(a)A dentist shall not independently diagnose
obstructive sleep apnea (OSA). A dentist may fabricate an oral appliance
for treatment of OSA only in collaboration with a licensed physician.
A dentist shall be responsible for monitoring and maintaining the
oral appliance to ensure the patient's dental health, while the physician
should be responsible for monitoring the patient's medical condition. [
A dentist may diagnose, treat, operate, or prescribe for a disease,
pain, injury, deficiency, deformity, or physical condition of the
human teeth, oral cavity, alveolar process, gums and jaws, and provide
surgical and adjunctive treatment for directly related and adjacent
masticatory structures.]
(b)A dentist who treats OSA, as described
above, shall complete, during the first year of treating OSA, 12 hours
of minimum basic education in sleep-disordered breathing from an educational
venue (a combination of didactic and clinical education). For each
subsequent year that a dentist treats OSA, the dentist shall complete
3 hours of education in sleep-disordered breathing.
[(b)Screening for Sleep Disorders.]
[(1)A dentist may screen a dental patient for benign
snoring and obstructive sleep apnea (OSA) by using validated subjective
and objective screening tools. Subjective measures may include but
not are limited to Epworth Sleepiness Scale, Stop-Bang Scoring Tool,
and Apnea Risk Evaluation System. Objective measures may include but
are not limited to evaluation of the oropharyngeal areas, arch forms,
tongue size, neck size, Mallampati classification, other morphometric
measures, and sleep studies. Sleep studies must be interpreted by
a Texas licensed physician.]
[(2)Any screening shall be for the sole purpose of
identification of contraindications to dental treatment or identification
of benign snoring and OSA in order to refer the patient to a Texas
licensed physician to confirm or rule out OSA, and not be for the
purpose of the dentist diagnosing or ruling out OSA.]
[(c)Dental Treatment.]
[(1)A dentist may independently diagnose, treat, and
monitor any dental comorbidity related to benign snoring or OSA. A
dental comorbidity may include, but is not limited to, periodontal
disease, bruxism, occlusal disorders, temporomandibular joint disorders,
and deformities of the soft palate, tongue, and uvula. A dentist should
consider referral to a Texas licensed physician to diagnose or rule
out OSA in accordance with the standard of care.]
[(2)A dentist may treat and monitor benign snoring,
when no apneic episodes are reported or discovered, with an oral appliance
only after consideration of referral to a Texas licensed physician
in accordance with the standard of care.]
[(3)A dentist may not treat or monitor OSA without
collaboration with a Texas licensed physician.]
[(4)An oral appliance shall only be fabricated by
a Texas licensed dentist or by a Texas registered dental lab under
a prescription or work order prepared by a dentist.]
[(d)A dentist who treats benign snoring
or OSA must provide, on a yearly basis, adequate follow up of the
orthotics, stability and health of occlusion and orofacial musculoskeletal
system.]
(c) [(e)] A dentist treating
a patient for [benign snoring or] OSA shall comply with
the Dental Practice Act and Board Rules, including but not limited
to provisions related to fair dealing, standard of care, records,
and business promotion.
(d)[(f)] A dentist shall maintain
records as required by the Dental Practice Act and Board Rules including,
but not limited to records related to treatment planning, recommendations
and options, informed consent, consultations and recommended referrals,
and post treatment recommendations.
[(g)A dentist who treats or monitors
benign snoring or OSA, as described above, shall complete, during
the first year of treating or monitoring benign snoring or OSA, 12
hours of minimum basic education in sleep-disordered breathing from
an educational venue (a combination of didactic and clinical education).
For each subsequent year that a dentist treats or monitors benign
snoring or OSA, the dentist shall complete 3 hours of education in
sleep-disordered breathing.]
The agency certifies that legal counsel has reviewed
the proposal and found it to be within the state agency's legal authority
to adopt.
Filed with the Office
of the Secretary of
State on March 7, 2016
TRD-201601131 Nycia Deal
General Counsel
State Board of Dental Examiners
Earliest possible date of adoption: April 17, 2016
For further information, please call: (512) 475-0977
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