Texas Register Preamble

The State Board of Dental Examiners (Board) proposes new rule §110.17, concerning Sedation/Anesthesia of Pediatric Patients. This new rule will require dentists to undergo additional didactic and clinical training prior to providing levels 2, 3, or 4 sedation/anesthesia to pediatric patients. This rule is being proposed to comply with the requirements of S.B. 313.

W. Boyd Bush, Jr., Ed.D., Executive Director, has determined that for the first five-year period the proposed rule is in effect, there will not be any fiscal implications for state or local government as a result of enforcing or administering the rule.

W. Boyd Bush, Jr. has also determined that for the first five-year period the proposed rule is in effect, the public benefit anticipated as a result of this rule will be the agency's compliance with legislative directives and increased public safety as a result of increased training requirements for dentists.

W. Boyd Bush, Jr. has also determined that an economic impact statement and regulatory flexibility analysis for small businesses, micro-businesses, and rural communities is necessary for this rule. The Board has approximately 3,400 permit holders affected by this rule across the State of Texas. Many of these permit holders are considered small or micro-businesses in that they are independent practitioner-business owners employing fewer than 100 employees. Many of them practice in rural communities, defined as municipalities with fewer than 25,000 people. Small businesses, micro-businesses, and rural communities will almost certainly experience an adverse economic effect from this proposed rule. Informal comments presented at stakeholder and committee meetings estimate the cost of the new additional training program will be in the range of $10-20,000. Permit holders will have to take at least 16 hours out of their schedule for the didactic training and obtaining the necessary clinical training may likely require even further time, travel, and expense. As for rural communities, it is an inevitable consequence of this regulation that there will be fewer providers levels 2, 3, and 4 sedation/anesthesia for these patients throughout the State of Texas. There are already fewer of these providers in rural areas than in urban areas and presumably that gap will grow wider due to the costs associated with this regulation. A provider in a rural area who only performs these procedures a few times a year likely will not go through the additional training required to continue doing so. As a result, rural patients may have to seek out someone else who is qualified to perform the procedures, likely in a more urban setting that will require additional time and expense. As such, rural communities will likely experience an adverse economic impact from this proposed regulation. That said, this rule is being proposed due to a legislative mandate in Senate Bill 313 (85th Legislature) that requires these practitioners to undergo "additional didactic and clinical training," as defined by the Board. The legislature has mandated further training to protect the health and safety of all Texans. The Board was charged with defining "additional training" and after many discussions about alternatives they arrived at the requirements that are being proposed. The proposed requirements could be higher or lower, but either way, the legislature has mandated "additional training" and any amount of "additional training" is going to have an adverse economic effect on small businesses and rural communities. It would not have been acceptable to the Board or the legislature to have proposed one standard for rural providers and another for urban providers. The Board believes the proposed rule strikes a good balance between protecting the public health and safety and keeping the new regulation economically feasible for those who wish to provide or receive this service.

W. Boyd Bush, Jr. has also determined that for the first five-year period the proposed rule is in effect, the following government growth effects apply: the rule does not create or eliminate a government program; implementation of the proposed rule does not require the creation or elimination of employee positions; the implementation of the proposed rule does not require an increase or decrease in future appropriations; the proposed rule does not require an increase or decrease in fees paid to the agency; the proposed rule creates a new regulation; the proposed rule expands an existing regulation; the proposed rule increases the number of individuals subject to it; the proposed rule does not adversely affect the state's economy.

Comments on the proposed new rule may be submitted to W. Boyd Bush, Jr., Ed.D., Executive Director, 333 Guadalupe, Suite 3-800, Austin, Texas 78701, by Fax to (512) 305-9364, or by email to official_rules_comments@tsbde.texas.gov no later than 30 days from the date that the proposed rule is published in the Texas Register.

This rule is proposed 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, and Texas Occupations Code §258.1554(b), which authorizes the Board to establish limitations on the administration of anesthesia by a permit holder to a pediatric or high-risk patient.

This proposed rule implements Texas Occupations Code §258.1554. W. Boyd Bush, Jr., has determined that this rule is necessary to protect the health, safety, and welfare of the residents of Texas, and as such, Texas Government Code 2001.0045(c)(6) is applicable to this proposed rule.

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