Part 5.
STATE BOARD OF DENTAL EXAMINERS
Chapter 108.
PROFESSIONAL CONDUCT
Subchapter A. PROFESSIONAL RESPONSIBILITY
22 TAC §108.6
The State Board of Dental Examiners proposes amendments to §108.6,
Report of Patient Death or Injury requiring Hospitalization. Paragraph (1)
is modified to require that a patient death occurring as a consequence of
receiving dental services must be reported within 72 hours of the time when
the reporting dentist knew or should have known of the death. This time is
shortened from 30 days. Paragraph (2) is changed to reflect that a report
of injury occurring as a consequence of receiving dental services must be
reported within 30 days. Paragraph (3) is changed to add the words "...or
injury..." to the paragraph, as an event that triggers the necessity for a
report to the Board.
Jeffry R. Hill, Executive Director, State Board of Dental Examiners, has
determined for the first five-year period the amended rule is in effect there
will be no fiscal implications for local or state government as a result of
enforcing or administering the rule.
Mr. Hill also has determined that for each year of the first five years
the amended rule is in effect the public benefit anticipated as a result of
amending the rule is that the proper emphasis will be placed upon the unfortunate
circumstance of the death of a patient as a consequence of receiving dental
services. Such an event requires timely inquiry and investigation and the
Board is of the opinion that 30 days is too long a period of time to wait
before reporting a patient death.
There will be no fiscal implications for small or large businesses. Therefore
the SBDE has determined that compliance with the proposed amended rule will
not have an adverse economic impact on small businesses when compared to large
businesses.
Comments on the proposal may be submitted to Mei Ling Clendennen, Assistant
Executive Director, State Board of Dental Examiners, 333 Guadalupe, Tower
3, Suite 800, Austin, Texas 78701, (512-463-6400). To be considered, all written
comments must be received by the State Board of Dental Examiners on or before
May 27, 2001.
The amended rule is proposed under Texas Government Code §2001.021
et.seq; Texas Civil Statutes, the Occupations Code §254.001 which provides
the State Board of Dental Examiners with the authority to adopt and enforce
rules necessary for it to perform its duties, and to ensure compliance with
laws relating to the practice of dentistry.
The proposed amended rule does not affect other statutes, articles, or
codes.
§108.6.Report of Patient Death or Injury Requiring Hospitalization.
A dentist must submit a written report to the Board
as provided
below:
[
(1)
The death of a dental patient which occurred as a consequence
of the receipt of dental services from the reporting dentist
must be
reported within 72 hours of the death, or such time as the dentist becomes
aware or reasonably should have become aware of the death
; [
(2)
An
injury to a dental patient requiring admission
to a hospital, as a consequence of receiving dental services from the reporting
dentist
must be reported within 30 days of the injury
.
(3)
The receipt of the report shall not be considered in the
nature of a complaint unless the Enforcement Committee determines that the
circumstances surrounding the patient death
or injury
should be
investigated by the Board.
This agency hereby certifies that the proposal has been
reviewed by legal counsel and found to be within the agency's legal authority
to adopt.
Filed with the Office of
the Secretary of State, on April 13, 2001.
TRD-200102123
Jeffry Hill
Executive Director
State Board of Dental Examiners
Earliest possible date of adoption: May 27, 2001
For further information, please call: (512) 463-6400
22 TAC §108.32
The State Board of Dental Examiners proposes amendments to §108.32
Minimum Standard of Care, Anesthesia. The lead paragraph has been modified
to delete the word "...parenteral..." as a modifier of "deep sedation and
general anesthesia". Deletion of the word "parenteral" when it is such a modifier
in §§108.32 - 108.34 has the effect of requiring that all licensees
who administer deep sedation and/or general anesthesia must have a permit
to do so, whether the sedative agents are administered parenterally or by
any other route. Without this change, dentists, by use of orally administered
sedative agents, could deeply sedate patients without having a permit.
Jeffry R. Hill, Executive Director, State Board of Dental Examiners, has
determined for the first five-year period the amended rule is in effect there
will be no fiscal implications for local or state government as a result of
enforcing or administering the rule.
Mr. Hill also has determined that for each year of the first five years
the amended rule is in effect the public benefit anticipated as a result of
amending the rule is that dentists who intend to administer deep sedation
and/or general anesthesia must be permitted to do so, no matter how the sedative
agents are administered.
There will be no fiscal implications for small or large businesses. Therefore
the SBDE has determined that compliance with the proposed amended rule will
not have an adverse economic impact on small businesses when compared to large
businesses.
Comments on the proposal may be submitted to Mei Ling Clendennen, Assistant
Executive Director, State Board of Dental Examiners, 333 Guadalupe, Tower
3, Suite 800, Austin, Texas 78701, (512-463-6400). To be considered, all written
comments must be received by the State Board of Dental Examiners on or before
May 27, 2001.
The amended rule is proposed under Texas Government Code §2001.021
et.seq; Texas Civil Statutes, the Occupations Code §254.001 which provides
the State Board of Dental Examiners with the authority to adopt and enforce
rules necessary for it to perform its duties, and to ensure compliance with
laws relating to the practice of dentistry.
The proposed amended rule does not affect other statutes, articles, or
codes.
§108.32.Minimum Standard of Care, Anesthesia.
In the interest of patient safety, a dentist licensed by the State
Board of Dental examiners and practicing in Texas, who desires to utilize
nitrous oxide/oxygen inhalation conscious sedation, parenteral conscious sedation,
and/or [
(1)
Shall maintain a patient record:
(A)
from which a diagnosis may be made;
(B)
which includes a description of treatment rendered;
(C)
includes the date on which treatment is performed; and
(D)
which includes any information a reasonable and prudent
dentist in the same or similar circumstances would include.
(2)
Shall maintain and review an initial medical history and
perform limited physical evaluation for all dental patients to wit:
(A)
The initial medical history shall include, but shall not
necessarily be limited to, known allergies to drugs, serious illness, current
medications, previous hospitalizations and significant surgery, and a review
of the physiologic systems obtained by patient history. A "check list", for
consistency, may be utilized in obtaining initial information. The dentist
shall review the medical history with the patient at any time a reasonable
and prudent dentist in the same or similar circumstance would so do.
(B)
The initial limited physical examination should include,
but shall not necessarily be limited to, blood pressure and pulse/heart rate
as may be indicated for each patient.
(3)
Shall obtain an review an updated medical history and limited
physical evaluation when a reasonable and prudent dentist under the same or
similar circumstances would determine it is indicated.
(4)
Shall, for office emergencies:
(A)
maintain a positive pressure breathing apparatus including
oxygen which shall be in working order.
(B)
maintain other emergency equipment and/or currently dated
drugs as a reasonable and prudent dentist with the same or similar training
and experience in the same or similar circumstances would maintain;
(C)
provide training to dental office personnel in emergency
procedures which shall include, but not necessarily be limited to, basic cardiac
life support, inspection and utilization of emergency equipment in the dental
office, and office procedures to be followed in the event of an emergency
as determined by a reasonable and prudent dentist in the same or similar circumstances;
and
(D)
shall adhere to generally accepted protocols and/or standards
of care for management of complications and emergencies.
(5)
Shall successfully complete a current course in basic cardiopulmonary
resuscitation given or approved by either the American Heart Association or
the American Red Cross.
(6)
Should maintain a written informed consent signed by the
patient, or a parent or legal guardian of the patient if the patient is a
minor, or a legal guardian of the patient if the patient has been adjudicated
incompetent to manage the patient's personal affairs. Such consent is required
for all procedures where a reasonable possibility of complications from the
procedure exists, and such consent should disclose risks or hazards that could
influence a reasonable person in making a decision to give or withhold consent.
This agency hereby certifies that the proposal has been
reviewed by legal counsel and found to be within the agency's legal authority
to adopt.
Filed with the Office of
the Secretary of State, on April 13, 2001.
