The State Board of Dental Examiners (Board) adopts new §110.10, concerning the use of general anesthetic agents. The new rule is adopted without changes to the proposed text as published in the May 24, 2013, issue of the Texas Register (38 TexReg 3271).

This new rule will limit the use of certain general anesthetic agents to dentists that posses a valid Level 4 - General Anesthesia or Deep Sedation permit issued by the Board.

The Board received three written comments. One comment was received from the Texas Academy of General Dentistry (TAGD). TAGD does not oppose the proposed rule but it is concerned that it deviates from the American Dental Association (ADA) Guidelines for the Use of Sedation and General Anesthesia by identifying specific drugs that may not be used by dentists holding moderate sedation permits. TAGD is concerned that creating a laundry list of drugs is inconsistent with ADA guidelines and will create barriers as scientific advancements are made in the delivery of anesthesia services. TAGD understands that sedation is a unique issue and such itemization may be deemed necessary. TAGD also suggests that the proposed rule be moved to a new section following §110.5, concerning Moderate Sedation, and that the title be renamed as Anesthetic Agents for Use by Level 4 Permit Holders. The Board believes a list is appropriate and can be updated as needed. The Board also believes this section should be in the general section for anesthesia because it effects both level 3 and 4 permit holders.

One comment was received from Texas Society of Anesthesiologists (TSA). TSA supports the effort to make anesthesia safer for patients and agrees with the proposed rule as written, with one addition. TSA suggests to improve patient safety, additional language that mandates that if volatile inhalation anesthetics are administered, then dantrolene shall be immediately available to treat malignant hyperthermia. The Board believes it is not appropriate to add the additional language because it is a new issue and is not needed. The Board also believes that the general standard of care section for anesthesia covers that every dentist using anesthesia should have all the appropriate drugs on hand in cases of emergency.

One comment was received from Jerry Teague, DDS. Dr. Teague recommends that the Board define General Anesthesia and Exclusive of Recovery so as not to encourage unsafe practice and insurance companies not paying. The Board believes that recovery is a commonly used clinical term and need not be defined. The purpose of this rule is not to exclude insurance reimbursement for recovery time. The purpose of this rule is to ensure the patient's safety by requiring the dentist's presence during the administration of anesthetic agents.

The new rule is adopted under Texas Occupations Code §254.001(a). The Board interprets §254.001(a) to give the Board authority to adopt rules necessary to perform its duties and ensure compliance with state law relating to the practice of dentistry to protect the public health and safety.

No other statutes, articles, or codes are affected by the rule.