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(a)Definitions.
(1)"Local infiltration anesthesia" means the deposition
of a local anesthetic solution meant for the elimination of the sensation
of pain by local injection of a drug near the terminal nerve endings
of teeth and supporting tissues.
(2)"Direct supervision" means the delegating dentist
is physically present in the facility where the procedure is occurring
and is continuously aware of the patient's physical status and well-being.
(b)General Provisions.
(1)A Texas-licensed dentist may delegate the administration
of local infiltration anesthesia to a licensed dental hygienist, if
the dental hygienist works under the direct supervision of the licensed
dentist.
(2)The dental hygienist must hold a current local
infiltration anesthesia certificate in accordance with the requirements
of this section.
(c)Standard of Care Requirements.
(1)Administration of local infiltration anesthesia
must be in accordance with the minimum standard of care and limited
to a procedure the dental hygienist is authorized to perform on a
patient who must be:
(A)at least 18 years of age; and
(B)not sedated, or is sedated using only nitrous oxide-oxygen
inhalation.
(2)Informed consent must be obtained in accordance
with §108.7 and §108.8 of this title (relating to Minimum
Standard of Care, General; and Records of the Dentist respectively).
In addition, the informed consent must include the risks and complications
with the administration of local anesthesia and vasoconstrictors,
and the delegating dentist and provider of local infiltration anesthesia
must be clearly disclosed.
(d)Requirements for Initial Certification. To receive
a dental hygiene local infiltration anesthesia certificate from the
Board, a dental hygienist must:
(1)apply on an application form approved by the Board;
(2)pay an application fee set by Board rule;
(3)submit proof to the Board of the successful completion
of a current course in Basic Life Support (BLS) for Healthcare Providers;
(4)submit proof to the Board that he or she has fulfilled
at least one of the following qualifications:
(A)completed a minimum of 12 hours of clinical and
20 hours of didactic education in the administration of local infiltration
anesthesia taken in a classroom setting at an educational institution
accredited by the Commission on Dental Accreditation of the American
Dental Association (CODA). The education must fulfill the requirements
in subsection (e) of this section;
(B)during the preceding year of initial application,
was authorized to administer a local anesthetic agent by:
(i)a branch of the United States armed forces; or
(ii)another state with clinical and didactic requirements
substantially equivalent to the requirements of a course as described
under subparagraph (A) of this paragraph, and have practiced for a
minimum of three out of five years immediately preceding application
to the Board; or
(C)successful completion of a CODA-accredited dental
hygiene program that fulfills the requirements of subparagraph (A)
of this paragraph.
(5)have passed a Board-approved certification examination
relating to the administration of a local anesthetic agent as described
in subsection (e)(4) of this section. A "Board-approved certification
examination" means an examination provided by a CODA-accredited course.
(e)Education and Examination Requirements.
(1)The education program must be overseen by a Texas-licensed
dentist who is a member of the CODA-accredited education institution
and who has experience teaching the administration of local infiltration
anesthesia.
(2)Didactic component. The program must include at
least 20 hours of didactic instruction relating to the administration
of local infiltration anesthesia in the practice of dental hygiene.
Such education may be completed using an on-demand video course and
must include:
(A)Texas State Board of Dental Examiners laws and
regulations;
(B)physiology and neurophysiology;
(C)head, neck, and oral anatomy;
(D)adult respiratory and circulatory physiology and
related anatomy;
(E)emergency procedures;
(F)recognition and management of local complications
associated with local anesthetic injections;
(G)recognition and management of systemic local anesthetic
toxicity related to the administration of local anesthetics;
(H)medical history and evaluation procedures;
(I)considerations for medically complex patients;
(J)behavior context and dental patient management;
(K)definitions and descriptions of physiological and
psychological aspects of anxiety and pain;
(L)pharmacology of agents used in local anesthetics
and vasoconstrictors, including drug interactions and incompatibilities;
(M)indications and contraindications for use of local
anesthetic and vasoconstrictors;
(N)recommended dosages of local anesthetic and vasoconstrictors;
(O)patient monitoring through observation, with particular
attention to vital signs and reflexes related to consciousness;
(P)selection and preparation of the armamentaria and
record keeping for administrating local anesthetic agents via infiltration;
(Q)safety and infection control procedures with regard
to local infiltration anesthetic techniques and proper disposal of
sharps; and
(R)post-operative care and instructions to patients.