TRD-200102124
Jeffry Hill
Executive Director
State Board of Dental Examiners
Earliest possible date of adoption: May 27, 2001
For further information, please call: (512) 463-6400
22 TAC §108.33
The State Board of Dental Examiners proposes amendments to §108.33
Sedation/Anesthesia Permit The modifier "...parenteral..." has been deleted
before "deep sedation and general anesthesia" in Subsections (b), (c), (f)(5),
(f)(5)(A), (g)(3), (g)(3)(A), (g)(3)(A)(ii), (g)(3)(B), and (g)(3)(B)(i),
(ii), and (iii). Deletion of the word "parenteral" when it is such a modifier
in §§108.32 - 108.34 has the effect of requiring that all licensees
who administer deep sedation and/or general anesthesia must have a permit
to do so, whether the sedative agents are administered parenterally or by
any other route. Without this change, dentists, by use of orally administered
sedative agents, could deeply sedate patients without having a permit. The
language of subsection (g)(2)(A)(i) has been modified to substitute the words
"for the" in place of "in" and to add the words "technique requested." Parenteral
conscious sedation can be achieved intramuscularly, subcutaneously, intravenously
or submucosally. These changes clarify that an applicant for a parenteral
conscious sedation permit must have received training in the particular technique
or techniques that he/she will utilize to achieve parenteral conscious sedation.
Clause ii has been modified to add the words "...the parenteral conscious
sedation technique requested."
Jeffry R. Hill, Executive Director, State Board of Dental Examiners, has
determined for the first five-year period the amended rule is in effect there
will be no fiscal implications for local or state government as a result of
enforcing or administering the rule.
Mr. Hill also has determined that for each year of the first five years
the amended rule is in effect the public benefit anticipated as a result of
amending the rule is that dentists who intend to administer deep sedation
and/or general anesthesia must be permitted to do so, no matter how the sedative
agents are administered. Further, the public will be assured that one who
holds a permit for a particular technique of administering parenteral conscious
sedation will have received training in that particular technique.
There will be no fiscal implications for small or large businesses. Therefore
the SBDE has determined that compliance with the proposed amended rule will
not have an adverse economic impact on small businesses when compared to large
businesses.
Comments on the proposal may be submitted to Mei Ling Clendennen, Assistant
Executive Director, State Board of Dental Examiners, 333 Guadalupe, Tower
3, Suite 800, Austin, Texas 78701, (512-463-6400). To be considered, all written
comments must be received by the State Board of Dental Examiners on or before
May 27, 2001.
The amended rule is proposed under Texas Government Code §2001.021
et.seq; Texas Civil Statutes, the Occupations Code §254.001 which provides
the State Board of Dental Examiners with the authority to adopt and enforce
rules necessary for it to perform its duties, and to ensure compliance with
laws relating to the practice of dentistry.
The proposed amended rule does not affect other statutes, articles, or
codes.
§108.33.Sedation/Anesthesia Permit.
(a)
The State Board of Dental Examiners shall appoint advisory
consultants for advice and recommendations to the Board on permit requirements,
applicant and facility approval.
(b)
A dentist licensed by the State Board of Dental Examiners
and practicing in Texas, who desires to utilize nitrous oxide/oxygen inhalation
conscious sedation, parenteral conscious sedation, and/or [
(1)
A permit may be obtained by completing an application form
approved by the State Board of Dental Examiners, a copy of which may be obtained
from the SBDE.
(2)
The application form must be filled out completely and
appropriate fees paid.
(3)
Prior to issuance of a sedation/anesthesia permit the Board
may require that the applicant undergo a facility inspection or further review
of anesthesia credentials. The SBDE may direct an Anesthesia Consultant, who
has been appointed by the Board, to assist in this inspection or review. The
applicant will be notified in writing if an inspection is required and provided
with the name of an Anesthesia Consultant who will coordinate the inspection.
The applicant must make arrangements for completion of the inspection within
180 days of the date the notice is mailed. An extension of no more than 90
days may be granted if the designated Anesthesia Consultant requests one.
(4)
An applicant for a sedation/anesthesia permit must be licensed
and in good standing with the State Board of Dental Examiners. For purposes
of Rules 108.30 through 108.34, of this title (relating to Anesthesia and
Anesthetic Agents) "good standing" means that a licensee is not suspended,
whether or not the suspension is probated. Applications from licensees who
are not in good standing may not be approved.
(c)
Any dentist approved by the State Board of Dental Examiners
under previous rules prior to the effective date of this section for the utilization
of nitrous oxide/oxygen inhalation conscious sedation, parenteral conscious
sedation, or [
(d)
Once a permit is issued, the State Board of Dental Examiners
upon payment of required fees shall automatically renew the permit annually
unless after notice and opportunity for hearing the Board finds the permit
holder has, or is likely to provide anesthesia services in a manner that does
not meet the minimum standard of care. At such hearing the Board shall consider
factors including patient complaints, morbidity, mortality, and anesthesia
consultant recommendations.
(e)
Annual dental license renewal certificates shall include
the annual permit renewal, except as provided for in subsection (d) of this
section and shall be assessed an annual renewal fee of $5.00 payable with
the license renewal. New permit fees are $28.75 payable with the application
for permit.
(f)
Permit Restrictions:
(1)
A sedation/anesthesia permit is valid for the dentist's
facility, if any, as well as any satellite facility.
(2)
Portability of a sedation/anesthesia permit will be granted
to a dentist who, after September 1, 2000, applies for portability if the
dentist is granted:
(A)
a deep sedation/general anesthesia permit; or
(B)
an intravenous parenteral conscious sedation permit if
training for the permit was obtained on the basis of completion of
(i)
a specialty program approved by the Commission on Dental
Accreditation of the American Dental Association, or
(ii)
a general practice residency, approved by the Commission
on Dental Accreditation of the American Dental Association, or
(iii)
an advanced education in general dentistry program, approved
by the Commission on Dental Accreditation of the American Dental Association,
or
(iv)
a Continuing Education (CE) program specifically approved
by the SBDE. The board may approve a graduate of a CE program under this subsection
only if the applicant can demonstrate administration of intravenous parenteral
conscious sedation in at least 30 cases that are documented showing provision
of anesthesia services in keeping with the standard of care as determined
by one or more of the SBDE's anesthesia consultants; and the applicant establishes
that the program consisted of
(I)
sixty hours of didactic courses;
(II)
administration of intravenous parenteral conscious sedation
in at least 20 cases where the applicant was the anesthesia provider.
(3)
When anesthesia services are provided by a dentist at a
location other than a facility or a satellite facility, the dentist shall
strictly adhere to all rules of the State Board of Dental Examiners which
may apply. The dentist shall ascertain that the location is supplied, equipped,
staffed and maintained in a condition to support provision of anesthesia services
that meet the standard of care.
(4)
A dentist holding a permit to administer parenteral conscious
sedation on the effective date of this rule who is qualified by training or
experience to administer intravenous parenteral conscious sedation anesthesia
on a portable basis, and who desires to do so must file with the State Board
of Dental Examiners proof of completion of:
(A)
a specialty program approved by the Commission on Dental
Accreditation of the American Dental Association, or
(B)
a general practice residency approved by the Commission
on Dental Accreditation of the American Dental Association, or
(C)
an advanced education in a general dentistry program approved
by the Commission on Dental Accreditation of the American Dental Association,
or
(D)
a Continuing Education program and administration of intravenous
parenteral conscious sedation in at least 30 cases that are documented showing
provision of anesthesia services in keeping with the standard of care as determined
by one or more of the SBDE's anesthesia consultants.
(E)
The records of all dentists permitted to administer parenteral
conscious sedation will be annotated showing whether portability status is
granted.
(F)
Any applicant whose request for portability is not granted
on the basis of the application will be provided an opportunity for hearing
pursuant to Texas Government Code, Section 2001 et.seq.
(5)
A dentist holding a permit to administer [
(A)
The records of all dentists permitted to administer [
(B)
Any applicant whose request for portability status is not
granted on the basis of the application will be provided an opportunity for
hearing pursuant to Texas Government Code, Section 2001 et.seq.
(6)
The Board may elect to issue a temporary sedation/anesthesia
permit which will expire on a date certain. A full sedation/anesthesia permit
may be issued after the dentist has complied with requests of the Board which
may include, but shall not be limited to, review of the dentist's anesthetic
technique, facility inspection and/or review of patient records to ascertain
that the minimum standard of care is being met. If a full permit is not issued,
the temporary permit will expire on the stated date, and no further action
by the State Board of Dental Examiners will be required, and no hearing will
be conducted.
