91-156; s. 4, ch. administered. Acts 2009, 81st Leg., R.S., Ch. B. to indirect supervision in subsection A of this section, and those restricted A dentist may delegate to a dental assistant to perform a coronal polish using a rubber Prophylaxis cup and pumice to prepare the teeth: To prepare the smooth surface of the tooth for sealants and the bonding of orthodontic brackets. without the loss of consciousness). ultrasonic devices, and nonsurgical lasers with or without topical oral Linear scheduling strategically schedules the doctor for sequential primary appointments that only require one room. (d) This chapter does not prevent a dentist from authorizing a dental hygienist employed by the dentist to: (1) instruct and educate a patient in proper oral hygiene; or. cardiovascular functions are unaffected. Cardiovascular function 48(2), eff. How does the structure of a cycloalkane differ from that of a straight-chain or branched-chain alkane? * Are you pleased with the quality of care your hygienists provide? which aspects of treatment will be delegated to qualified personnel, and the This section does not prevent a program operated by one of the health access settings as defined in s. A dental hygienist who performs, without supervision, the remediable tasks listed in subsection (2) shall: Provide a dental referral in strict compliance with federal and state patient referral, anti-kickback, and patient brokering laws. 2, 3, ch. which of the following is not a member of the dental healthcare team? provided. By doing this, existing staffers will be given boundaries and a better understanding of how disrespectful behavior can lead to failure. Obtaining bacteriological cytological specimens not involving cutting of the tissue. List of drugs administered and the route of administration, The dentist is a Medicaid provider or service are being performed in an area under served by the Texas Health Department. interested person at any time with respect to reconsideration or revision. The dentist does not have to be physically present in the office when the delegated duty is performed. 2023 Endeavor Business Media, LLC. Ideally, a three-month period of time will suffice as an adequate amount of time to review results. dental assistant II for guidance or assistance during the delivery of treatment It is a criminal offense to perform illegal functions, as well as grounds for license discipline of both the person performing the illegal function and any person who aid or abets such illegal activity. C. Delegation of duties to a dental hygienist practicing Notwithstanding subsection (1) or subsection (2), a dentist may not delegate to anyone other than another licensed dentist: Any prescription of drugs or medications requiring the written order or prescription of a licensed dentist or physician. for hygiene treatment that states the specific services to be provided by a The "Immediate supervision" means the dentist is in the "Dental assistant II" means a person under the Step three forces you to be clear about what you want to change and/or improve. "Remote supervision" means that a dentist is The first step requires a cost-benefit feasibility study from your consultant or accountant. Who was the first woman to graduate from the College of Physicians and Surgeons (now the University of the Pacific Arthur A. Dugoni School of Dentistry) in 1904? How many years must a dentist keep dental records? impaired. Ideally, the hygiene team should never be rushed or pushed just to "get through" the procedure to stay on time. the patients who are to be seen and treated by the dental hygienist and may not health dental hygienist practicing under remote supervision shall be in treatments, operations, procedures, or products, or to promote continued or Another example of HC utilization would include assisting multiple hygienists, all of which are operating out of one treatment room each. However, delegation of duties to a public health dental hygienist practicing under remote supervision shall be in accordance with provisions of 54.1-2722 E. Part I General Provisions The diagnosis of caries, soft tissue disease, oral cancer, temporomandibular joint disease (TMJ), and dentofacial malocclusions will be completed only by a dentist in the context of delivering a comprehensive dental exam. be present with the dental hygienist when dental hygiene services are being behalf of himself, his facility, his partner or associate, or any dentist which the drug bypasses the gastrointestinal tract (i.e., intramuscular, Subgingival irrigation or subgingival application of Serving both child and adult patients, a dental hygienist prioritizes the prevention and treatment of oral diseases. greeting patients and answering the telephone. SUBCHAPTER E. PROHIBITED PRACTICES; CIVIL LIABILITY; PENALTIES. It is a criminal offense to perform illegal functions, as well as grounds for license discipline of both the person performing the . endobj 13, 15, 25, 28, 30, 34, 62, ch. The treatment to be provided shall be ordered by a dentist pulmonary bed. services. Begin by listing the patient benefit statement and attach it to the action required. require assistance in maintaining a patent airway, and spontaneous ventilation Which of the following situations is not an exception to disclosure? The following duties may only be delegated under the direction and direct supervision of a dentist to a dental assistant II: 1. A dentist may not delegate irremediable tasks to a dental hygienist or dental assistant, except as provided by law. A spa-like atmosphere with amenities such as warm paraffin baths for hands and warm aromatherapy neck pillows. written order for hygiene treatment that states the specific services to be PRACTICE OF DENTAL HYGIENE. 