Response: Effective January 8, 2025, the CDHNS Council, NSDTA Council, and DLBNS Board adopted a Joint Practice Standard regarding Sexual Misconduct & Sexual Abuse. This was subsequently approved by the initial NSRDHDTD Board on May 1, 2025. The Standard prohibits sexualized behaviour and remarks by a registrant towards a client or in the presence of a client. In certain circumstances, a spouse or intimate partner may be considered a client. If a spouse or intimate partner is not exempted as a client under the Standard, a registrant must not provide oral health services to the spouse or intimate partner.

Each registrant is responsible for reviewing and understanding the provisions of the Standard prior to providing oral health services to a spouse or intimate partner. In particular, a registrant is responsible for reviewing and understanding the definitions of “spouse” and “intimate partner” set out at section 1.8 of the Standard. A registrant may only provide services if the spousal or intimate partner relationship pre-exists the individual becoming the registrant’s client. 

While treating a spouse/intimate partner, the dental hygienist/denturist, or dental technologist must provide oral health services in accordance with the profession-specific Standards of Practice and Code of Ethics, just like you would for any other client.  If an oral health professional believes that their professional judgment and ability to provide safe and ethical oral health care is affected by the personal relationship with the spouse/intimate partner, they must refer the client to another oral health care provider, following the protocols set out in the new Joint Standard.

The ability to treat a spouse or partner does not prevent an individual from making a complaint to the NSRDHDTD about a registrant. That complaint would be addressed through the NSRDHDTD complaints process.

*In the Joint Standard, “intimate partner” is defined as “a person with whom one has been in a conjugal relationship for at least six months, regardless of whether or not they cohabitate, or they have a natural or adopted child together.”

Perform AGPs when the anticipated benefits outweigh the risks to the client, the health professional, and the greater community. 

It is up to each clinician to determine the appropriate procedure(s) needed for each client. As a regulated professional, you must use your professional judgement and clinical evaluation to construct and implement a client-specific treatment (care) plan that addresses their oral health needs.  The decision around which specific oral health services to provide must be based on individual client needs i.e., client centred care. The decision to perform Aerosol Generating Procedures (AGPs) versus Non-Aerosol Generating Procedures (NAGPs) is another client-specific decision. Consider acceptable NAGP treatment options over AGP procedures.

As you re-evaluate your in-office practices to ensure that you are safely and effectively providing care,  take this opportunity to evaluate some of the routine “processes”  that may not align with current best practices or standards of care. One example is performing routine prophylaxis (teeth polishing). This procedure will generate aerosols, regardless of the type of paste selected. The decision to perform this procedure should be made when it is deemed appropriate, after weighing all the factors, above.

Consider these facts about 'routine prophylaxis' (polish):

• There is no therapeutic value to a prophylaxis. It is strictly a cosmetic concern, not a pathological condition. You are removing extrinsic stain or other removable discolorations on the teeth.
• It is contraindicated on newly erupted and deciduous teeth.
• Consider the particle impact, particularly immediately after periodontal debridement, when tissues may be irritated.
• Most individuals do not require a prophy in the absence of stain.
• There may be other dental/dental hygiene procedures which require a form of prophylaxis to be performed e.g., sealants, certain orthodontic procedures.  
• Consider other methods to remove biofilm – particularly a method that has a lower risk for generating aerosols.
• Educate your clients on the risks versus benefits associated with “routine polishing” so that they can make an informed decision about their care.

This response draws on concepts outlined in the Joint Infection Prevention & Control Standards. The concepts about appropriate use of Aerosol Generating Procedures (AGPs) versus Non-Aerosol Generating Procedures (NAGPs) is woven throughout the entire document.

No, do not provide clinical oral health care services if the client has potentially contagious lesions in or near the mouth, whether from primary herpetic gingivostomatitis or from recurrent oral herpes simplex. Provide oral health care once the vesicles/ulcers have completely healed. There is a risk of transmission of the virus to other head and neck areas of the client or to the oral health care provider.

Mode of transmission: HSV-1 is primarily transmitted via contact with the saliva of carriers, resulting in oral herpes. Transmission may also occur through contact of active cold sores on the lips of carriers or via contact with other active herpetic lesions. Transmission of HSV-2 is usually via sexual contact and causes genital herpes. However, oral-genital, oral-anal or anal-genital contact means that HSV-1 and HSV-2 may be transmitted to various sites, and the historical distinction between the two types of HSV in terms of site of infection is now blurred. After the initial infection, the virus becomes dormant in the sensory ganglia of the face (or genital area); reactivation of the virus causes cold sores of the mouth (or genital sores, if the primary infection was in the genital area).

