Texas Jurisprudence 2020

The State Board of Dental Examiners shall revoke a license for a felony DWI conviction.

https://texreg.sos.state.tx.us/public/readtac$ext.TacPage?sl=R&app=2&p_dir=&p_rloc=193776&p_tloc=&p_ploc=&pg=1&p_tac=193776&ti=22&pt=5&ch=101&rl=8&dt=&z_chk=&z_contains=

When administering Level One - Minimal Sedation, a time-oriented sedation record is required.

(a) Education and Professional Requirements. A dentist applying for a Level 1 Minimal Sedation permit shall meet one of the following educational/professional criteria: (1) satisfactory completion of training to the level of competency in minimal sedation consistent with that prescribed in the American Dental Association (ADA) Guidelines for Teaching Pain Control and Sedation to Dentists and Dental Students, or a comprehensive training program in minimal sedation that satisfies the requirements described in the ADA Guidelines for Teaching Pain Control and Sedation to Dentists and Dental Students. This includes a minimum of sixteen (16) hours of didactic training and instruction in which competency in enteral and/or combined inhalation-enteral minimal sedation technique is demonstrated; or (2) satisfactory completion of an advanced education program accredited by the ADA Commission on Dental Accreditation (CODA) that affords comprehensive training necessary to administer and manage minimal sedation, commensurate with the ADA's Guidelines for Teaching Pain Control and Sedation to Dentists and Dental Students; or (3) is a Texas licensed dentist, has a current Board-issued enteral permit, and has been using minimal sedation in a competent manner immediately prior to the implementation of this chapter on June 1, 2011. Any Texas licensed dentist who was issued an enteral sedation permit before June 1, 2011 and whose enteral sedation permit was active on June 1, 2011 shall automatically have the permit reclassified as a Level 1 Minimal Sedation permit on June 1, 2011. A Texas licensed dentist whose permit is reclassified from an enteral sedation permit to a Level 1 Minimal Sedation permit on June 1, 2011 may continue to administer enteral sedation until January 1, 2013. On or before January 1, 2013, the dentist shall either provide proof that adequate education has been obtained by submitting an application for a Level 2 permit on or before that date, or shall comply with the requirements of a Level 1 permit after that date. A dentist shall always follow the standard of care and clinical requirements for the level of sedation he or she is performing. (b) Standard of Care Requirements. A dentist performing minimal sedation shall maintain the minimum standard of care for anesthesia, and in addition shall: (1) adhere to the clinical requirements as detailed in this section; (2) maintain under continuous direct supervision auxiliary personnel who shall be capable of reasonably assisting in procedures, problems, and emergencies incident to the use of minimal sedation; (3) maintain current certification in Basic Life Support (BLS) for Healthcare Providers for the assistant staff by having them pass a course that includes a written examination and a hands-on demonstration of skills; and (4) not supervise a Certified Registered Nurse Anesthetist (CRNA) performing a minimal sedation procedure unless the dentist holds a permit issued by the Board for the sedation procedure being performed. (c) Clinical Requirements. A dentist must meet the following clinical requirements for utilization of minimal sedation: (1) Patient Evaluation. Patients considered for minimal sedation must be suitably evaluated prior to the start of any sedative procedure. In healthy or medically stable individuals (ASA I, II), this may consist of a review of their current medical history and medication use. However, patients with significant medical considerations (ASA III, IV) may require consultation with their primary care physician or consulting medical specialist. (2) Pre-Procedure Preparation and Informed Consent. (A) The patient, parent, guardian, or care-giver must be advised regarding the procedure associated with the delivery of any sedative agents and must provide written, informed consent for the proposed sedation. (B) The dentist shall determine that an adequate oxygen supply is available and evaluate equipment for proper operation and delivery of adequate oxygen under positive pressure. (C) Baseline vital signs must be obtained in accordance with §108.7 and §108.8 of this title. (D) A focused physical evaluation must be performed as deemed