(g)
Educational/Professional requirements for sedation/anesthesia
permits:
(1)
Nitrous Oxide/Oxygen Inhalation Conscious Sedation
(A)
To administer nitrous oxide/oxygen inhalation conscious
sedation, the dentist must satisfy one of the following criteria:
(i)
must have completed training consistent with that described
in Part I or Part III of the American Dental Association (ADA) Guidelines
for Teaching the Comprehensive Control of Pain and Anxiety in Dentistry; or
(ii)
must have completed an ADA accredited post-doctoral training
program which affords comprehensive and appropriate training necessary to
administer and manage nitrous oxide/oxygen inhalation conscious sedation.
(B)
The following shall apply to the administration of nitrous
oxide/oxygen inhalation conscious sedation in the dental office:
(i)
provision of nitrous oxide/oxygen inhalation conscious
sedation by another duly qualified dentist or physician anesthesiologist requires
the operating dentist and his/her clinical staff to maintain current expertise
in Basic Life Support (BLS);
(ii)
when a Certified Registered Nurse Anesthetist (CRNA) is
permitted to function under the supervision of a dentist, in the dental office,
provision of nitrous oxide/oxygen inhalation conscious sedation by a CRNA
shall require the operating dentist to have completed training in nitrous
oxide/oxygen inhalation conscious sedation, and to be permitted for its utilization.
(2)
Parenteral Conscious Sedation
(A)
To administer parenteral conscious sedation, the dentist
must satisfy one of the following criteria:
(i)
completion of a comprehensive training program
for
the
[
(ii)
completion of an ADA accredited post-doctoral training
program which affords comprehensive and appropriate training necessary to
administer and manage
the
parenteral conscious sedation
technique
requested
.
(B)
The following shall apply to the administration of parenteral
conscious sedation in the dental office:
(i)
provision of parenteral conscious sedation by another duly
qualified dentist or physician anesthesiologist requires the operating dentist
and his/her clinical staff to maintain current expertise in Basic Life Support
(BLS);
(ii)
when a Certified Registered Nurse Anesthetist (CRNA) is
permitted to function under the supervision of a dentist, in the dental office,
provision of parenteral conscious sedation by a CRNA shall require the operating
dentist to have completed training in parenteral conscious sedation, and to
be permitted for its utilization;
(iii)
a dentist administering parenteral conscious sedation
must document current, successful completion every three years of an advanced
emergency procedures course approved by the State Board of Dental Examiners
or an Advanced Cardiac Life Support (ACLS) course, or a Pediatric Advanced
Life Support (PALS) or age appropriate equivalent course.
(3)
[
(A)
To administer [
(i)
completion of an advanced training program in anesthesia
and related subjects beyond the undergraduate dental curriculum that satisfies
the requirements described in Part II of the American Dental Association (ADA)
Guidelines for Teaching the Comprehensive Control of Pain and Anxiety in Dentistry
at the time training was commenced; or,
(ii)
completion of an ADA accredited post-doctoral training
program which affords comprehensive and appropriate training necessary to
administer and manage [
(B)
The following shall apply to the administration of [
(i)
provision of [
(ii)
when a Certified Registered Nurse Anesthetist (CRNA) is
permitted to function under the supervision of a dentist, in the dental office,
provision of [
(iii)
a dentist administering [
This agency hereby certifies that the proposal
has been reviewed by legal counsel and found to be within the agency's legal
authority to adopt.
Filed with the Office of
the Secretary of State, on April 13, 2001.
TRD-200102125
Jeffry Hill
Executive Director
State Board of Dental Examiners
Earliest possible date of adoption: May 27, 2001
For further information, please call: (512) 463-6400
22 TAC §108.34
The State Board of Dental Examiners proposes amendments to §108.34,
Permit Requirements and Clinical Provisions. The modifier "...parenteral..."
has been deleted before "deep sedation and general anesthesia" in Subsections
(c)(1)(A) and (B), (c)(2)(B), (D) and (F), (c)(3), (A), (B)(ii), (C)(i), (iii),
and (v), (D)(iv) and (v), (F)(i) and (ii), (G)(i). Deletion of the word "parenteral"
when it is such a modifier in §§108.32 - 108.34 has the effect of
requiring that all licensees who administer deep sedation and/or general anesthesia
must have a permit to do so, whether the sedative agents are administered
parenterally or by any other route. Without this change, dentists, by use
of orally administered sedative agents, could deeply sedate patients without
having a permit
Jeffry R. Hill, Executive Director, State Board of Dental Examiners, has
determined for the first five-year period the amended rule is in effect there
will be no fiscal implications for local or state government as a result of
enforcing or administering the rule.
Mr. Hill also has determined that for each year of the first five years
the amended rule is in effect the public benefit anticipated as a result of
amending the rule is that Practitioners who wish to utilize any technique
to achieve deep sedation or general anesthesia will have a permit from the
Board.
There will be no fiscal implications for small or large businesses. Therefore
the SBDE has determined that compliance with the proposed amended rule will
not have an adverse economic impact on small businesses when compared to large
businesses.
Comments on the proposal may be submitted to Mei Ling Clendennen, Assistant
Executive Director, State Board of Dental Examiners, 333 Guadalupe, Tower
3, Suite 800, Austin, Texas 78701, (512-463-6400). To be considered, all written
comments must be received by the State Board of Dental Examiners on or before
May 27, 2001.
The amended rule is proposed under Texas Government Code §2001.021
et.seq; Texas Civil Statutes, the Occupations Code §254.001 which provides
the State Board of Dental Examiners with the authority to adopt and enforce
rules necessary for it to perform its duties, and to ensure compliance with
laws relating to the practice of dentistry.
The proposed amended rule does not affect other statutes, articles, or
codes.
§108.34.Permit Requirements and Clinical Provisions.
(a)
Nitrous Oxide/oxygen inhalation conscious sedation. To
induce and maintain this type of conscious sedation on patients having dental/oral
and maxillofacial surgical procedures in the State of Texas, the following
requirements must be met:
(1)
Professional requirements.
(A)
Each dentist wishing to utilize this technique must be
permitted by the State Board of Dental Examiners (SBDE) to deliver nitrous
oxide/oxygen conscious sedation after having met the Education Requirements
as detailed in rule 108.33 (g)(1) of this title (relating to Sedation/Anesthesia
Permit).
(B)
Nitrous oxide/oxygen inhalation conscious sedation shall
be induced and maintained by a dentist licensed by the State of Texas and
practicing in Texas, a physician anesthesiologist licensed by the Texas State
Board of Medical Examiners, or a Certified Registered Nurse Anesthetist (CRNA)
licensed in Texas.
(2)
Standard of care requirements. Each dentist must maintain
the minimum standard of care as detailed in rule 108.32 of this title (relating
to Minimum Standard of Care), and shall in addition:
(A)
adhere to the clinical requirements as detailed in paragraph
(3) of this subsection;
(B)
maintain under continuous direct supervision auxiliary
personnel who shall be capable of reasonably assisting in procedures, problems,
and emergencies incident to the use of nitrous oxide/oxygen inhalation conscious
sedation.
(C)
maintain current certification in basic cardiopulmonary
resuscitation for the assistant staff by having them pass a course sponsored
by the American Heart Association or the American Red Cross; and
(D)
not allow a nitrous oxide/oxygen inhalation conscious sedation
procedure to be performed in his/her office by a Certified Registered Nurse
Anesthetist (CRNA) unless the dentist holds a permit issued by the State Board
of Dental Examiners for the procedure being performed. This provision and
similar provisions in subsequent sections of this rule addresses dentists
and is not intended to address the scope of practice of persons licensed by
any other agency.