Considerations:

1. Oral health care providers must not treat clients while the lesions are present.
2. Oral health care providers have an ethical responsibility to educate their clients about the significance of their diseases, the potential for recurrence, and the risk of infection of others.
3. Not only are resulting lesions to the oral health care providers' fingers and thumbs a possibility (e.g., herpetic whitlow), but the virus is also shed in the saliva which means that splatter during treatment can be risky.
4. Clients may become upset if rescheduling is required. This is another reason that education is key.
5. Developing a clear office policy regarding rescheduling clients until lesions are healed will ensure consistent messaging and approaches in your office.

References: 1. Bowen, D., & Pieren, J. (2020). Darby and Walsh Dental Hygiene, 5th Edition. Elsevier. 2. Centers for Disease Control and Prevention (USA). (2017, Aug 28). CDC Herpes Facts and Brochures. Retrieved Aug 12, 2020, from Herpes - CDC Fact Sheet: https:// www.cdc.gov/std/herpes/stdfact-herpes.htm#:~:text=It%20is%20also%20possible%20 to,silverware%2C%20soap%2C%20or%20towels. 3. CDHO. Advisories. (May 2014). CDHO Factsheet Herpes Simplex. Retrieved Aug 4, 2020 at: https://www.cdho.org/Advisories/CDHO_Factsheet_Herpes_Simplex.pdf

The response below comes from the NSRDHDTD Practice Standard on Professional Judgment and Collaboration (2025) and is intended to support—not replace—your clinical judgment. This new standard on Professional Judgment and Collaboration is an addition to the general Code of Ethics and Practice Standards. All the foundational requirements, such as obtaining informed consent and following health privacy laws, must still be followed. When in doubt, reflect on the Dental Hygiene Process of Care (ADPIE) and prioritize what's best for your client.

As a regulated health professional, it is your responsibility to use your knowledge, skills, and judgment to provide safe and effective dental hygiene care.

This includes:

• Completing a comprehensive health history at every visit, not just at the first appointment. Clients’ health can change over time, and updated information helps you make informed decisions.
• Consulting or collaborating with other healthcare professionals (e.g., physicians, dentists, pharmacists) when needed. This could include situations such as:
• Medical conditions that may require medical clearance before treatment (e.g., certain heart conditions, immunosuppression).
• Complex oral health conditions that go beyond your scope.
• Medications that could affect treatment decisions.
• Systemic health concerns such as active infections, chemotherapy, or recent radiation therapy.

The expectation to collaborate or consult hasn’t gone away—it has just evolved. While written approval is no longer legally required in all cases, it’s still your professional obligation to reach out when needed. If you're unsure, it's better to ask and document your decision-making process.

Best Practice Reminders:

• Clearly communicate relevant health information to others involved in the client’s care.
• Document all consultations, referrals, and decisions thoroughly.
• Use secure methods (email, fax, etc.) when sharing client information, following privacy laws.
• Keep the client involved—explain why consultation is important for their health.

No. It is not a legislated requirement that an RDH obtains a prescription prior to performing teeth whitening.

Decisions around the scope of practice for dental hygiene are determined by the NSRDHDTD, in alignment with Dental Hygienist Legislation, and any further standards or policies that are developed by the NSRDHDTD around specific areas. This includes teeth whitening. 

As with all competencies/scopes of practice, the individual dental hygienist must be competent to perform it.

NSRDHDTD Practising dental hygiene registrants performing teeth whitening for their clients must:

• Practice within the dental hygiene Code of Ethics adopted by the NSRDHDTD. Certain ethical considerations can arise around the use of bleaching/whitening. These usually involve respect for the client’s personal values, and informed consent.
• Make evidence-based decisions regarding implementation of new techniques, technology, or research before incorporating them into practice. It is the registrant’s responsibility to understand the processes involved in tooth whitening.
• Be competent in the procedures, and have appropriate education on the use of the product and equipment.
• Assess the client for contraindications to teeth whitening procedures (e.g., bleaching), apply appropriate selection criteria and knowledge of contraindications.
• Provide client education on the nature of the stain or discoloration of the teeth, including discussion on the expectations of results and other ramifications of bleaching, including possible adverse effects.
• Consider preventive measures to reduce any possible sensitivity.
• Obtain written informed consent.
• Use the product and equipment according to the manufacturer’s direction.
• Practice collaboratively to determine that the planned procedure aligns with the overall treatment plan for the client.

These products are not to be used in Canada. Products like the ones listed above are customized compounded anaesthetics that are being used in the dental field. The products above are produced and marketed in the USA. In the USA, there is concern about compounded topical anaesthetics – partially because these types of products are not really approved by the United States Food and Drug Administration (FDA). The products that are used to compound them are approved, but not the actual finished product. These products contain high concentrations of local anaesthetics and use should be evaluated on a client-by-client basis. They are not supposed to be sold on a “bulk basis” to dental/dental hygiene practices; but are compounded for a specific client. They are not intended for office wide use, like the non-compounded topical anaesthetics approved by Health Canada. “Because compounded agents can include various FDA approved drugs, there are infinite possible combinations and concentrations (Patel, 2019).” Additionally, there is no known toxic level for these customized products. Packaging for compounded substances is unmetered. As a result, inaccurate dosing can easily occur, which can put clients at risk for systemic intoxication. (Kravitz, 2007) Furthermore, both of these compounded products combine amides and esters, which put a variety of clients at risk. All dental hygienists must remain current regarding the use or recommendation of topical and injectable anaesthetic agents.