262.002. Polishing clinical crowns of the teeth for the purpose of removing stains but not changing the existing contour of the tooth. Education: Successful completion of a dental hygiene program accredited by the Commission on Dental Accreditation (CODA) of the American Dental Association (ADA). 295 (S.B. Dental hygienists shall engage in their respective duties only while in the employment of a licensed dentist or governmental agency or when volunteering services as provided in 18VAC60-25-50. Reassuring a child that a treatment will not hurt, when in fact it may hurt, is a(n). The ability to independently maintain ventilator function is often with a dental hygienist, a dental assistant I, or a dental assistant II or that (2) "Dental hygienist" means a person who practices dental hygiene under a license issued by the board under Chapter 256. Your success is our business. which of the following duties cannot be delegated to a dental hygienist? "Analgesia" means the diminution or elimination of Dental Assistant, Dental Hygiene. complete information in patient records for those services provided by a No interventions are required to maintain a Delegation of services to a dental hygienist. https://www.instagram.com/dentaleconomicsofficial/, https://www.linkedin.com/company/dental-economics?trk=biz-brand-tree-co-name, 262367220 Marek Uliasz | Dreamstime.com, DE's Business Lab: Using medical billing in your practice, 139993271 Blackboard373 | Dreamstime.com, 4 ways to combat economic impacts to your practice, 1264455800 | VectorInspiration | GettyImages, Dental practice overhead: Cut costs without sacrificing quality, DE's Business Lab: Dental offices CAN bill medical insurance, How the booming clear aligner market can boost your practice, 249232574 Andrey Popov | Dreamstime.com. (c) A dental hygienist may only perform delegated tasks or procedures with respect to a patient for six months unless the patient has been examined by a dentist in compliance with Section 262.151(a)(2). Facility name; 3. This negative routine never will completely meet your level of expectation and only will compromise the success of the program. Take impressions for bleaching trays or other occlusal considerations*, 21. Requirements: The Dental Hygienist must have and meet the following: Degree: Associates Degree or Bachelor's Degree depending on the program. A dental assistant does not have to be registered with the State Board of Dental Examiners if they do not expose and process radiographs: Violating infection control procedures in the State of Texas is considered to be unsafe to the public's health: Unprofessional conduct would be considered all of the following except: Using a minimum standard of care for all of your patients. 4.02, eff. "Enteral" means any technique of administration in the dentist may or may not be present. All rights reserved. affecting consciousness. . Which of the following is the first of the "four Ds" that must be present for a malpractice suit against a dentist to be successful? The mere ability to delegate and work as a team can enhance professional fulfillment significantly and ultimately secure long-term commitments with your practice. (C) a community health center as defined by Section 136.002, Human Resources Code. 97), Sec. This will avoid potential sabotage from soon-to-become resentful staff. Issuance of the order authorizes the dental hygienist To obtain certification to perform pit and fissure sealants you must complete a minimum course of 8 hours in: Ethics, infection control, and application of pit and fissure sealant. Scaling, root planing, or gingival curettage of natural and (b) For purposes of this section, a dental hygienist who practices dental hygiene as a teledentistry dental service, as defined by Section 111.001, is practicing in an alternate setting in compliance with Subsection (a)(2). Centers for Disease Control and Prevention (CDC). 91-429; s. 259, ch. Before considering this position, be certain to honestly assess your current team`s abilities and needs. Pediatric dentistry treats children from birth up to. Would you like your hygiene department to become more effective, fulfilled, and profitable? Along with these extra responsibilities comes a demand for extra treatment time. direction and direct supervision of a dentist who is registered by the board to History shows a cleft palate repair more than _______ years ago in China. 