The State Board of Dental Examiners (Board) adopts new §108.14, concerning pediatric and special needs case management and protective stabilization, with changes to the proposed text as published in the March 28, 2014, issue of the Texas Register (39 TexReg 2232). The rule text will be republished.

This new rule will define the scope of practice of a dentist in the treatment of pediatric and special needs patients.

The Board received three written comments regarding this new rule from the Texas Dental Association (TDA), the Texas Academy of Pediatric Dentistry (TAPD), and South Texas Dental. South Texas Dental wrote in support of the proposed rule. In addition to several clarification suggestions, TAPD and TDA requested: (1) that staff assisting the dentist also be required to take courses pertaining to protective stabilization; (2) that written informed consent for protective stabilization be obtained separately from informed consent for other procedures and include the signatures of dentists, assistants and third parties; (3) allowing the use of protective stabilization when a patient becomes uncooperative only until the dentist reaches a safe stopping point; and (4) more specific documentation requirements. TAPD also recommended that protective stabilization be contraindicated for all non-emergent treatment needs. TDA also requested: (1) increasing the CE hours from 8 to 12; (2) specifying that informed consent be obtained each time treatment is performed; and (3) requiring that the dentist consider referral to a specialist when treatment is deferred.

The Board has included TDA and TAPD's non-substantive revisions. The Board does not agree that staff should be required to take protective stabilization courses as the dentist should be able to adequately direct his or her staff in the use of protective stabilization. The Board does not agree that written informed consent should be required to be obtained separately from other informed consent or that anyone other than the patient or patient's guardian should be required to sign informed consent pursuant to §108.7--patient or guardian consent is all that is required and a separate form is not necessary. In addition, §108.7 and §108.8 already require written informed consent each time treatment is rendered. The Board has drafted a revised proposal of this rule including the requirement that dentists stop using protective stabilization once they reach a safe stopping point for uncooperative patients. The Board will vote to either adopt this version or the revised version of the rule. The Board does not agree that protective stabilization is contraindicated for all non-emergent treatment needs as it could be appropriate in very limited non-emergent treatment. The Board does not agree with the suggested increased documentation requirements. Section 108.8 already requires documentation of treatment provided and requiring documentation of why other treatment was contraindicated is not necessary and is not required for any other type of dental treatment. The Board does not agree with the recommended language concerning referrals to a specialist as the minimum standard of care dictates whether or not a dentist should refer patients to a specialist. The Board also believes that requiring a minimum of 8 hours of continuing education is sufficient.

New §108.14 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 new rule.