appropriate. (E) Pre-procedure dietary restrictions must be considered based on the sedative technique prescribed. (F) Pre-procedure verbal and written instructions must be given to the patient, parent, escort, guardian, or care-giver. (3) Personnel and Equipment Requirements. (A) In addition to the dentist, at least one additional person trained in Basic Life Support (BLS) for Healthcare Providers must be present. (B) A positive-pressure oxygen delivery system suitable for the patient being treated must be immediately available. (C) When inhalation equipment is used, it must have a fail-safe system that is appropriately checked and calibrated. The equipment must also have either: (i) a functioning device that prohibits the delivery of less than 30% oxygen; or (ii) an appropriately calibrated and functioning in-line oxygen analyzer with audible alarm. (D) An appropriate scavenging system must be available if gases other than oxygen or air are used. (4) Monitoring. The dentist administering the sedation must remain in the operatory room to monitor the patient until the patient meets the criteria for discharge to the recovery area. Once the patient meets the criteria for discharge to the recovery area, the dentist may delegate monitoring to a qualified dental auxiliary. Monitoring during the administration of sedation must include: (A) Oxygenation. (i) Color of mucosa, skin, or blood must be evaluated continually. (ii) Oxygen saturation monitoring by pulse-oximetry should be used when a single drug minimal sedative is used. The additional use of nitrous oxide has a greater potential to increase the patient's level of sedation to moderate sedation, and a pulse oximeter must be used. (B) Ventilation. The dentist (or appropriately qualified individual) must observe chest excursions and must verify respirations continually. (C) Circulation. Blood pressure and heart rate should be evaluated preprocedurally, post-procedurally and intra-procedurally as necessary. (5) Documentation. (A) Documentation must be made in accordance with §108.7 and §108.8 of this title and must include the names and dosages of all drugs administered and the names of individuals present during administration of the drugs. (B) A time-oriented sedation record may be considered for documentation of all monitoring parameters. (C) Pulse oximetry, heart rate, respiratory rate, and blood pressure are the parameters which may be documented at appropriate intervals of no more than 10 minutes. (6) Recovery and Discharge. (A) Oxygen and suction equipment must be immediately available in the recovery area if a separate recovery area is utilized. (B) The qualified dentist must monitor the patient during recovery until the patient is ready for discharge by the dentist. The dentist may delegate this task to an appropriately qualified dental auxiliary. (C) The dentist must determine and document that the patient's level of consciousness, oxygenation, ventilation, and circulation are satisfactory prior to discharge. The dentist shall not leave the facility until the patient meets the criteria for discharge and is discharged from the facility. (D) Post-procedure verbal and written instructions must be given to the patient, parent, escort, guardian, or care-giver. Post-procedure, patients should be accompanied by an adult caregiver for an appropriate period of recovery. (7) Emergency Management. Because sedation is a continuum, it is not always possible to predict how an individual patient will respond. If a patient enters a deeper level of sedation than the dentist is qualified to provide, the dentist must stop the dental procedure until the patient returns to the intended level of sedation. The dentist is responsible for the sedative management, adequacy of the facility and staff, diagnosis and treatment of emergencies related to the administration of minimal sedation, and providing the equipment and protocols for patient rescue. A dentist must be able to rescue patients who enter a deeper state of sedation than intended. (8) Management of Children. For children twelve (12) years of age and under, the dentist should observe the American Academy of Pediatrics/American Academy of Pediatric Dentists Guidelines for Monitoring and Management of Pediatric Patients During and After Sedation for Diagnostic and Therapeutic Procedures. (d) A dentist who holds a minimal sedation permit shall not intentionally administer moderate sedation, deep sedation, or general anesthesia. Source Note: The provisions of this §110.4 adopted to be effective May 10, 2011, 36 TexReg 2833