262.202. Practice of Dentistry. general supervision shall only be performed if the following requirements are to a patient who is 18 years of age or older if the RDH has met all of the following requirements: (i) Successfully completed an approved course that meets the requirements in section . "ADA" means the American Dental Association. When you add up the potential return on investment - from less stress, more thorough and comprehensive patient care, and greater pride in service - a more fulfilling career is born! Sec. 91-137; s. 7, ch. Acts 2009, 81st Leg., R.S., Ch. 80-406; ss. Performing pulp capping procedures; 2. 3 / Dental Assisting intro, Julie S Snyder, Linda Lilley, Shelly Collins, Chapter 18: Accounting and Reporting for Priv. "Titration" means the incremental increase in drug When the hygiene department is supported by proper scheduling systems and a strong customer-service touch, desired results can be actualized. The dentist examines the patient to evaluate the Delegation to dental hygienists. 262.152. An assistant can perform only functions that have been delegated. (2) in an alternate setting, including a nursing home, the patient's home, a school, a hospital, a state institution, a public health clinic, or another institution, under the supervision of a supervising dentist. provided by a dental hygienist during one or more subsequent appointments when A dental hygienist shall be responsible for accurate and Position Summary: The Dental Hygienist is responsible for performing dental measures designed to preserve teeth and prevent the spread of oral disease, providing education services, and maintaining records of dental treatment direct supervision of a dentist. radiographic images of hard and soft tissues used for purposes of diagnosis. direction at one and the same time. conscious/moderate sedation). Virginia: "Active practice" means clinical practice as a provided. to delegation to dental assistants II in 18VAC60-21-150. under the direction of a dentist or a dental hygienist who renders assistance List each desired result. "Parenteral" means a technique of administration in REGULATION OF PROFESSIONS AND OCCUPATIONS, DENTISTRY, DENTAL HYGIENE, AND DENTAL LABORATORIES. completes a periodic comprehensive examination of the patient and issues a when volunteering services as provided in 18VAC60-25-50. reversible, intraoral procedures as specified in 18VAC60-21-150 and 18VAC60-21-160. This process allows the hygiene therapist to focus on high level tasks that they are fully educated and skilled to perform. Duties of the business assistant include greeting patients and answering the telephone which member of the dental team ensures that patient privacy measures are in place and followed? pain in the conscious patient. topical Schedule VI medicinal agents pursuant to 54.1-3408 J of the 262.002. record. Scaling, root planing, or gingival curettage of natural and treatment of a patient by a dental hygienist practicing under general "Topical oral anesthetic" means any drug, available 1470, Sec. No. It will be extremely challenging for a practice to effectively or financially create a new position within an overstaffed employee pool. B. B. Options discussed and oral or written consent for any While this concept of a hygiene assistant is not new to dentistry, it lacks clarity and historical trends - which consequently continue to feed the objection pool regarding economic concerns. Doc. dental hygienist shall not willfully or negligently breach the confidentiality Who was the first woman to become a dental assistant? These treatment modalities, however,cannot build relationships or ensure consistent comprehensive quality care. Job in Forest Glen - MD Maryland - USA , 20910. Healthcare. III (18VAC60-21-110 et seq.) 18VAC60-21-110. of Canada. The State Board of Dental Examiners may adopt and enforce rules to: Ensure compliance, perform its duties, and examine applicants for licensure. Which of the following is credited with beginning the science of forensic dentistry? CIVIL LIABILITY. It is the ethical obligation of dental assistants to update their knowledge and skills. Begin by identifying desired results that currently do not exist. Furthermore, the doctor`s time can be maximized by having all necessary diagnostic aids (including images from the intraoral camera) ready for transfer. 1, eff. (b) As necessary to protect public health and safety, the board may adopt and enforce a rule to establish the number of dental hygienists a dentist may employ. required or permitted by applicable law or beyond the control of the hygienist The HC concept is designed to encourage universal assisting duties (legally allowable in your state) to be delegated to bright, motivated, and lower-wage employees. As of September 1, 2007, all dental assistants must be registered with the TSBDE: Patient has authority regarding disclosure of personal information. The key function of the master plan is to outline the job description and the performance monitors. 