of clinical
dental hygiene is defined as the removal of hard and soft deposits and stains
from the portion of the crown and root surfaces to the depth of the gingival
sulcus, polishing natural and restored surfaces of teeth, the application of
preventive chemical agents to the coronal surfaces of teeth, which chemical
agents have been approved by the board of dentistry, and the use of mouth
washes approved by the board, but shall not include the performing of any
repair work or the preparation thereof, or any other operation on the teeth or
tissues of the mouth; provided that nothing in this subsection shall prohibit a
dental hygienist from using or applying topically any chemical agent that has
been approved in writing by the department of health for any of the purposes
set forth in part V of chapter 321, and other procedures delegated by a dentist
in accordance with the rules of the board of dentistry.
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In addition, a licensed dental
hygienist may administer intra-oral infiltration local anesthesia and
intra-oral block anesthesia under the supervision of a licensed dentist as
provided in section 447-1(f) after being certified by the board, and for those
categories of intra-oral infiltration local anesthesia and intra-oral block
anesthesia for which the licensed dental hygienist has been certified through a
course of study meeting the requirements of this chapter.
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(c)
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A licensed dental hygienist may operate in the office of any licensed
dentist, or legally incorporated eleemosynary dental dispensary or infirmary,
private school, welfare center, hospital, nursing home, adult day care center
or assisted living facility, mental institution, nonprofit health clinic, or in
any building owned or occupied by the State or any county, but only under the
aforesaid employment and under the direct or general supervision of a licensed
dentist as provided in section 447-1(f).
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No dental hygienist may establish or operate any separate care facility
that exclusively renders dental hygiene services.
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(d)
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Notwithstanding section 447-1(f), a licensed
dental hygienist may operate under the supervision of any licensed dentist
providing dental services in a public health setting.
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General supervision
is permitted in a public health setting; provided that the supervising licensed
dentist is available for consultation; provided further that a licensed dental
hygienist shall not perform any irreversible procedure or administer any intra-oral
block anesthesia under general supervision.
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In a public health setting, the supervising licensed dentist shall be
responsible for all delegated acts and procedures performed by a licensed
dental hygienist.
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Notwithstanding
section 447-1(f), a licensed dental hygienist under the general supervision of
a licensed dentist employed in a public health setting may perform dental
education, dental screenings, teeth cleanings, intra-oral or extra-oral
photographs, x-rays if indicated, and fluoride applications on individuals who
are not yet patients of record, have not yet been examined by a licensed
dentist, or do not have a treatment plan.
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Other permissible duties shall be pre-screened and authorized by a
supervising licensed dentist, subject to the dentist's determination that the
equipment and facilities are appropriate and satisfactory to carry out the
recommended treatment plan.
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A licensed
dental hygienist shall refer individuals not currently under the care of a
dentist and who are seen in a public health setting to a dental facility for
further dental care.
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No direct reimbursements
shall be provided to licensed dental hygienists.
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[
As
used in this subsection,
"public health setting"
includes but is not limited to dental services in a legally incorporated
eleemosynary dental dispensary or infirmary, private or public school, welfare
center, community center, public housing, hospital, nursing home, adult day
care center or assisted living facility, mental institution, nonprofit health
clinic or facility, or the State or any county.
]
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(e)
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Notwithstanding section 447-1(f), a licensed
dental hygienist may perform preventive dental sealant screenings and apply
preventive dental sealants on individuals who may or may not yet be patients of
record, have not been previously examined by a licensed dentist, or do not have
a treatment plan prescribed by a licensed dentist, when under the general
supervision of a licensed dentist in a school-based oral health program.
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(f)
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A licensed dental hygienist may place an
interim therapeutic restoration in a public health setting under the general
supervision of a licensed dentist, when the treatment is planned and prescribed
by a licensed dentist, and upon meeting the following requirements:
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(1)
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The licensed
dental hygienist has completed and received didactic, laboratory, and clinical
training in the clinical applications and placement of interim therapeutic
restorations provided by a dental or dental hygiene school program accredited by
the Commission on Dental Accreditation, or through a dental continuing
education program offered by a provider recognized by the Academy of General
Dentistry's Program Approval for Continuing Education, American Dental
Association's Continuing Education Recognition Program, or American Academy of
Dental Hygiene, Inc.;
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(2)
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For dental
continuing education programs, the programs shall have a minimum duration of
ten hours in total, including:
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(A)
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Didactic
training:
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Four hours covering the
scientific basis for interim therapeutic restorations, materials selection, and
placement techniques;
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(B)
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Laboratory
training:
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Two hours in a laboratory or
simulated environment for hands-on placement of interim therapeutic
restorations; and
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(C)
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Clinical
training:
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Four hours including placement
of at least three interim therapeutic restorations on patients; and
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(3)
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The supervising
licensed dentist shall provide additional hands-on training on the placement of
an interim therapeutic restoration, including the properties and handling of
dental materials being used and calibration of clinical applications and
placement techniques on an annual basis.
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For purposes of this subsection,
"interim therapeutic restoration" means a provisional caries-control
technique involving the removal of soft material from the tooth with hand
instruments and placement of an adhesive restorative material, primarily for
disease control and tooth preservation.
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(g)
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For purposes of this section:
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"Licensed dentist"
means a dentist licensed under chapter 448.
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"Public health setting"
includes but is not limited to dental services in a legally incorporated
eleemosynary dental dispensary or infirmary, private or public school, welfare
center, community center, public housing, hospital, nursing home, adult day
care center or assisted living facility, mental institution, nonprofit health
clinic or facility, or the State or any county.
"
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SECTION 3.
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Statutory material to be repealed is
bracketed and stricken.
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New statutory
material is underscored.
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SECTION 4.
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This Act shall take effect on July 1, 2026.
INTRODUCED BY:
_____________________________
Report Title:
Dental
Hygienists; Interim Therapeutic Restoration; Public Health Settings; General
Supervision
Description:
Allows a
licensed dental hygienist to place interim therapeutic restorations in public
health settings under the general supervision of licensed dentist.
The summary description
of legislation appearing on this page is for informational purposes only and is
not legislation or evidence of legislative intent.