Texas Register

TITLE 22 EXAMINING BOARDS
PART 5STATE BOARD OF DENTAL EXAMINERS
CHAPTER 108PROFESSIONAL CONDUCT
SUBCHAPTER APROFESSIONAL RESPONSIBILITY
RULE §108.7Minimum Standard of Care, General
ISSUE 09/04/2020
ACTION Emergency
Preamble Texas Admin Code Rule

Each dentist shall:

  (1)conduct his/her practice in a manner consistent with that of a reasonable and prudent dentist under the same or similar circumstances;

  (2)maintain patient records that meet the requirements set forth in §108.8 of this title (relating to Records of the Dentist);

  (3)maintain and review an initial medical history and perform a limited physical evaluation for all dental patients;

    (A)The 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 would do so under the same or similar circumstances.

    (B)The limited physical examination shall include, but shall not necessarily be limited to, measurement of blood pressure and pulse/heart rate. Blood pressure and pulse/heart rate measurements are not required to be taken on any patient twelve (12) years of age or younger, unless the patient's medical condition or history indicate such a need.

  (4)obtain and review an updated medical history and limited physical evaluation when a reasonable and prudent dentist would do so under the same or similar circumstances. At a minimum, a medical history and limited physical evaluation should be obtained and reviewed at the initial appointment and updated annually;

  (5)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 under 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 under the same or similar circumstances; and

    (D)shall adhere to generally accepted protocols and/or standards of care for management of complications and emergencies;

  (6)successfully complete a current course in basic cardiopulmonary resuscitation given or approved by either the American Heart Association or the American Red Cross;

  (7)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 the patient has been adjudicated incompetent to manage the patient's personal affairs. A signed, written informed consent is required for all treatment plans and procedures where a reasonable possibility of complications from the treatment planned or a procedure exists, or the treatment plans and procedures involve risks or hazards that could influence a reasonable person in making a decision to give or withhold consent. Such consents must disclose any and all complications, risks and hazards;

  (8)safeguard patients against avoidable infections as required by this chapter;

  (9)not be negligent in the provision of dental services;

  (10)use proper diligence in the dentist's practice;

  (11)maintain a centralized inventory of drugs;

  (12)report patient death or hospitalization as required by this chapter;

  (13)abide by sanitation requirements as required by this chapter;

  (14)abide by patient abandonment requirements as required by this chapter;

  (15)abide by requirements concerning notification of discontinuance of practice as required by this chapter; and

   (16)conduct his/her practice according to the minimum standards for safe practice during the COVID-19 disaster pursuant to the Centers for Disease Control Guidelines and the following guidelines:

    (A)Before dental treatment begins:

      (i)each dental office shall create COVID-19 procedures and provide dental health care personnel (DHCP) training regarding the COVID-19 office procedures. These procedures must include the pre-schedule screening protocol, in office screening protocol for patients and DHCP, office's transmission-based infection control precautions, as well as protocol to be implemented if DHCP suspects an exposure to COVID-19;

      (ii)DHCP experiencing influenza-like-illness (ILI) (fever with either cough or sore throat, muscle aches) should not report to work;

      (iii)DHCP who are of older age, have a pre-existing, medically compromised condition, pregnant, etc., are perceived to be at a higher risk of contracting COVID-19 from contact with known or suspected COVID-19 patients. Providers who do not fall into these categories (older age; presence of chronic medical conditions, including immunocompromising conditions; pregnancy) may be prioritized to provide care;

      (iv)all DHCP should self-monitor by remaining alert to any respiratory symptoms (e.g., cough, shortness of breath, sore throat) and check their temperature twice a day, regardless of the presence of other symptoms consistent with a COVID-19 infection;

      (v)contact your local health department immediately if you suspect a patient has COVID-19, to prevent transmission to DHCP or other patients;

      (vi)remove magazines, reading materials, toys and other objects that may be touched by others and which are not easily disinfected;

      (vii)place signage in the dental office for instructing staff and patients on standard recommendations for respiratory hygiene/cough etiquette and social distancing;

      (viii)develop and utilize an office protocol to screen all patients by phone before scheduling and during patient confirmation prior to appointment;

      (ix)schedule appointments apart enough to minimize possible contact with other patients in the waiting room;

      (x)notify patients that they may not bring a companion to their appointment, unless the patient requires assistance (e.g., pediatric patients, special needs patients, elderly patients, etc.). Patient companions should also be screened for signs and symptoms of COVID- 19 during patient check-in.

    (B)During dental care:

      (i)perform in office screening protocol which must include a temperature check, upon patient arrival;

      (ii)DHCP shall adhere to standard precautions, which include but are not limited to: hand hygiene, use of personal protective equipment (PPE), respiratory hygiene/etiquette, sharps safety, safe injection practices, sterile instruments and devices, clean and disinfected environmental surfaces;

      (iii)DHCP shall implement Transmission-Based Precautions, including N-95 respirator masks, KN-95 masks, or their substantial equivalent for all DHCP who will be within six (6) feet of any and all procedures likely to involve aerosols;

      (iv)DHCP shall adhere to the standard sequence of donning and doffing of PPE;

    (C)Clinical technique:

      (i)Patients should perform a pre-procedure rinse, if medically safe;

      (ii)Reduce aerosol production as much as possible, as the transmission of COVID-19 seems to occur via droplets or aerosols, DHCP may prioritize the use of hand instrumentation;

      (iii)DHCP should use dental isolation if an aerosol-producing procedure is being performed to help minimize aerosol or spatter.

    (D)After dental care is provided:

      (i)instruct patients to contact the office if they experience COVID-19 symptoms within 14 days after the dental appointment;

      (ii)DHCPs should remove PPE before returning home.

The agency certifies that legal counsel has reviewed the emergency adoption and found it to be within the state agency's legal authority to adopt.

Filed with the Office of the Secretary of State on August 24, 2020

TRD-202003504

Casey Nichols

General Counsel

State Board of Dental Examiners

Effective date: August 25, 2020

Expiration date: December 22, 2020

For further information, please call: (512) 305-9380



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