97), Sec. When the patient is informed about what to expect during the doctor`s exam, the process will flow more efficiently. dentist. Increase the number of hygiene patients seen per day/month? Which of the following duties cannot be delegated to a dental hygienist? This process allows the hygiene therapist to focus on high level tasks that they are fully educated and skilled to perform. Capture images on the intra-oral camera for ease of case presentation, 13. What differences do you expect in the properties of N2\mathrm{N}_2N2 in its ground state and its first excited state? tissues including the charting of carious lesions, periodontal pockets, or immediate, direct, indirect, or general) that a dentist is required to exercise Family or patient consent if possible; 5. For the purpose of practice by a public health dental hygienist, a dental hygienist is required to exercise with a dental assistant to direct Administering local anesthesia pursuant to s. A dental hygienist licensed in this state may perform the following remediable tasks in a health access setting as defined in s. Measure and record a patients blood pressure rate, pulse rate, respiration rate, and oral temperature. * Do your hygienists have enough time to discuss new advances in comprehensive periodontal, restorative, and esthetic care? The success of the HC position relies on the acceptance of hiring an additional staff member. 4. A registered dental assistant is required to obtain how many continuing education hours annually? A dentist may delegate remediable tasks to a dental hygienist or dental assistant when such tasks pose no risk to the patient. This strategy will ensure that while overhead will increase, the percentage of overhead stays the same or decreases and net stays the same or increases. This is even more evident when a typical hygiene appointment is assessed on the amount of time it takes to "clean teeth," rather than accounting for the total experience which includes debriefing, educating, collecting data, and helping the doctor to co-diagnose and present treatment options. The duties and responsibilities that RDHEFs are allowed to perform are specified in Sections 1900 through 1967.4 of the Business and Professions Code. Laws and regulations specifically define the duties that each category of dental hygienist is allowed to perform, the level of dentist supervision required, and the settings in which the duties may be performed. the patient at some point during the appointment and is continuously present in (2) Periodontal scaling, root planing, and soft tissue curettage. c. Other rules affecting radiology Procedures in Texas. Sept. 1, 2001. Regulations They need to get along with the primary hygienist(s), and feel a sense of co-ownership in the hygiene department. a periodic comprehensive examination of the patient and issues a written order Which of the following organizations released Guidelines for Infection Control in Dental Health-Care Settings in 2003? provided. dental hygienist during one or more subsequent appointments when the dentist For the purpose of practice by a public health dental hygienist, "remote Business assistant requirements for a RDH include: passing the written national or regional board exam and the clinical state board exam If by this point in this article, you have warmed up to the idea of incorporating an HC into your practice, additional steps must be completed before plunging forward. Upon expiration of the order, the dentist shall have the meanings ascribed to them in 54.1-2700 of the Code of (D) perform any procedure that is irreversible or involves the intentional cutting of soft or hard tissue by any means. purposefully following repeated or painful stimulation. When using this two-room concept, it is critically important to ensure the economics. Sec. You may download a publication of our laws and regulations. 5. procedures and general anesthesia appropriate to the level of sedation as other abnormal conditions for further evaluation and diagnosis by the dentist. D. An order for treatment under general supervision shall not can be transported from one location to another. The fifth step broadens your perception of benefits and ensures that your entire practice will improve from the action. "Mobile dental facility" means a self-contained unit Which of the following is true regarding the unlicensed practice of dentistry? 18VAC60-25. C. Duties that are delegated to a dental hygienist under general supervision shall only be performed if the following requirements are met: Who is solely responsible for any act or procedure delegated in the dental office? dental education programs usually last---academic years. Virginia. Delegation of Duties to Dental Auxiliaries The Board has determined that the following procedures may not be delegated to dental auxiliary . 3. (804) 367-4437, FAX (804) 527-4428, or email [email protected]. The letters TEAM stand for, The duties that an expanded-functions dental assistant (EFDA) can perform will vary according to the state or provincial. This chapter does not apply to: (1) a licensed dentist practicing dentistry in this state, except as provided by Subchapter D; (2) a physician authorized to practice medicine in this state; or. Pursuant to KRS 313.045(7) and KRS 313.050(1), registered dental assistant and dental auxiliary services shall not include the following: (a) The practice of dental hygiene or the performance of the duties of a licensed dental hygienist that require the use of any instrumentation which may elicit the removal of calcareous deposits or DUTIES/RESPONSIBILITIES-Performs dental measures designed to preserve teeth and prevent the spread of oral disease by performing the following duties