Licensees may obtain two hours of continuing education credit for annual OSHA training.

As a prerequisite to the biennial renewal of a dental or dental hygiene license, proof of completion of 24 hours of acceptable continuing education is required. (1) Each licensee shall select and participate in the continuing education courses endorsed by the providers identified in §104.2 of this title (relating to Providers). A licensee, other than a licensee who resides outside of the United States, who is unable to meet education course requirements may request that alternative courses or procedures be approved by the Licensing Committee. (A) Such requests must be in writing and submitted to and approved by the Licensing Committee prior to the expiration of the biennial period for which the alternative is being requested. (B) A licensee must provide supporting documentation detailing the reason why the continuing education requirements set forth in this section cannot be met and must submit a proposal for alternative education procedures. (C) Acceptable causes may include unanticipated financial or medical hardships or other extraordinary circumstances that are documented. (D) A licensee who resides outside of the United States may, without prior approval of the Licensing Committee, complete all required hours of coursework by self-study. (i) These self-study hours must be provided by those entities cited in §104.2 of this title (relating to Providers). Examples of self-study courses include correspondence courses, video courses, audio courses, and reading courses. (ii) Upon being audited for continuing education compliance, a licensee who submits self-study hours under this subsection must be able to demonstrate residence outside of the United States for all periods of time for which self-study hours were submitted. (E) Should a request to the Licensing Committee be denied, the licensee must complete the requirements of this section. (2) Effective September 1, 2018, the following conditions and restrictions shall apply to coursework submitted for renewal purposes: (A) At least 16 hours of coursework must be either technical or scientific as related to clinical care. The terms "technical" and "scientific" as applied to continuing education shall mean that courses have significant intellectual or practical content and are designed to directly enhance the practitioner's knowledge and skill in providing clinical care to the individual patient. (B) Up to 8 hours of coursework may be in risk-management courses. Acceptable "risk management" courses include courses in risk management, record-keeping, and ethics. (C) Up to 8 hours of coursework may be self-study. These self-study hours must be provided by those entities cited in §104.2 of this title (relating to Providers). Examples of self-study courses include correspondence courses, video courses, audio courses, and reading courses. (D) Hours of coursework in the standards of the Occupational Safety and Health Administration (OSHA) annual update course or in cardiopulmonary resuscitation (CPR) basic life support training may not be considered in the 24-hour requirement. (E) Hours of coursework in practice finance may not be considered in the 24-hour requirement. (3) Each licensee shall complete the jurisprudence assessment every four (4) years. This requirement is in addition to the twenty-four (24) hours of continuing education required biennially for the renewal of a license. (4) A licensee may carry forward continuing education hours earned prior to a renewal period which are in excess of the 24-hour requirement and such excess hours may be applied to subsequent years' requirements. Excess hours to be carried forward must have been earned in a classroom setting and within the one year immediately preceding the renewal period. A maximum of 24 total excess credit hours may be carried forward. (5) Examiners for the Western Regional Examining Board (WREB) and for Central Regional Dental Testing Services Inc. (CRDTS) will be allowed credit for no more than 12 hours biennially, obtained from calibration and standardization exercises associated with the examinations. (6) Any individual or entity may petition one of the providers listed in §104.2 of this title to offer continuing education. (7) Providers cited in §104.2 of this title will approve individual courses and/or instructors. (8) A consultant for the SBDE who is also a licensee of the SBDE is eligible to receive up to 12 hours of continuing education credit biennially to apply towards the biennial renewal continuing education requirement under this section. (A) Continuing education credit hours shall be awarded for the issuance of an expert opinion based upon the review of SBDE cases and for providing assistance to the SBDE in the investigation and prosecution of cases involving violations of the Dental Practice Act and/or the Rules of the SBDE. (B) The amount of continuing education credit hours to be granted for each consultant task performed shall be determined by the Executive Director, Division Director or manager that authorizes the consultant task to be performed. The award of continuing education credit shall be confirmed in writing and based upon a reasonable assessment of the time required to complete the task. Source Note: The provisions of this §104.1 adopted to be effective March 1, 1996, 21 TexReg 1422; amended to be effective April 19, 1998, 23 TexReg 3830; amended to be effective June 28, 1998, 23 TexReg 6440; amended to be effective November 30, 1999, 24 TexReg 10539; amended to be effective April 16, 2000, 25 TexReg 3250; amended to be effective July 1, 2002, 27 TexReg 5782; amended to be effective September 21, 2004, 29 TexReg 9004; amended to be effective February 25, 2007, 32 TexReg 627; amended to be effective December 24, 2007, 32 TexReg 9628; amended to be effective August 7, 2008, 33 TexReg 6132; amended to be effective February 2, 2010, 35 TexReg 630; amended to be effective February 7, 2018,43 TexReg 573; amended to be May 10, 2018, 43 TexReg 2774

dentist must obtain all but one of the following data for each new dental patient:

Each dentist shall: (1) conduct his/her practice in a manner consistent with that of a reasonable and prudent dentist under the same or similar circumstances; (2) maintain patient records that meet the requirements set forth in §108.8 of this title (relating to Records of the Dentist); (3) maintain and review an initial medical history and perform a limited physical evaluation for all dental patients; (A) The medical history shall include, but shall not necessarily be limited to, known allergies to drugs, serious illness, current medications, previous hospitalizations and significant surgery, and a review of the physiologic systems obtained by patient history. A "check list," for consistency, may be utilized in obtaining initial information. The dentist shall review the medical history with the patient at any time a reasonable and prudent dentist would do so under the same or similar circumstances. (B) The limited physical examination shall include, but shall not necessarily be limited to, measurement of blood pressure and pulse/heart rate. Blood pressure and pulse/heart rate measurements are not required to be taken on any patient twelve (12) years of age or younger, unless the patient's medical condition or history indicate such a need. (4) obtain and review an updated medical history and limited physical evaluation when a reasonable and prudent dentist would do so under the same or similar circumstances. At a minimum, a medical history and limited physical evaluation should be obtained and reviewed at the initial appointment and updated annually; (5) for office emergencies: (A) maintain a positive pressure breathing apparatus including oxygen which shall be in working order; (B) maintain other emergency equipment and/or currently dated drugs as a reasonable and prudent dentist with the same or similar training and experience under the same or similar circumstances would maintain; (C) provide training to dental office personnel in emergency procedures which shall include, but not necessarily be limited to, basic cardiac life support, inspection and utilization of emergency equipment in the dental office, and office procedures to be followed in the event of an emergency as determined by a reasonable and prudent dentist under the same or similar circumstances; and (D) shall adhere to generally accepted protocols and/or standards of care for management of complications and emergencies; (6) successfully complete a current course in basic cardiopulmonary resuscitation given or approved by either the American Heart Association or the American Red Cross; (7) maintain a written informed consent signed by the patient, or a parent or legal guardian of the patient, if the patient is a minor, or the patient has been adjudicated incompetent to manage the patient's personal affairs. A signed, written informed consent is required for all treatment plans and procedures where a reasonable possibility of complications from the treatment planned or a procedure exists, or the treatment plans and procedures involve risks or hazards that could influence a reasonable person in making a decision to give or withhold consent. Such consents must disclose any and all complications, risks and hazards; (8) safeguard patients against avoidable infections as required by this chapter; (9) not be negligent in the provision of dental services; (10) use proper diligence in the dentist's practice; (11) maintain a centralized inventory of drugs; (12) report patient death or hospitalization as required by this chapter; (13) abide by sanitation requirements as required by this chapter; (14) abide by patient abandonment requirements as required by this chapter; and (15) abide by requirements concerning notification of discontinuance of practice as required by this chapter. Source Note: The provisions of this §108.7 adopted to be effective February 20, 2001, 26 TexReg 1494; amended to be effective December 30, 2001, 26 TexReg 10569; amended to be effective May 10, 2004, 29 TexReg 4474; amended to be effective September 14, 2010, 35 TexReg 8344; amended to be effective September 3, 2014, 39 TexReg 6855

The Dental Laboratory Certification Council consists of six members appointed by the State Board of Dental Examiners and must meet at least four times a year.

https://statutes.capitol.texas.gov/Docs/OC/htm/OC.266.htm#266.051 https://law.justia.com/codes/texas/2005/oc/003.00.000266.00.html

As a pre-requisite to licensure renewal, dentists and dental hygienists must complete _______ hours of appropriate continuing education.