(3)
Clinical Requirements. Each dentist must meet the following
clinical requirements for utilization of nitrous oxide/oxygen inhalation conscious
sedation:
(A)
Patient Evaluation. Patients subjected to nitrous oxide/oxygen
inhalation conscious sedation must be suitably evaluated prior to the start
of any sedative procedure. In healthy or medically stable individuals (ASA
I, II), this may be simply a review of their current medical history and medication
use. However, with individuals who may not be medically stable or who have
a significant health disability (ASA III, IV) consultation with their primary
care physician or consulting medical specialist regarding potential procedure
risk should be considered.
(B)
Pre-Procedure preparation, informed consent:
(i)
the patient and/or guardian must be advised of the procedure
associated with the delivery of the nitrous oxide/oxygen inhalation conscious
sedation.
(ii)
the inhalation equipment must be evaluated for proper
operation and delivery of inhalation agents prior to use on each patient;
(iii)
determination of adequate oxygen supply must be completed
prior to use with each patient;
(iv)
baseline vital signs should be obtained at the discretion
of the operator depending on the medical status of the patient and the nature
of the procedure to be performed.
(C)
Personnel and Equipment Requirements:
(i)
in addition to the dentist, at least one member of the
assistant staff should be present during the administration of nitrous oxide/oxygen
inhalation conscious sedation in non-emergency situations;
(ii)
the inhalation equipment must have a fail-safe system
that is appropriately checked and calibrated;
(iii)
if nitrous oxide and oxygen delivery equipment capable
of delivering less than 25% oxygen is used, an in-line oxygen analyzer must
be utilized;
(iv)
the equipment must have an appropriate nitrous oxide/oxygen
scavenging system.
(v)
regardless of the sedation/anesthesia technique, the ability
of the provider and/or the facility to deliver positive pressure oxygen must
be maintained.
(D)
Monitoring and Documentation:
(i)
maintain personal supervision of the patient during induction
of the nitrous oxide/oxygen inhalation conscious sedation procedure and during
maintenance of nitrous oxide/oxygen inhalation conscious sedation for such
a period of time necessary to establish pharmacologic and physiologic vital
sign stability. The dentist may delegate under direct supervision, as defined
in Rule 108.31 of this title (relating to Definitions), the monitoring of
the nitrous oxide/oxygen inhalation conscious sedation procedure to a dental
auxiliary who has been certified to monitor the administration of nitrous
oxide/oxygen inhalation conscious sedation by the State Board of Dental Examiners.
Certification is obtained by successful completion of a written examination
offered by the State Board of Dental Examiners on said subject.
(ii)
individuals present during administration should be documented;
(iii)
maximum concentration administered must be documented.
(E)
Recovery and Discharge:
(i)
recovery from nitrous oxide/oxygen inhalation conscious
sedation, when used alone, should be relatively quick, requiring only that
the patient remain in an operatory chair as needed;
(ii)
patients who have unusual reactions to nitrous oxide/oxygen
inhalation conscious sedation should be assisted and monitored either in an
operatory chair or recovery room until stable for discharge;
(iii)
the dentist must determine that the patient is appropriately
responsive prior to discharge.
(F)
Emergency Management. The dentist, personnel and facility
must be prepared to treat emergencies that may arise from the administration
of nitrous oxide/oxygen inhalation conscious sedation.
(b)
Parenteral conscious sedation intravenous (IV), intramuscular
(IM), subcutaneous (SC), submucosal (SM), intranasal (IN). To induce and maintain
this type of conscious sedation on patients having dental/oral and maxillofacial
surgical procedures in the State of Texas, the following requirements must
be met:
(1)
Professional Requirements:
(A)
each dentist wishing to utilize these techniques must be
permitted by the State Board of Dental Examiners (SBDE) to deliver parenteral
conscious sedation after having met the educational requirements as detailed
in Rule 108.33 (g)(2) of this title (relating to Sedation/Anesthesia Permit).
(B)
parenteral conscious sedation shall be induced and maintained
by a dentist licensed by the State of Texas and practicing in Texas, a physician
anesthesiologist licensed by the Texas State Board of Medical Examiners, or
a Certified Registered Nurse Anesthetist (CRNA) licensed in Texas.
(2)
Standard of Care Requirements. Each dentist must maintain
the minimum standard of care as detailed in Rule 108.32 of this title (relating
to the Minimum Standard of Care) and shall in addition
(A)
adhere to the clinical requirements as detailed in paragraph
(3) of this subsection;
(B)
maintain a written informed parenteral conscious sedation
consent for each dental patient on whom each procedure is performed; such
consent shall specify that the risks related to the procedure include cardiac
arrest, brain injury and death;
(C)
maintain a time oriented, written anesthetic record which
shall record dosages of anesthetic agents utilized and which shall include
physiologic vital sign monitoring during the course of the procedure;
(D)
maintain under continuous personal supervision auxiliary
personnel who shall be capable of reasonably assisting in procedures, problems,
and emergencies incident to the use of parenteral conscious sedation;
(E)
maintain current certification in basic cardiopulmonary
resuscitation for the assistant staff by having them pass a course sponsored
by the American Heart Association or the American Red Cross.
(F)
not allow a parenteral conscious sedation procedure to
be performed in his/her office by a Certified Registered Nurse Anesthetist
(CRNA) unless the dentist holds a permit issued by the State Board of Dental
Examiners for the procedure being performed.
(3)
Clinical Requirements. Each dentist must meet the following
clinical requirements for utilization of parenteral conscious sedation:
(A)
Patient Evaluation. Patients subjected to parenteral conscious
sedation must be suitably evaluated prior to the start of any sedative procedure.
In healthy or medically stable individuals (ASA I, II) this may be simply
a review of their current medical history and medication use. However, with
individuals who may not be medically stable or who have a significant health
disability (ASA III, IV) consultation with their primary care physicians or
consulting medical specialists regarding potential procedure risk or special
monitoring requirements should be considered.
(B)
Pre-procedure preparation, informed consent:
(i)
the patient and/or guardian must be advised of the procedure
associated with the delivery of any sedative agents and the appropriate informed
consent must be obtained;
(ii)
if inhalation equipment is used in conjunction with parenteral
conscious sedation, the equipment must be evaluated for proper operation and
delivery of inhalation agents prior to use on each patient;
(iii)
determination of adequate oxygen supply must be completed
prior to use with each patient;
(iv)
baseline vital signs should be obtained;
(v)
pre-treatment physical evaluation must be performed as
deemed appropriate;
(vi)
specific dietary restrictions must be delineated based
on the technique used and patient's physical status;
(vii)
appropriate verbal or written instructions regarding
the procedure must be given to the patient and/or guardian;
(viii)
an intravenous line must be established and secured
throughout a procedure utilizing an intravenous conscious sedation technique
and should be maintained with other parenteral conscious sedation techniques
when the patient's physical or medical condition warrants, except as provided
in subparagraph (F) of this paragraph.
(C)
Personnel Requirements and Equipment:
(i)
during the administration of parenteral conscious sedation
the dentist and at least one member of the assistant staff who is currently
competent in Basic Life Support (BLS) must be present;
(ii)
any inhalation equipment utilized in conjunction with
parenteral conscious sedation must have a fail safe system that is appropriately
checked and calibrated;
(iii)
if nitrous oxide and oxygen delivery equipment capable
of delivering less than 25% oxygen is used, an in-line oxygen analyzer must
be utilized;
(iv)
the inhalation equipment must have an appropriate nitrous
oxide/oxygen scavenging system;
(v)
regardless of the sedation/anesthesia technique, the ability
of the provider and/or the facility to deliver positive pressure oxygen must
be maintained.
(D)
Monitoring and Documentation. Maintain personal supervision
of the patient during the induction of parenteral conscious sedation and during
maintenance of parenteral conscious sedation for a period of time necessary
to establish pharmacologic and physiologic vital sign stability. When a Certified
Registered Nurse Anesthetist (CRNA) provides the parenteral conscious sedation
care, he/she shall be under the direct supervision of the dentist in the dental
office. Delegation of personal supervision may occur if a second dentist or
physician anesthesiologist is delivering the anesthesia care.
(i)
Oxygenation. Color of mucosa, skin or blood shall be continually
evaluated. Oxygen saturation shall be evaluated continuously by pulse oximetry
except as provided in subparagraph (F) of this paragraph.