References: Kravitz, N. D. (2007). The use of compound topical anesthetics: a review. J AM Dent Assoc (138), 1333-1339. doi: https://doi.org/10.14219/jada. archive.2007.0048 Patel, T. J. (2019, May 9). Update on Dental Topical Anesthetics. Retrieved from The Journal of Multidisciplinary Care: Decisions in Dentistry: https:// decisionsindentistry.com/article/update-on-dental-topical-anesthetics/

There are no 'set' protocols about how often fluoride varnish can be applied. It depends on the individual needs of the client.

For example: 

• A client with high caries risk may have professional fluoride varnish more frequently than a client with low caries risk.
• A client with radiation caries would need fluoride varnish applications more frequently than a client with incipient (code 1) caries.

It depends on caries risk factors: diet, poor oral hygiene, low salivary flow, medications, past history of caries, deep pit & fissures on occlusal surfaces, clinical or radiographic signs of carious lesions.

As always, the practitioner should read the manufacturer's instructions. 

https://www.iccms-web.com/content/resources/elearning

*Response provided by Kim Haslam, RDH (2022)

Myofascial Release Therapy/Orofacial Myofunctional Therapy (OMT) is not within the scope of practice of dental hygiene in Nova Scotia. Accordingly, registrants of the NSRDHDTD are not authorized to provide Myofascial Release Therapy or OMT services as a RDH. RDHs that provide Myofascial Release Therapy or OMT must clearly advise clients that these are not dental hygiene services. Further, RDHs cannot offer these services as part of their dental hygiene practice.   

The NSRDHDTD is in the middle of reviewing Myofascial Release Therapy and OMT and has not yet determined if these services are within the scope of dental hygiene practice in Nova Scotia. If a decision is made that these services are within the scope of DH practice in NS, it may also include any restrictions or requirements for delivery of these services. This review has been ongoing for awhile, but it is important that a comprehensive analysis is completed, prior to making a final decision. As soon as a decision is made, we will circulate this out to all NSRDHDTD registrants.

Please note any hours you practice Orofacial Myofunctional Therapy or Myofascial Release Therapy cannot be counted as practice hours for the purpose of licence renewal with the NSRDHDTD. Further, please note that your DH professional liability insurance may not cover you for these services.

The Indigenous Health Primer that was published by the Royal College of Physicians and Surgeons of Canada in 2019 describes how it is the [client] who decides whether a culturally safe space has been created. This can be fluid and can change over time. You may have one interaction that a [client] considers to be healthy and safe, but another interaction that the same patient would consider unsafe. Cultural safety is an outcome and the end goal.

We can maximize our chances of creating culturally safe spaces through the practice of cultural humility. Cultural humility is an ongoing process whereby we develop an honest assessment of who we are and how this impacts our interaction with others. This is achieved through active reflection and can be further honed through formal and informal feedback from those around us. This information must be applied to change the way we see and relate to the world. In the context of Indigenous people, this requires ongoing interrogation of power, privilege, and racism. Some appreciation of cultural difference is necessary, but cultural humility is centred largely on gentle curiousity, respect, and empathy for the human experience.

*Response provided by Dr. Brent Young

No, all NSRDHDTD advanced practice authorizations, specific to a certain 'scope of practice', e.g., local anaesthetic administration, dentures over implants, you remain authorized to perform those procedures as long as you hold a practising licence with the NSRDHDTD, unless advised differently by the  NSRDHDTD. At all times, as per section 60 (1)(f) of the Regulated Health Professions Act, you are expected to restrict yourself to only performing procedures that you are individually competent to perform, regardless of authorization.

No. In Nova Scotia, it is not within the scope of practice for any of the three oral health professions regulated by the NSRDHDTD to perform injections for Botox® (botulinum toxin for injection) or fillers. 

Registrants who complete courses that cover the concepts, may submit for continuing education credit hours for course completion, however, registrants are not to administer these injections. Additional education about potential services that Nova Scotians may access through dental practices, such as Botox® or filler injections, will allow you, as a practising registrant, to provide insights and/or appropriate referrals, as needed, regarding the services in question. 

Sharpening of contaminated instruments presents a risk for disease transmission through accidental exposures. Sterilized instruments that require sharpening must be sharpened at point of care to maintain sterility using a sterilizable sharpening stone or card.

If using a non-sterilizable sharpening stone or card, instruments must be sterile prior to sharpening and reprocessed and sterilized after sharpening. These stones or cards must be cleaned after use and appropriately stored according to manufacturer’s instructions.

Response taken from page 23 of IPAC document.