The State Board of Dental Examiners adopts amendments to §108.8, Records of the Dentist with changes to the proposed text as published in the July 20, 2001, issue of the Texas Register (26 TexReg 5331). Changes to §108.8(a), (b)(4), and (c)(11) were made.

The amendments to §108.8 are the result of several meetings with representatives from the Texas Department of Health, the Health and Human Services Commission, the three Texas dental schools, National Heritage Insurance Corporation and members of the Board and staff to discuss records keeping requirements for dentists. The effect of the amendments is to provide more specific rules for dental practitioners to follow in making and maintaining dental records.

The following entity, Texas Dental Association ("TDA") furnished written comments on the proposed amendments to §108.8(a). TDA comments that §108.8(a) defines the term "dental records" to include "documentation of" a list of items, including "study models, casts, molds, impressions." TDA comments that the term "documentation of" is confusing because the dental record would be the tangible item itself, rather than documentation of that item. Further, TDA comments that in many dental practices, models, casts, molds, and impressions are often simply made and used as steps in the actual treatment of patients and may be destroyed or damaged during use for that treatment. TDA points out that other dentists have study models and casts as part of their records, but classifying models, casts, molds, and impressions as "dental records" and requiring them to be retained for five years could cause storage problems for many dentists. TDA suggests that the phrase "documentation of" be deleted and the phrase, "if applicable" be inserted to reference models, casts, molds, and impressions.

The Board agrees and §108.8(a) is amended to read:

(a) The term dental records includes, but is not limited to: identification of the practitioner providing treatment; medical and dental history; limited physical examination; radiographs; dental and periodontal charting; diagnoses made; treatment plans; informed consent statements or confirmations; study models, casts, molds, and impressions, if applicable; cephalometric diagrams; narcotic drugs, dangerous drugs, controlled substances dispensed, administered or prescribed; anesthesia records; pathology and medical laboratory reports; progress and completion notes; materials used; dental laboratory prescriptions; billing and payment records; appointment records; consultations and recommended referrals; and post treatment recommendations.

TDA furnished written comments on the proposed amendments to §108.8(b)(4) requiring that a dentist document a patient's "vital signs." TDA seeks clarification asking if the requirement includes taking vital signs on every patient at every visit. TDA further inquires as to whether this requirement includes taking of vital signs for children, orthodontic, post-op patients, and patients who receive denture adjustments. TDA suggests that substituting the phrase, "if taken" for "when applicable" and following with an explanation that vital signs should be taken any time a reasonable and prudent dentist practicing in the same or similar circumstance would take vital signs.

The Board agrees and amends §108.8(b)(4) to read:

(4) Vital signs, including but not limited to, blood pressure and heart rate, when applicable in accordance with §108.7 of this title (relating to Minimum Standard of Care, General).

TDA requested that the Board clarify the language of when vital signs should not be omitted. The Board feels that the provisions are clear based on §108.7 and §108.8. The Board declines this suggestion.

TDA furnished written comments on the proposed amendments to §108.8(c)(11) stating that the term "licensed dentist" is confusing. TDA suggests that the term "provider dentist" be substituted for "licensed dentist."

The Board agrees and amends §108.8(c)(11) to read:

(11) Confirmable identification of provider dentist, and confirmable identification of person making record entries if different from provider dentist.

The amended rule is adopted under Texas Government Code §2001.021 et. seq; Texas Civil Statutes, the Occupations Code §254.001 which provides the State Board of Dental Examiners with the authority to adopt and enforce rules necessary for it to perform its duties, and to ensure compliance with laws relating to the practice of dentistry.