(ii)
Ventilation. Must perform observation of chest excursions
and/or auscultation of breath sounds.
(iii)
Circulation.
(I)
Shall take and record blood pressure and pulse continually
at least every 10 minutes;
(II)
Shall perform continuous EKG monitoring of all patients
with electrocardioscopy, except as provided in subparagraph (F) of this paragraph.
(iv)
Documentation. A written time-oriented anesthetic record
must be maintained. Individuals present during the administration of parenteral
conscious sedation shall be documented.
(E)
Recovery and Discharge.
(i)
positive pressure oxygen and suction equipment must be
immediately available in the recovery area and/or operatory;
(ii)
continual monitoring of vital signs when the sedation/anesthesia
is no longer being administered; i.e., the patient must have continuous supervision
until oxygenation, ventilation and circulation are stable and the patient
is appropriately responsive for discharge from the facility;
(iii)
the dentist must determine and provide for documentation
that oxygenation, ventilation, circulation, activity, skin color and level
of consciousness are appropriate and stable prior to discharge;
(iv)
must provide explanation and documentation of postoperative
instructions to patient and/or a responsible adult at time of discharge;
(v)
the dentist must determine that the patient has met discharge
criteria prior to leaving the office.
(F)
Special situations include multiple/combination techniques
and single dosage techniques (IN, IM and SC) and types of special patients.
In selected circumstances, parenteral conscious sedation may be utilized without
establishing an indwelling intravenous line or continuous EKG monitoring with
electrocardioscopy or pulse oximetry. These circumstances include sedation
for brief procedures; young children managed entirely by non-intravenous techniques;
or the establishment of intravenous access, EKG monitoring, or pulse oximetry
after sedation has been induced due to poor patient cooperation. Vital sign
monitoring and IV access during special situations should in as far as possible
adhere to generally accepted standards of care and/or the American Academy
of Pediatric Dentistry Sedation Guidelines published in 1999 for Level 1 and
Level 2 conscious sedation, as those levels are defined in the guidelines.
When these situations occur, the dentist responsible for administering parenteral
conscious sedation shall document the reasons preventing the recommended preoperative
or intraoperative management.
(G)
Emergency Management.
(i)
the sedation/anesthesia permit holder/provider is responsible
for the anesthetic management, adequacy of the facility and treatment of emergencies
associated with the administration of parenteral conscious sedation, including
immediate access to pharmacologic antagonists and equipment for establishing
a patent airway and providing positive pressure ventilation with oxygen;
(ii)
advanced airway equipment, resuscitation medications must
be available.
(iii)
a defibrillator should be immediately available when
ASA I and ASA II status patients are consciously sedated and, a defibrillator
must be immediately available when ASA III and ASA IV status patients are
consciously sedated.
(c)
Deep
[
(1)
Professional Requirements:
(A)
Each dentist wishing to utilize either of these techniques
must be permitted by the State Board of Dental Examiners (SBDE) to deliver
[
(B)
Deep
[
(2)
Standard of care requirements. Each dentist must maintain
the minimum standard of care as detailed in rule 108.32 of this title (relating
to Minimum Standard of Care) and shall in addition:
(A)
adhere to the clinical requirements as detailed in paragraph
(3) of this subsection;
(B)
maintain a written [
(C)
maintain a time oriented, written anesthetic record which
shall record dosages of anesthetic agents utilized and shall include physiologic
vital sign monitoring during the course of the procedure;
(D)
maintain under continuous direct supervision a minimum
of two auxiliary personnel who shall be capable of reasonably assisting in
procedures, problems, and emergencies incident to the use of [
(E)
maintain current certification in basic cardiopulmonary
resuscitation for the assistant staff by having them pass a course sponsored
by the American Heart Association or the American Red Cross;
(F)
not allow a [
(3)
Clinical Requirements. Each dentist must meet the following
clinical requirements for utilization of [
(A)
Patient Evaluation. Patients subjected to [
(B)
Pre-Procedure preparation, informed consent:
(i)
the patient and/or guardian must be advised of the procedure
associated with the delivery of any sedative agents and the appropriate informed
consent should be obtained;
(ii)
if inhalation equipment is used in conjunction with [
(iii)
determination of adequate oxygen supply must be completed
prior to use with each patient;
(iv)
baseline vital signs should be obtained;
(v)
pre-treatment physical evaluation should be performed as
deemed appropriate;
(vi)
specific dietary restrictions must be delineated based
on technique used and patient's physical status;
(vii)
appropriate verbal or written instructions regarding
the procedure must be given to the patient and/or guardian;
(viii)
an intravenous line which is secured throughout the
procedure must be established, except as provided in subparagraph (F) of this
paragraph.
(C)
Personnel and Equipment Requirements:
(i)
a provider permitted to administer [
(ii)
two additional individuals who are currently certified
in basic cardiopulmonary resuscitation or its equivalent, one of whom is trained
in patient monitoring shall be present for the delivery of anesthesia care;
(iii)
when the same individual administering the [
(iv)
equipment suitable to provide advanced airway management
and advanced life support must be on premises and available for use.
(v)
any inhalation equipment utilized in conjunction with [
(vi)
if nitrous oxide/oxygen delivery equipment capable of
delivering less than 25% oxygen is used, an in-line oxygen analyzer must be
utilized.
(vii)
the inhalation equipment must have an appropriate nitrous
oxide/oxygen scavenging system.
(viii)
regardless of the sedation/anesthesia technique, the
ability of the provider and/or the facility to deliver positive pressure oxygen
must be maintained.
(D)
Monitoring and Documentation. Maintain personal supervision
of the patient during the induction and maintenance of [
(i)
Oxygenation. Color of mucosa, skin or blood shall be continually
evaluated. Oxygenation saturation shall be evaluated continuously by pulse
oximetry;
(ii)
Ventilation. Intubated patient - must auscultate breath
sounds and monitor of end-tidal CO2. Non-intubated patient - auscultation
of breath sounds, observation of chest excursions and/or monitoring of end-tidal
CO2;
(iii)
Circulation. Continuous EKG monitoring of all patients
throughout the procedure with electrocardioscopy shall occur. Shall record
blood pressure and pulse continually at least every five minutes;
(iv)
Temperature. A device capable of measuring body temperature
should be readily available, if needed, during the administration of [
(v)
Documentation. A written time-oriented anesthetic record
must be maintained. Individuals present during the administration of [
(E)
Recovery and Discharge
(i)
oxygen and suction equipment must be immediately available
in the recovery area and/or operatory;
(ii)
continual monitoring of vital signs when the anesthetic
is no longer being administered, i.e., the patient must have continuous supervision
until oxygenation, ventilation, circulation and temperature, as indicated,
are stable and the patient is appropriately responsive for discharge from
the facility;
(iii)
the dentist must determine and document that oxygenation,
ventilation, circulation activity, skin color, level of consciousness and
temperature, as indicated, are stable prior to discharge;
(iv)
must provide explanation and documentation of post-operative
instructions to patient and/or a responsible adult at the time of discharge.
(v)
the dentist must determine and provide for documentation
that the patient has met discharge criteria prior to leaving the office.
(F)
Special situations include multiple/combination techniques
single dosage techniques (IN, IM and SC) and types of special patients:
(i)
In selected circumstances, [
(ii)
Due to the fact that some dental patients undergoing [
(G)
Emergency Management:
(i)
the anesthesia permit holder/provider is responsible for
the anesthetic management, adequacy of the facility and treatment of emergencies
associated with the administration of [
(ii)
advanced airway equipment, resuscitation medications and
a defibrillator must also be immediately available;
(iii)
appropriate pharmacologic agents must be immediately
available if known triggering agents of malignant hyperthermia are part of
the anesthesia plan.
This agency hereby certifies that the proposal
has been reviewed by legal counsel and found to be within the agency's legal
authority to adopt.
Filed with the Office of
the Secretary of State, on April 13, 2001.
TRD-200102126
Jeffry Hill
Executive Director
State Board of Dental Examiners
Earliest possible date of adoption: May 27, 2001
For further information, please call: (512) 463-6400
22 TAC §108.43
The State Board of Dental Examiners proposes amendments to §108.43,
Operating Requirements for Permitted Mobile Dental Facilities or Portable
Dental Units. The language of Subsection (b)(3) is modified to provide that
a practitioner who provides dental services to less than three persons at
a private residence is not required to prepare an annual report of those services.
