The State Board of Dental Examiners (SBDE) adopts an amendment to §108.8, relating to Records of the Dentist, with changes to the proposed text as published in the February 17, 2012, issue of the Texas Register (37 TexReg 849).

The amendment is adopted to enhance the record-keeping requirements following visual diagnostic examinations performed by dentists.

The amendment requires a dentist to document in the patient record the findings of a thorough and visual examination of soft and hard tissues of the oral cavity when the examination is performed.

Nine comments were received regarding amendment of the rule. Five comments expressed concern that the requirement was too burdensome and redundant. The SBDE disagrees with these comments because a dentist should document any procedures performed. Although an examination may not be done at every visit, when it is performed, a dentist should document the exam and the level of examination provided. This information provides a baseline for future examinations of the oral cavity.

Three comments stated that the terms "thorough" and "tactile and visual" are too broad. The SBDE disagrees that these terms are too broad but agrees to remove "thorough" as it is redundant. The purpose of the rule is to require dentists to document their findings. Documentation should indicate what type of exam is performed, i.e. comprehensive, visual, tactile, etc. An oral cancer exam should be documented when performed.

Three comments state that it is unclear whether standard charting is sufficient. The amendment is not changing the manner in which dentists are expected to document. It reiterates the need for dentists to document sufficiently to reflect the treatment provided.

One comment stated that recording the findings of a tactile examination is unnecessary. The SBDE disagrees. The type of exam performed and the findings of the examination should always be documented whether everything is "within normal limits" or not.

Three comments state that the changes are redundant. The SBDE agrees that these changes may overlap existing requirements, but it adopts these changes to emphasize the need for adequate documentation and to encourage practitioners to do exams consistently and document what level of exam was performed in the record.

Two comments stated that this amendment will be financially burdensome to patients with no apparent benefit. The intent of this amendment is to encourage dentists to perform and document exams of the oral cavity and to examine for abnormal medical conditions in the mouth. An exam of the oral cavity by a dentist has the greatest propensity for discovering oral cancer or any other condition that is not within normal limits. Hopefully, whatever costs may be incurred by patients will be minimal when compared to the potential to discover a life-threatening condition at an early stage.

The amendment is adopted pursuant to Texas Government Code §2001.021 et seq. and Texas Occupations Code §254.001, which authorize the Board to adopt and enforce rules necessary for it to perform its duties.

The amendment affects Texas Occupations Code, Title 3, Subtitle D and Texas Administrative Code, Title 22, Part 5.