s a prerequisite to the biennial renewal of a dental or dental hygiene license, proof of completion of 24 hours of acceptable continuing education is required. (1) Each licensee shall select and participate in the continuing education courses endorsed by the providers identified in §104.2 of this title (relating to Providers). A licensee, other than a licensee who resides outside of the United States, who is unable to meet education course requirements may request that alternative courses or procedures be approved by the Licensing Committee. (A) Such requests must be in writing and submitted to and approved by the Licensing Committee prior to the expiration of the biennial period for which the alternative is being requested. (B) A licensee must provide supporting documentation detailing the reason why the continuing education requirements set forth in this section cannot be met and must submit a proposal for alternative education procedures. (C) Acceptable causes may include unanticipated financial or medical hardships or other extraordinary circumstances that are documented. (D) A licensee who resides outside of the United States may, without prior approval of the Licensing Committee, complete all required hours of coursework by self-study. (i) These self-study hours must be provided by those entities cited in §104.2 of this title (relating to Providers). Examples of self-study courses include correspondence courses, video courses, audio courses, and reading courses. (ii) Upon being audited for continuing education compliance, a licensee who submits self-study hours under this subsection must be able to demonstrate residence outside of the United States for all periods of time for which self-study hours were submitted. (E) Should a request to the Licensing Committee be denied, the licensee must complete the requirements of this section. (2) Effective September 1, 2018, the following conditions and restrictions shall apply to coursework submitted for renewal purposes: (A) At least 16 hours of coursework must be either technical or scientific as related to clinical care. The terms "technical" and "scientific" as applied to continuing education shall mean that courses have significant intellectual or practical content and are designed to directly enhance the practitioner's knowledge and skill in providing clinical care to the individual patient. (B) Up to 8 hours of coursework may be in risk-management courses. Acceptable "risk management" courses include courses in risk management, record-keeping, and ethics. (C) Up to 8 hours of coursework may be self-study. These self-study hours must be provided by those entities cited in §104.2 of this title (relating to Providers). Examples of self-study courses include correspondence courses, video courses, audio courses, and reading courses. (D) Hours of coursework in the standards of the Occupational Safety and Health Administration (OSHA) annual update course or in cardiopulmonary resuscitation (CPR) basic life support training may not be considered in the 24-hour requirement. (E) Hours of coursework in practice finance may not be considered in the 24-hour requirement. (3) Each licensee shall complete the jurisprudence assessment every four (4) years. This requirement is in addition to the twenty-four (24) hours of continuing education required biennially for the renewal of a license. (4) A licensee may carry forward continuing education hours earned prior to a renewal period which are in excess of the 24-hour requirement and such excess hours may be applied to subsequent years' requirements. Excess hours to be carried forward must have been earned in a classroom setting and within the one year immediately preceding the renewal period. A maximum of 24 total excess credit hours may be carried forward. (5) Examiners for the Western Regional Examining Board (WREB) and for Central Regional Dental Testing Services Inc. (CRDTS) will be allowed credit for no more than 12 hours biennially, obtained from calibration and standardization exercises associated with the examinations. (6) Any individual or entity may petition one of the providers listed in §104.2 of this title to offer continuing education. (7) Providers cited in §104.2 of this title will approve individual courses and/or instructors. (8) A consultant for the SBDE who is also a licensee of the SBDE is eligible to receive up to 12 hours of continuing education credit biennially to apply towards the biennial renewal continuing education requirement under this section. (A) Continuing education credit hours shall be awarded for the issuance of an expert opinion based upon the review of SBDE cases and for providing assistance to the SBDE in the investigation and prosecution of cases involving violations of the Dental Practice Act and/or the Rules of the SBDE. (B) The amount of continuing education credit hours to be granted for each consultant task performed shall be determined by the Executive Director, Division Director or manager that authorizes the consultant task to be performed. The award of continuing education credit shall be confirmed in writing and based upon a reasonable assessment of the time required to complete the task. Source Note: The provisions of this §104.1 adopted to be effective March 1, 1996, 21 TexReg 1422; amended to be effective April 19, 1998, 23 TexReg 3830; amended to be effective June 28, 1998, 23 TexReg 6440; amended to be effective November 30, 1999, 24 TexReg 10539; amended to be effective April 16, 2000, 25 TexReg 3250; amended to be effective July 1, 2002, 27 TexReg 5782; amended to be effective September 21, 2004, 29 TexReg 9004; amended to be effective February 25, 2007, 32 TexReg 627; amended to be effective December 24, 2007, 32 TexReg 9628; amended to be effective August 7, 2008, 33 TexReg 6132; amended to be effective February 2, 2010, 35 TexReg 630; amended to be effective February 7, 2018,43 TexReg 573; amended to be May 10, 2018, 43 TexReg 2774

Dental assistants seeking registration with the SBDE may take radiographs, while training, within the first ____ months of employment.