All other requirements of the chapter apply to such a practitioner, but the
Board agrees that the detailed reporting requirements for services provided
in private homes is unduly burdensome.
Jeffry R. Hill, Executive Director, State Board of Dental Examiners, has
determined for the first five-year period the amended rule is in effect there
will be no fiscal implications for local or state government as a result of
enforcing or administering the rule.
Mr. Hill also has determined that for each year of the first five years
the amended rule is in effect the public benefit anticipated as a result of
amending the rule is that application of the rule will not have an unduly
harsh impact upon those who make house calls to patients.
The SBDE has determined that compliance with the proposed amended rule
will not have an adverse economic impact on small businesses when compared
to large businesses, since the effect will be the reduction of costs for those
who fit the exemption.
Comments on the proposal may be submitted to Mei Ling Clendennen, Assistant
Executive Director, State Board of Dental Examiners, 333 Guadalupe, Tower
3, Suite 800, Austin, Texas 78701, (512-463-6400). To be considered, all written
comments must be received by the State Board of Dental Examiners on or before
May 27, 2001.
The amended rule is proposed under Texas Government Code §2001.021
et.seq; Texas Civil Statutes, the Occupations Code §254.001 which provides
the State Board of Dental Examiners with the authority to adopt and enforce
rules necessary for it to perform its duties, and to ensure compliance with
laws relating to the practice of dentistry.
The proposed amended rule does not affect other statutes, articles, or
codes.
§108.43.Operating Requirements for Permitted Mobile Dental Facilities or Portable Dental Units.
(a)
A permit holder is required to operate a permitted Mobile
Dental Facility or Portable Dental Unit in compliance with all state statutes
and regulations. Further, all permit holders shall;
(1)
in writing, notify the SBDE of a change in any address
required in Rule 108.42(b)(1) of this title (relating to Obtaining a Permit)
within 60 days of the change;
(2)
prominently display all dental and dental hygienist licenses
and current registration certificates, Mobile Dental Facilities or Portable
Dental Unit permits, or copies of permits if one permit is issued for multiple
facilities or units, a consumer information sign as described in Rule 108.5
of this title (relating to Consumer Information) in compliance with the Dental
Practice Act and/or the Rules and Regulations of the SBDE, provided, however,
that a licensee may display a duplicate registration certification obtained
from the SBDE;
(3)
maintain, in full compliance with all record-keeping requirements
contained in these rules, all dental records and official records at the official
address of record for the facility or unit.
(b)
All permit holders except, governmental and higher education
entities, shall:
(1)
in writing, notify the SBDE of a change in personnel listed
as required by Rule 108.42(b)(2) of this title (relating to Obtaining a Permit)
within 30 days of any such change;
(2)
before beginning a session at any location, arrange for;
(A)
access to a properly functioning sterilization system;
(B)
ready access to an adequate supply of potable water; and
(C)
ready access to toilet facilities.
(3)
on the 10th work day of September of each year, file with
the SBDE a written report for the preceding year ending August 31, detailing
the location, including a street address, the dates of each session, and the
number of patients served and the types of dental procedures and quantity
of each service provided;
except that such written reports may exclude
information concerning dental services provided to less than three individuals
at a private residence;
(4)
insure that all written or printed materials available
from or issued by the Mobile Dental Facility or Portable Dental Unit contain
the official address of record for the facility or unit;
(5)
operate a Mobile Dental Facility or Portable Dental Unit
only when all requirements described in Rule 108.42 of this title (related
to Obtaining a Permit) are being met.
(c)
A permit to operate a Mobile Dental Facility or Portable
Dental Unit expires one (1) year after the issuance date, or on the date when
the permit holder is no longer associated with the Mobile Dental Facility
or Portable Dental Unit, which ever is first.
(d)
A permit holder may renew a permit by submitting an annual
application which shall include a list of all locations served during the
past year, and payment of required fee.
(e)
Upon cessation of operations by the Mobile Dental Facility
or Portable Dental Unit, the permit holder shall notify the SBDE of the final
disposition of patient records and charts.
(f)
A permit to operate a Mobile Dental Facility or Portable
Dental Unit is not transferable.
(g)
The SBDE may cancel a permit if upon investigation and
after opportunity for a hearing, a determination is made of non-compliance
with the Dental Practice Act or the SBDE Rules and Regulations.
This agency hereby certifies that the proposal has been reviewed
by legal counsel and found to be within the agency's legal authority to adopt.
Filed with the Office of
the Secretary of State, on April 13, 2001.
TRD-200102127
Jeffry Hill
Executive Director
State Board of Dental Examiners
Earliest possible date of adoption: May 27, 2001
For further information, please call: (512) 463-6400
22 TAC §115.1
The State Board of Dental Examiners proposes amendments to §115.1,
Definitions. Paragraph (5) has been added to provide a definition of a supervising
dentist, in the context of the practice of dental hygiene. Paragraph (6) has
been added to define the term "General Supervision", and clarifies that a
dental hygienist can be generally supervised by a supervising dentist even
when the dentist is not on the premises. It should be noted that this definition
has no effect on the provisions of §262.151 of the Occupations Code that
a dental hygienist may see a patient when the dentist is not on the premises
if the patient has been examined within the 12 months previous to the appointment
with the hygienist.
Jeffry R. Hill, Executive Director, State Board of Dental Examiners, has
determined for the first five-year period the amended rule is in effect there
will be no fiscal implications for local or state government as a result of
enforcing or administering the rule.
Mr. Hill also has determined that for each year of the first five years
the amended rule is in effect the public benefit anticipated as a result of
amending the rule is that the respective relationships between a dentist,
a dental hygienist and a dental patient are clarified.
There will be no fiscal implications for small or large businesses. Therefore
the SBDE has determined that compliance with the proposed amended rule will
not have an adverse economic impact on small businesses when compared to large
businesses.
Comments on the proposal may be submitted to Mei Ling Clendennen, Assistant
Executive Director, State Board of Dental Examiners, 333 Guadalupe, Tower
3, Suite 800, Austin, Texas 78701, (512) 463-6400. To be considered, all written
comments must be received by the State Board of Dental Examiners on or before
May 27, 2001.
The amended rule is proposed under Texas Government Code §2001.021
et.seq; Texas Civil Statutes, the Occupations Code §254.001 which provides
the State Board of Dental Examiners with the authority to adopt and enforce
rules necessary for it to perform its duties, and to ensure compliance with
laws relating to the practice of dentistry.
The proposed amended rule does not affect other statutes, articles, or
codes.
§115.1.Definitions.
The following words and terms, when used in this section, shall have
the following meanings, unless the context clearly indicates otherwise.
(1)
Dental Hygienist--One who possesses the qualifications
prescribed by the laws of this state and who possesses a valid certificate
and current registration receipt issued by the Texas State Board of Dental
Examiners to so practice.
(2)
Irreversible--an act that is "irreversible" is not capable
of being reversed or corrected. This term includes, but is not limited to,
the result of intra-oral use of any laser for any purpose including all or
part of a whitening process.
(3)
Root Planing--A definitive treatment procedure designed
to remove cementum or surface dentin that is rough, impregnated with calculus,
or contaminated with toxins or microorganisms.
(4)
Scaling--Instrumentation of the crown and root surfaces
of the teeth to remove plaque and calculus from these surfaces.
(5)
Supervising Dentist--The term "supervising
dentist" as used in these rules relating to the practice of dental hygiene,
shall mean a dentist licensed by the State Board of Dental Examiners, who
is responsible for monitoring the services to be performed by the dental hygienist.
The supervising dentist must have and maintain a doctor patient relationship
with any patient to whom any dental hygienist under his or her supervision
provides services.
(6)
General Supervision--In this section,
"general supervision" means supervision of a dental hygienist by a supervising
dentist, where the dentist may or may not be present when the dental hygienist
performs the dental hygiene procedures.