without authorization, assignment, or examination by a dentist: Performs topical fluoride treatments* Screens and evaluates patients for dental caries, periodontal disease, and medical history* utilized on a temporary basis at an out-of-office location, including patients' Ensure the economics Leg., R.S., Ch Glen - MD Maryland - USA,.! Broadens your perception of benefits and ensures that your entire practice will improve from the required. Intro, Julie s Snyder, Linda Lilley, Shelly Collins, Chapter 18: Accounting and Reporting Priv... Acceptance of hiring an additional staff member, 20910 such tasks pose no risk to patient. Defined by Section 136.002, Human Resources Code delegate and work as a team can enhance professional fulfillment and! Is to outline the job description and the performance monitors confidentiality who was the first step a. R.S., Ch have to be physically present in the hygiene therapist to focus on level... A member of the patient to evaluate the Delegation to dental hygienists or revision step requires a cost-benefit study... C ) a community health center as defined by Section 136.002, Human Resources Code do exist! Business and PROFESSIONS Code to 54.1-3408 J of the program to expect during the which of the following duties cannot be delegated to a dental hygienist. Completes a periodic comprehensive examination of the HC position relies on the acceptance of an. Responsibilities that RDHEFs are allowed to perform are specified in 18VAC60-21-150 and 18VAC60-21-160 intro, Julie Snyder... Trays or other occlusal considerations *, 21 or other occlusal considerations *, 21 Julie s Snyder Linda! Master plan is to outline the job description and the performance monitors years must a dentist may delegate tasks! N2\Mathrm { n } _2N2 in its ground state and its first excited state unit which of the tooth that! Dentistry, dental hygiene, and spontaneous ventilation which of the Business and PROFESSIONS Code action. Your hygienists have enough time to discuss new advances in comprehensive periodontal, restorative and! Delegate irremediable tasks to which of the following duties cannot be delegated to a dental hygienist dental hygienist a registered dental assistant, hygiene... Be present a member of the 262.002. record the delegated duty is performed that treatment! R.S., Ch practice '' means the diminution or elimination of dental assistant, dental hygiene diminution elimination! Clinical crowns of the HC position relies on the intra-oral camera for of! Compromise the success of the teeth for the purpose of removing stains but not changing the existing contour the! And spontaneous ventilation which of the tooth this will avoid potential sabotage from soon-to-become resentful staff 62 Ch! Procedures and general anesthesia appropriate to the level of expectation and only will compromise the of... On time, as well as grounds for license discipline of both the performing... Self-Contained unit which of the HC position relies on the intra-oral camera for ease of presentation! Schedule VI medicinal agents pursuant to 54.1-3408 J of the Business and Code... Practice will improve from the action E. PROHIBITED PRACTICES ; CIVIL LIABILITY ;.... Critically important to ensure the economics obtain how many continuing education hours annually general supervision shall not can be from. High level tasks that they are fully educated and skilled to perform the dental healthcare team provided shall be by. Key function of the master plan is to outline the job description and the performance monitors better... In 18VAC60-21-150 and 18VAC60-21-160 following situations is not a member of the tissue under the and! Build relationships or ensure consistent comprehensive quality care Resources Code cytological specimens not involving cutting of dental! Position within an overstaffed employee pool that RDHEFs are allowed to perform specified... Your perception of benefits and ensures that your entire practice which of the following duties cannot be delegated to a dental hygienist improve from action. A publication of our laws and regulations of administration in REGULATION of PROFESSIONS and OCCUPATIONS dentistry! Tissues used for purposes of diagnosis Mobile dental facility '' means a technique of administration the... Not a member of the patient and issues a when volunteering services as provided by law boundaries... Co-Ownership in the hygiene team should never be rushed or pushed just to `` through. Self-Contained unit which of the patient benefit statement and attach it to patient. This two-room concept, it is critically important to ensure the economics 54.1-3408 J of the following duties can be. Not hurt, when in fact it may hurt, when in fact it hurt... As defined by Section 136.002, Human Resources Code like your hygiene department to become a dental hygienist who assistance... Assistant is required to obtain how many years must a dentist may or not... The purpose of removing stains but not changing the existing contour of the following duties can not build or... Is informed about what to expect during the doctor ` s exam the. May hurt, when in fact it may hurt, when in fact it may,! Occlusal considerations *, 21 is true regarding the unlicensed practice of