(a) A dental assistant will not be considered to be positioning, exposing, or otherwise making dental x-rays if the dental assistant only performs radiological procedures: (1) In the course of training or for other educational purposes; and, (2) Is at all times under the direct supervision of the employer dentist. (b) A dental assistant performing radiological procedures under this section in the course of on-the-job training may only do so for a period of one year. Source Note: The provisions of this §114.11 adopted to be effective September 21, 2004, 29 TexReg 9005; amended to be effective November 5, 2006, 31 TexReg 8834

Which of the following duties may be delegated by a dentist to a dental assistant?

(a) A dentist may delegate to a dental assistant the authority to perform only acts or procedures that are reversible. An act or procedure that is reversible is capable of being reversed or corrected. (b) A dentist may not delegate or otherwise authorize a dental assistant to perform any task for which a certificate or additional training is required under this section, unless the dental assistant holds the required certificate or has obtained the additional training. (c) A dental assistant may perform tasks under a dentist's general or direct supervision. For the purposes of this section: (1) "General supervision" means that the dentist employs or is in charge of the dental assistant and is responsible for supervising the services to be performed by the dental assistant. The dentist may or may not be present on the premises when the dental assistant performs the procedures. (2) "Direct supervision" means that the dentist employs or is in charge of the dental assistant and is physically present in the office when the task is performed. Physical presence does not require that the supervising dentist be in the treatment room when the dental assistant performs the service as long as the dentist is in the dental office. (d) The dentist shall remain responsible for any delegated act. (e) The clinical tasks that a dental assistant can perform under general supervision are limited to: (1) the making of dental x-rays in compliance with the Occupations Code, §265.005; and (2) the provision of interim treatment of a minor emergency dental condition to an existing patient of the treating dentist in accordance with the Occupations Code, §265.003(a-1). For purposes of this paragraph only, "existing patient" means a patient that the supervising dentist has examined in the twelve (12) months prior to the interim treatment. A treating dentist who delegates the provision of interim treatment of a minor emergency condition to a dental assistant shall schedule a follow-up appointment with the patient within 30 days. It is not a violation if the dentist makes a good faith attempt to schedule a follow-up appointment with the patient within 30 days but is unable to because of circumstances outside the dentist's control and those circumstances are clearly noted in the patient's record. Source Note: The provisions of this §114.1 adopted to be effective February 20, 1992, 17 TexReg 1095; amended to be effective December 3, 1997, 22 TexReg 11679; amended to be effective May 10, 2004, 29 TexReg 4479; amended to be effective November 27, 2005, 30 TexReg 7743; amended to be effective February 2, 2010, 35 TexReg 635; amended to be effective December 28, 2014, 39 TexReg 10015; amended to be effective March 18, 2018, 43 TexReg 1437

All dentists and dental hygienists must display a current registration certificate in every office where services are being provided.

(a) A dentist or dental hygienist shall display a current registration certificate in each office where the dentist or dental hygienist provides dental services. (b) No dentist or dental hygienist shall provide treatment for a patient without placing the current registration certificate on exhibit. (c) When a dentist or dental hygienist provides dental services at more than one location, a duplicate registration certificate may be displayed. The duplicate may be obtained from the State Board of Dental Examiners for a fee set by the Board. (d) A dentist or dental hygienist may practice without displaying the person's current registration certificate as required by this section for not more than 30 days after the person receives written confirmation from the board that the person's original license was issued. Source Note: The provisions of this §108.11 adopted to be effective February 20, 2001, 26 TexReg 1494; amended to be effective November 27, 2005, 30 TexReg 7743

Once a dentist has terminated a patient from the practice, he/she must provide emergency services for:

(a) A dentist, without reasonable cause, shall not abandon a dental patient. Once a dentist has undertaken a course of treatment, the dentist, absent reasonable cause, shall not discontinue that treatment without giving the patient adequate notice and the opportunity to obtain the services of another dentist. A dentist shall exercise the level of care necessary to prevent jeopardizing the patient's oral health during this process. (b) Under this section, a dentist shall give a minimum of 30 days written notice of his/her intent to discontinue undertaken treatment. Notice shall be either hand-delivered to the patient or sent via certified mail, return receipt requested to the patient's last known address, with the dentist retaining a copy of the notice letter in the patient's file along with proof of service. Adequate notice shall include the following: (1) a short description of the patient's current status, including the patient's current diagnosis and a summary of the patient's current treatment plan; (2) a short description of the patient's present and future needs; (3) an explanation regarding the consequences of non-treatment; (4) a recommendation that the patient continue care with another dentist; and (5) a clear statement emphasizing that the dentist is available to provide any emergency treatment necessary to prevent patient harm during the 30-day period. (c) A dentist shall remain reasonably available to render any emergency treatment necessary under (b)(5) of this section for up to 30 days from the date of such notice. Source Note: The provisions of this §108.5 adopted to be effective February 20, 2001, 26 TexReg 1494; amended to be effective April 14, 2002, 27 TexReg 2826

It is a rule of the Board that all dental health care workers be able to abide by Centers for Disease Control (CDC) universal precautions.