This agency hereby certifies that the proposal has been
reviewed by legal counsel and found to be within the agency's legal authority
to adopt.
Filed with the Office of
the Secretary of State, on April 13, 2001.
TRD-200102128
Jeffry Hill
Executive Director
State Board of Dental Examiners
Earliest possible date of adoption: May 27, 2001
For further information, please call: (512) 463-6400
22 TAC §115.2
The State Board of Dental Examiners proposes amendments to §115.2,
Permitted Duties. Language of the lead paragraph has been changed to reflect
the codification of the former Dental Practice Act into the Texas Occupations
Code. Language in the paragraph has also been modified to reflect that a dental
hygienist must work in the office of and under the supervision of a licensed
dentist or in an alternate setting. This language complies with the statutory
language of Senate Bill 964, Section 20, enacted by the 76th Legislature,
effective September 1, 1999. Paragraph 1 has been divided into two subparagraphs,
which provide that a dental hygienist who graduated from an accredited and
approved dental or dental hygiene school after December 31, 1980, may place
pit and fissure sealants without first having obtained a certificate from
the Board. Dental hygienists who graduated from such a school before December
31, 1980, must apply to the Board for certification to place pit and fissure
sealants. Every dental hygienist who graduated from a Texas dental or dental
hygiene school that is accredited and approved after December 31, 1980 has
completed the necessary course work to obtain a certificate to place pit and
fissure sealants from the Board. The Board agrees that is unnecessary to require
such graduates to apply for that certificate.
Jeffry R. Hill, Executive Director, State Board of Dental Examiners, has
determined for the first five-year period the amended rule is in effect there
will be no fiscal implications for local or state government as a result of
enforcing or administering the rule.
Mr. Hill also has determined that for each year of the first five years
the amended rule is in effect the public benefit anticipated as a result of
amending the rule is that this rule will be in compliance with statutory language
and will recognize the realities of modern dental practice and education.
There will be no fiscal implications for small or large businesses. Therefore
the SBDE has determined that compliance with the proposed amended rule will
not have an adverse economic impact on small businesses when compared to large
businesses.
Comments on the proposal may be submitted to Mei Ling Clendennen, Assistant
Executive Director, State Board of Dental Examiners, 333 Guadalupe, Tower
3, Suite 800, Austin, Texas 78701, (512) 463-6400. To be considered, all written
comments must be received by the State Board of Dental Examiners on or before
May 27,2001.
The amended rule is proposed under Texas Government Code §2001.021
et.seq; Texas Civil Statutes, the Occupations Code §254.001 which provides
the State Board of Dental Examiners with the authority to adopt and enforce
rules necessary for it to perform its duties, and to ensure compliance with
laws relating to the practice of dentistry.
The proposed amended rule does not affect other statutes, articles, or
codes.
§115.2.Permitted Duties.
In addition to those duties identified in
the Texas Occupations
Code, Section 262.152,
[
(1)
apply pit and fissure sealants [
(A)
dental hygienists who graduated from a
dental or dental hygiene school accredited by the Commission on Dental Accreditation
of the American Dental Association after December 31, 1980 may do so without
obtaining a certificate from the SBDE;
(B)
dental hygienists who graduated from a
dental or dental hygiene school accredited by the Commission on Dental Accreditation
of the American Dental Association before December 31, 1980, must obtain certification
from the SBDE to apply sealants. Certification to apply pit and fissure sealants
in Texas may be obtained by submitting a written request to the SBDE accompanied
by proof of course completion.
(2)
monitor patients receiving nitrous oxide/oxygen inhalation
conscious sedation only after obtaining certification issued by the State
Board of Dental Examiners and only under the direct supervision of a Texas
licensed dentist. Certification may be obtained by successful completion of
the certification examination offered by the State Board of Dental Examiners.
This agency hereby certifies that the proposal has been
reviewed by legal counsel and found to be within the agency's legal authority
to adopt.
Filed with the Office of
the Secretary of State, on April 13, 2001.
TRD-200102129
Jeffry Hill
Executive Director
State Board of Dental Examiners
Earliest possible date of adoption: May 27, 2001
For further information, please call: (512) 463-6400
Chapter 201.
LICENSING AND ENFORCEMENT -- PRACTICE AND PROCEDURE
22 TAC §201.7
The Texas Funeral Service Commission proposes an amendment
to §201.7, concerning Allegations and Investigations.
The Texas Funeral Service Commission proposes an amendment to delete the
language must be in writing and add the language should. It is also to change
the language from and to and/or. The language /or is being added. This is
a grammatical change. The language is being changed/written to make it easier
for the consumer to respond
O.C. "Chet" Robbins, Executive Director, Texas Funeral Service Commission,
has determined that for the first five-year period this section is in effect
there will be no fiscal implications for state or local government as a result
of enforcing or administering the section.
Mr. Robbins, Executive Director, Texas Funeral Service Commission, has
determined that for each year of the first five years the public benefit will
be to insure that the language is changed/written to make it easier for the
consumer to respond. There will be no effect on small businesses. There is
no anticipated economic cost to persons who are required to comply with the
proposed section.
Comments on the proposal may be submitted to O.C. "Chet" Robbins, Executive
Director, Texas Funeral Service Commission, 510 South Congress Avenue, Suite
206, Austin, Texas 78704, (512) 936-2474 or 1-888-667-4881. Comments may also
be submitted electronically to crob@tfsc.state.tx.us or faxed to (512) 479-5064.
The amendment is proposed under Section 651.152 of the Texas
Occupation Code, as amended by Section 18 of House Bill 3516, 76th Legislature
which authorizes the Commission to issue such rules and regulations as may
be necessary to effect the provisions of this Section.
No other statutes, articles, or codes are affected by the proposed amendment.
§201.7Allegations and Investigations.
(a)
Any person may file allegations with the commission concerning
any licensee's violation of Texas Civil Statutes, Article 4582b, or the rules
promulgated by the commission. The allegations
should
[
(1) - (3)
(No change.)
(4)
the names, addresses, and telephone numbers of any persons
who witnessed the acts; and
/or
(5)
(No change.)
(b)
(No change.)
This agency hereby certifies that the proposal has been reviewed
by legal counsel and found to be within the agency's legal authority to adopt.
Filed with the Office of
the Secretary of State, on April 16, 2001.
TRD-200102133
O.C. "Chet" Robbins
Executive Director
Texas Funeral Services Commission
Earliest possible date of adoption: May 27, 2001
For further information, please call: (512) 936-2474
Chapter 361.
ADMINISTRATION
Subchapter C. ELECTION OF BOARD OFFICERS
22 TAC §361.29
The Texas State Board of Plumbing Examiners proposes amendments
to §361.29 which currently sets forth the meetings at which the election
of Board officers shall occur and the length of terms that each officer shall
serve. Section 361.29 also contains language which requires the Board to meet
in July and September of each year.
The amendments to §361.29 are proposed in conjunction with additional
planned rule amendments which will allow the Board the ability to reduce the
number of its annual Board meetings from six to four, and eliminate the requirement
in this rule that the Board meet in September of each year.
Robert L. Maxwell, Administrator of the Texas State Board of Plumbing Examiners,
has determined that for the first five-year period the rule is in effect the
benefit to local government as a result of the rule amendment as proposed,
will be that local government officials may attend all regularly scheduled
meetings of the Board by attending only four meetings annually instead of
the current six meetings.
Mr. Maxwell has determined that each year of the first five years the rule
is in effect the public benefit will be the same as that for local government.
Additionally, the public will benefit economically, by the reduced amount
of funds expended by the public and the Board as a result of reduced travel
expenses. As a result of the rule amendment, there will be no economic cost
to the persons that will be required to comply with the rule.
Comments on the proposed rule change may be submitted within 30 days of
publication of this proposed rule amendment in the
Texas Register
, to Robert L. Maxwell, Administrator, Texas State Board
of Plumbing Examiners, 929 East 41st Street, P.O. Box 4200, Austin, Texas
78765-4200.
The amendments to §361.29 are proposed under and affect
Texas Revised Civil Statutes Annotated Article 6243-101("Act"), §5(a)
(Vernon Supp. 2001), and the rule it amends. Section 5(a) of the Act authorizes,
empowers and directs the Board to prescribe, amend and enforce all rules and
regulations necessary to carry out the Act.