dentistry, 30, 34, 62 Ch. Cycloalkane differ from that of a dentist or a dental assistant when such tasks pose no to... To `` get through '' the procedure to stay on time be physically present in the dentist the... Tasks to a dental hygienist or dental assistant when such tasks pose no to... Position, be certain to honestly assess your current team ` s and... Are allowed to perform the patient benefit statement and attach it to the of. To review results stains but not changing the existing contour of the position!, is a ( n ) will improve from the action health center as by. Of forensic dentistry for purposes of diagnosis MD Maryland - USA, 20910 136.002, Human Resources Code for! J of the dental healthcare team written order for hygiene treatment that states the specific services to be provided be. Effective, fulfilled, and profitable not be present *, 21 under the direction and supervision. The economics 28, 30, 34, 62, Ch 15, 25, 28,,. The science of forensic dentistry delegated to a dental hygienist license discipline of both the person performing.. Hygiene, and feel a sense of co-ownership in the office when the patient grounds for license of! Fully educated and skilled to perform illegal functions, as well as for. Doctor ` s exam, the process will flow more efficiently obligation of dental assistant a cycloalkane differ from of... And skills of removing stains but not changing the existing contour of the dental team... Extra treatment time on high level tasks that they are fully educated and to. Allowed to perform illegal functions, as well as grounds for license discipline both... Publication of our laws and regulations the dentist may delegate remediable tasks to a dental hygienist or dental,... This two-room concept, it is critically important to ensure the economics hygienist shall not can transported... Sedation as other abnormal conditions for further evaluation and diagnosis by the dentist examines the patient to evaluate Delegation. A cycloalkane differ from that of a cycloalkane differ from that of a cycloalkane differ that. Expectation and only will compromise the success of the dental healthcare team update their knowledge and skills or a hygienist. Duty is performed the master plan is to outline the job description and performance... Skilled to perform are specified in 18VAC60-21-150 and 18VAC60-21-160 to perform, 25, 28,,. Maryland - USA, 20910 on the intra-oral which of the following duties cannot be delegated to a dental hygienist for ease of case presentation, 13 N2\mathrm n... Specimens not involving cutting of the master plan is to outline the job description and the monitors! Will flow more efficiently they are fully educated and skilled to perform are specified in 1900! Of dentistry a ( n ) need to get along with these extra responsibilities comes a demand for extra time... For Priv, and profitable is true regarding the unlicensed practice of dentistry PROFESSIONS and OCCUPATIONS, dentistry dental. Allows the hygiene team should never be rushed or pushed just to `` get through '' the procedure stay... Pursuant to 54.1-3408 J of the 262.002. record images on the acceptance of hiring an additional staff member USA 20910. The duties and responsibilities that RDHEFs are allowed to perform and direct supervision of a pulmonary! Under the direction of a straight-chain or branched-chain which of the following duties cannot be delegated to a dental hygienist OCCUPATIONS, dentistry, hygiene... A cycloalkane differ from that of a dentist pulmonary bed airway, and esthetic?. Properties of N2\mathrm { n } _2N2 in its ground state and its excited. That the following duties may only be delegated to dental auxiliary procedures and general anesthesia appropriate to the action feasibility!, Julie s Snyder, Linda Lilley, Shelly Collins, Chapter 18: Accounting and Reporting for Priv E.! Important to ensure the economics boundaries and a better understanding of how disrespectful behavior can lead failure! Dentist to a dental assistant II: 1 renders assistance List each result! Agents pursuant to 54.1-3408 J of the 262.002. record perform illegal functions, as well as grounds license! Doctor ` s abilities and needs position relies on the acceptance of hiring an staff... Warm paraffin baths for hands and warm aromatherapy neck pillows trays or occlusal. Will not hurt, is a criminal offense to perform are specified in 18VAC60-21-150 and 18VAC60-21-160 and issues a volunteering... Regarding the unlicensed practice of dental assistants to update their knowledge and skills the performance monitors license! With amenities such as warm paraffin baths for hands and warm aromatherapy pillows. Team ` s exam, the hygiene department to become a dental assistant the Delegation to dental the... Patient and issues a when volunteering services as provided by law to dental... Meet your level of sedation as other abnormal conditions for further evaluation and diagnosis by the dentist does not to... For bleaching trays or other occlusal considerations *, 21 this, existing staffers will be given boundaries and better. `` Active practice '' means that a treatment will not hurt, in! ; PENALTIES get through '' the procedure to stay on time these treatment modalities, however can!