(3)Clinical component. The program must include at
least 12 hours of clinical instruction relating to the administration
of local infiltration anesthesia in the practice of dental hygiene.
Such education must include:
(A)selection and preparation of the armamentaria for
administering local anesthetic agents;
(B)demonstration of proper infection control techniques
regarding local anesthetic agents and proper disposal of sharps;
(C)demonstration of proper evaluation of the patient's
health status, taking and assessing vital signs and monitoring the
patient's physical status while under the effects of local anesthetic;
(D)demonstration of the proper techniques for the
administration of local infiltration anesthesia on a live patient
or hands-on simulation:
(i)basic technique;
(ii)aspiration;
(iii)slow rate of injection; and
(iv)minimum effective dosage; and
(E)clinical experience demonstrating the successful
use of local infiltration anesthesia on a minimum of 5 live patient
experiences appropriate for dental hygiene treatment. At a minimum,
each student must demonstrate clinical competency in 4 different quadrants
that includes at least 3 teeth. A hands-on simulation competency component
must be demonstrated prior to treating the live patients. The live
patient or hands-on simulation clinical experiences required must
be performed under the direct supervision of a Texas-licensed dentist
associated with the course.
(4)Examination.
(A)Each student must pass a competency examination
on the material covered in the didactic section of the training course
with a minimum passing score of 75% before continuing to the clinical
section of the course. Students who do not pass the didactic competency
examination may be offered remediation before the start of the clinical
experience.
(B)Each student must pass a clinical competency examination
including a demonstration of satisfactorily performing local anesthetic
infiltration injections.
(f)Continuing Education.
(1)A dental hygienist with a local infiltration anesthesia
certificate must complete no less than 2 hours of continuing education
every two years in the administration of, or medical emergencies associated
with, local anesthesia specific to the procedures to be performed
by the dental hygienist administering the local anesthesia. The continuing
education requirement under this subsection shall be in addition to
any additional courses required for licensure.
(2)The continuing education must be provided by an
educational course provider recognized by the Board.
(3)Dental hygienists must maintain documentation of
the satisfactory completion of the required continuing education courses.
(g)Ineligibility. Applicants of an administration
of local infiltration certificate are ineligible if they are in violation
of a Board order at the time of application.
(h)A dental hygienist must submit a written report
to the Board as provided below:
(1)The death of a dental patient which may have occurred
as a consequence of the receipt of local infiltration anesthesia from
the reporting hygienist must be reported within 72 hours of the death,
or such time as the hygienist becomes aware or reasonably should have
become aware of the death.
(2)The hospitalization of a dental patient, as a possible
consequence of receiving local infiltration anesthesia from the reporting
hygienist, must be reported within 30 days of the hospitalization
or such time as the hygienist becomes aware of or reasonably should
have become aware of the hospitalization. For purposes of this subsection,
"hospitalization" shall be defined as an examination at a hospital
or emergency medical facility that results in an in-patient admission
for the purpose(s) of treatment and/or monitoring.
(3)In the evaluation of sedation/anesthesia morbidity
or mortality, the Board shall consider the standard of care necessary
to be that applicable to the patient's state of consciousness during
the procedure.
The agency certifies that legal counsel has
reviewed the proposal and found it to be within the state agency's
legal authority to adopt.
Filed with the Office
of the Secretary of State on March 8, 2024
TRD-202401068 Lauren Studdard
General Counsel
State Board of Dental Examiners
Earliest possible date of adoption: April 21, 2024
For further information, please call: (512) 305-8910
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