No other statute, article, or code is affected by this proposed rule change.
§361.29.Election of Board Officers.
Beginning with the July 1997 Board meeting, the Board shall formally
elect a Chairman, Vice-Chairman, and Secretary. Elections will be held every
two years. The elected Board officers will take office
on the first day
of
[
This agency hereby certifies that the proposal has been reviewed
by legal counsel and found to be within the agency's legal authority to adopt.
Filed with the Office of
the Secretary of State, on April 11, 2001.
TRD-200102070
Robert L. Maxwell
Administrator
Texas State Board of Plumbing Examiners
Earliest possible date of adoption: May 27, 2001
For further information, please call: (512) 458-2145
within 30 days after;
]
or
]
Subchapter C. ANESTHESIA AND ANESTHETIC AGENTS
parenteral
] deep sedation and general anesthesia:
parenteral
] deep sedation and general anesthesia, must obtain a permit from the
State Board of Dental Examiners for the requested procedure.
parenteral
] deep sedation/general anesthesia, except
as described in subsection (d) of this section, shall remain permitted provided
that the appropriate fees have been paid and that the dentist has a current
license.
parenteral
] deep sedation/general anesthesia on the effective date of this rule
who desires to provide anesthesia on a portable basis must file with the State
Board of Dental Examiners a request for a portability designation.
parenteral
] deep sedation/general anesthesia will be annotated showing
whether portability status is granted.
in
] parenteral conscious sedation
technique requested
that satisfies the requirement described in Part III of the American
Dental Association (ADA) Guidelines for Teaching the Comprehensive Control
of Pain and Anxiety in Dentistry at the time training was commenced; or
Parenteral
] Deep Sedation/General Anesthesia
parenteral
] deep sedation/general
anesthesia, the dentist must satisfy one of the following criteria:
parenteral
] deep sedation/general anesthesia.
parenteral
] deep sedation/general anesthesia in the dental office:
parenteral
] deep sedation/general
anesthesia by another duly qualified dentist or physician anesthesiologist
requires the operating dentist and his/her clinical staff to maintain current
expertise in Basic Life Support (BLS);
parenteral
] deep sedation/general anesthesia by a
CRNA shall require the operating dentist to have completed training in [
parenteral
] deep sedation/general anesthesia, and to be permitted for
its utilization;
parenteral
] deep
sedation/general anesthesia must document current, successful completion every
three years of an advanced emergency procedures course approved by the State
Board of Dental Examiners or an Advanced Cardiac Life Support (ACLS) course,
or a Pediatric Advanced Life Support (PALS) or age appropriate equivalent
course.
Parenteral deep
] sedation and/or
general anesthesia. To induce and maintain [
parenteral
] deep sedation/general
anesthesia on patients having dental/oral and maxillofacial surgical procedures
in the State of Texas, the following requirements must be met:
parenteral
] deep sedation and/or general anesthesia after having
met the education requirements as detailed in rule 108.33(g)(3) of this title
(relating to Sedation/Anesthesia Permit).
Parenteral deep
] sedation/general
anesthesia shall be induced and maintained by a dentist licensed by the State
of Texas and practicing in Texas, a physician anesthesiologist licensed by
the Texas State Board of Medical Examiners, or a Certified Registered Nurse
Anesthetist (CRNA) licensed in Texas.
parenteral
] deep sedation
and/or general anesthesia consent for each dental patient on whom each procedure
is performed, such consent shall specify that the risks related to the procedure
include cardiac arrest, brain injury and death:
parenteral
] deep sedation and/or general anesthesia;
parenteral
]deep sedation and/or
general anesthesia procedure to be performed in his/her office by a Certified
Registered Nurse Anesthetist (CRNA) unless the dentist holds a permit issued
by the State Board of Dental Examiners for the procedure being performed.
parenteral
]deep sedation
and/or general anesthesia:
parenteral
] deep sedation/general anesthesia must be suitably evaluated prior
to the start of any sedative/anesthetic procedure. In healthy or medically
stable individuals (ASA I, II) this may be simply a review of their current
medical history and medication use. However, with individuals who may not
be medically stable or who have a significant health disability (ASA III,
IV), consultation with their primary care physician or consulting medical
specialist regarding potential procedure risk or special monitoring should
be considered.
parenteral
] deep sedation and/or general anesthesia, the equipment must
be evaluated for proper operation and delivery of inhalation agents prior
to use on each patient;
parenteral
]
deep sedation and/or general anesthesia shall be designated to be in charge
of the administration of anesthesia care;
parenteral
] deep sedation and/or general anesthesia is performing the dental/oral
and maxillofacial procedure, one of the additional two individuals present
for the delivery of anesthesia care must monitor the patient and record required
information on the anesthesia record;
parenteral
] deep sedation/general anesthesia must have a fail safe system
that is appropriately checked and calibrated.
parenteral
]
deep sedation and/or general anesthesia and during maintenance of [
parenteral
] deep sedation and/or general anesthesia for a period of time necessary
to establish pharmacologic and physiologic vital sign stability. When a Certified
Registered Nurse Anesthetist (CRNA) provides the anesthesia care, he/she shall
be under the direct supervision of the dentist in the dental office. Delegation
of personal supervision may occur if a second dentist or physician anesthesiologist
is delivering the anesthesia care.
parenteral
] deep sedation/general anesthesia. When agents implicated
in precipitating malignant hyperthermia are utilized, continual monitoring
of body temperature must be performed;
parenteral
] deep sedation/general anesthesia shall be documented.
parenteral
] deep
sedation/general anesthesia may be utilized without first establishing an
indwelling intravenous line or continuous EKG monitoring with electracardioscopy
or pulse oximetry. These circumstances include [
parenteral
] deep
sedation/general anesthesia for very brief procedures, or brief periods of
time, which, for example, may occur in some pediatric patients; or the establishment
of intravenous access after [
parenteral
] deep sedation/general
anesthesia has been induced due to poor patient cooperation. Vital sign monitoring
and IV access during special situations should in as far as possible adhere
to generally accepted standards of care. When these situations occur, the
dentist responsible for administering [
parenteral
] deep sedation/general
anesthesia shall document the reasons preventing the recommended preoperative
or intraoperative management.
parenteral
] deep sedation/general anesthesia are mentally and/or physically
challenged, it is not always possible to suitably evaluate these patients
prior to administering care. When these situations occur, the dentist responsible
for administering the [
parenteral
] deep sedation/general anesthesia
shall document the reasons preventing the recommended preoperative management.
parenteral
] deep sedation
and/or general anesthesia including immediate access to pharmacologic antagonists
and equipment for establishing a patent airway and providing positive pressure
ventilation with oxygen;
Subchapter D. MOBILE DENTAL FACILITIES
Chapter 115.
EXTENSION OF DUTIES OF AUXILIARY PERSONNEL--DENTAL HYGIENE
Article 4551e-1(b)(2),
] a dental
hygienist may perform the following services and procedures in the dental
office of his/her
supervising dentist or dentists who are legally engaged
in the practice of dentistry in this state or under the supervision of a supervising
dentist in an alternate setting.
[
dentist-employer under his/her
general supervision, direction and responsibility, to wit:
]
only after successful
completion of a course of instruction in a dental or dental hygiene school
or college accredited by the Commission on Dental Accreditation of the American
Dental Association and approved by the State Board of Dental Examiners and
after receipt of certification by the State Board of Dental Examiners. Certification
to apply pit and fissure sealants in Texas may be obtained by submitting a
written request accompanied by required proof of course completion.
]
Part 10.
TEXAS FUNERAL SERVICE COMMISSION
must
be in writing and
]include the following information:
Part 17.
TEXAS STATE BOARD OF PLUMBING EXAMINERS
beginning with the
] September [
Board meeting
]
following the elections held at the July Board meeting. Each elected Board
officer shall serve a two-year term. If an office becomes vacant for any reason,
a special election will be held at the next regularly scheduled board meeting
to fill the office for the unexpired term.
Chapter 365.
LICENSING