Response: The Board's proposed amendment to §108.7 allows a dentist to provide teledentistry dental services without requiring an in-person examination prior to providing the service as long as the dentist adheres to the standard of care. No changes to this proposed rule were made as a result of the comment.

Texas Association of Business (TAB) provided a written comment in opposition of adoption of the rule as initially proposed in the November 12, 2021 issue of the Texas Register. TAB states the reference to §108.7 in subsection (e)(2)(A) of this rule requires an in-person examination of the patient before the dentist can perform teledentistry dental services. TAB requests that the Board revise the rule to clarify that dentists are not required to perform an in-person examination prior to providing teledentistry dental services.

Response: The Board's proposed amendment to §108.7 allows a dentist to provide teledentistry dental services without requiring an in-person examination prior to providing the service as long as the dentist adheres to the standard of care. No changes to this proposed rule were made as a result of the comment.

Texas Association of Orthodontists (TAO) provided a written comment in opposition of adoption of the rule as proposed. Subsection (e)(2)(A) of this rule refers to §108.7, but TAO disagrees with the proposed amendment to §108.7(4) regarding a limited physical examination. The proposed amendment to §108.7(4) will require a dentist to perform a limited physical examination when a reasonable and prudent dentist would do so under the same or similar circumstances. TAO requests that the Board revise the rule to require dentists to perform a physical examination on a patient prior to performing an irreversible dental procedure. TAO is also concerned that subsection (c) does not clearly indicate what is expected from licensees and requests further details regarding the rule's prevention of fraud and abuse.

Response: The Board's proposed amendment to §108.7 allows a dentist to provide teledentistry dental services without requiring an in-person examination prior to providing the service as long as the dentist adheres to the standard of care. The Board declines to include rule language pertaining to an irreversible procedure because even some of the least complicated dental procedures could be considered irreversible. Subsection (c) of this rule requires dentists to adopt protocols to prevent fraud and abuse through the use of teledentistry dental services. In accordance with §108.9(6), dentists are required to comply with all laws relating to the regulation of dentists, which includes applicable laws pertaining to fraud and abuse. No changes to this proposed rule were made as a result of the comment.

Texas Conservative Coalition Research Institute (TCCRI) provided a written comment in opposition of adoption of the rule as initially proposed in the November 12, 2021 issue of the Texas Register. TCCRI is concerned with subsection (e)(2)(A) of this rule in that it references §108.7, which appears to require a physical in-person examination to establish the practitioner-patient relationship prior to the provision of teledentistry services. TCCRI requests that the Board require dentists to establish a practitioner-patient relationship, but not require that to be done solely by an in-office visit.

Response: The Board's proposed amendment to §108.7 allows a dentist to provide teledentistry dental services without requiring an in-person examination prior to providing the service as long as the dentist adheres to the standard of care. No changes to this proposed rule were made as a result of the comment.

Texas Dental Association (TDA) provided a written comment in opposition of adoption of the rule as proposed. TDA believes the proposed rule is consistent with House Bill 2056, however it requests that the Board change subsection (e)(5) of this rule to the following: "Any individual may provide any photography or digital imaging to a Texas licensed dentist or Texas licensed dental hygienist for the sole and limited purpose of screening, assessment, or examination that is within the scope of that dentist's or hygienist's respective license." TDA states that this change will ensure there is no confusion about the scope of practice under teledentistry.

Response: The scope of practice for dentists and hygienists is specified in the Dental Practice Act and Board rules, and this proposed rule does not change or expand the law in this regard. No changes to this proposed rule were made as a result of the comment.

Texas e-Health Alliance submitted a comment in opposition of adoption of the rule as initially proposed in the November 12, 2021 issue of the Texas Register. The organization is concerned the rule's reference to §108.7 prevents technology from being used to replicate an in-person physical examination under any circumstances.

Response: The Board's proposed amendment to §108.7 allows a dentist to provide teledentistry dental services without requiring an in-person examination prior to providing the service as long as the dentist adheres to the standard of care. No changes to this proposed rule were made as a result of the comment.

Texas Public Policy Foundation (TPPF) submitted a comment in opposition of adoption of

the rule as proposed in the November 12, 2021 issue of the Texas Register. TPPF states that the requirement of an in-person examination inhibits practitioners of teledentistry from expanding their practices by increasing the difficulty of reaching new markets that teledentistry technologies make easy and efficient.

Response: The Board's proposed amendment to §108.7 allows a dentist to provide teledentistry dental services without requiring an in-person examination prior to providing the service as long as the dentist adheres to the standard of care. No changes to this proposed rule were made as a result of the comment.

United Spinal Association (United Spinal) submitted a written comment in opposition of

adoption of the rule as initially proposed in the November 12, 2021 issue of the Texas Register . United Spinal provides that teledentistry is a valuable tool, especially for people with mobility challenges, and the in-person examination requirement would make access to teledentistry impossible. United Spinal states that this requirement is unnecessary so long as the treatment is performed to the standard of care. United Spinal requests that the Board remove the reference to §108.7 in subsection (e)(2)(A) of this rule.

Response: The Board's proposed amendment to §108.7 allows a dentist to provide teledentistry dental services without requiring an in-person examination prior to providing the service as long as the dentist adheres to the standard of care. No changes to this proposed rule were made as a result of the comment.

This rule is adopted under Texas Occupations Code §254.001(a), which gives the Board authority to adopt rules necessary to perform its duties and ensure compliance with state laws relating to the practice of dentistry to protect the public health and safety.

Legal counsel for the Board has reviewed the adopted rule and has found it to be within the Board's authority to adopt.