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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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