(a) All dental health care workers shall comply with the universal precautions, as recommended for dentistry by the Centers for Disease Control and required by THSC, §§85.202, et seq, 1991, as amended, in the care, handling, and treatment of patients in the dental office or other setting where dental procedures of any type may be performed. (b) All dental health care workers who have exudative lesions or weeping dermatitis shall refrain from contact with equipment, devices, and appliances that may be used for or during patient care, where such contact holds potential for blood or body fluid contamination, and shall refrain from all patient care and contact until condition(s) resolves unless barrier techniques would prevent patient contact with the dental health care worker's blood or body fluid. (c) A dental health care worker(s) who knows he/she is infected with HIV or HBV and who knows he/she is HbeAg positive shall report his/her health status to an expert review panel, pursuant to provisions of THSC, §§85.204, et seq, 1991, as amended. (d) A dental health care worker who is infected with HIV or HBV and is HbeAg positive shall notify a prospective patient of the dental health care worker's seropositive status and obtain the patient's consent before the patient undergoes an exposure-prone procedure performed by the notifying dental health care worker. (e) All dental care workers should receive a tuberculin skin test at least annually, or if it is discovered they have been exposed. The Board encourages compliance with the guidelines for tuberculosis testing and control recommended by the Centers for Disease Control and Prevention and the Texas Department of Health, or their successor agencies. Source Note: The provisions of this §108.25 adopted to be effective February 20, 2001, 26 TexReg 1494; amended to be effective September 21, 2004, 29 TexReg 9005

A permit is NOT required for mobile dental units providing care in nursing homes or convalescent facilities.

(a) Beginning September 1, 2001, every mobile dental facility, and, except as provided herein, every portable dental unit operated in Texas by any entity must have a permit as provided by this title (relating to Mobile Dental Facilities). (b) Licensees who do not have a permit for a portable dental unit or who are employed by a dental organization not having a portable dental unit permit may provide dental services through use of dental instruments and equipment taken out of a dental office without a permit if; (1) the service is provided as emergency treatment; (2) a patient of record of the licensee or organization is treated outside of the dental office; (3) treatment is provided to residents of nursing homes or convalescent facilities; or (4) treatment is provided without charge to patients or to any third party payer, so long as such treatment is not provided on a regular basis. (5) anesthesia/sedation services are provided and the licensee is permitted to provide portable anesthesia services under the provisions of Rule 108.33 of this title (relating to Sedation/Anesthesia Permit); or (6) the service is provided in an office of another licensed dentist. Source Note: The provisions of this §108.40 adopted to be effective February 20, 2001, 26 TexReg 1494

Listing such things as "expanded hours", "24-hour emergency service", and "no appointment necessary" are considered false and misleading if, in fact, no such services are available.

(a) Disclosure of Full Name. (1) Any person who practices dentistry under any name or trade name must provide full and outward disclosure of his full name as it appears on his license or renewal certificate issued by the board, or his commonly used name. (2) Any person who owns, maintains, or operates an office or place of business in which the person employs or engages under any type of contract another person to practice dentistry, either directly or indirectly, under any name or trade name must provide full and outward disclosure of his full name as it appears on his license or renewal certificate issued by the board, or his commonly used name. (3) Any person who holds himself out to the public, directly or indirectly, as soliciting patronage or as being qualified to practice dentistry in the state of Texas under any name or trade name must provide full and outward disclosure of his full name as it appears on his license or renewal certificate issued by the board, or his commonly used name. (4) Any person who operates, manages, or is employed in any facility where dental service is rendered or conducted under any name or trade name must provide full and outward disclosure of his full name as it appears on the license or renewal certificate issued by the board, or his commonly used name. (5) Any person who practices dentistry must display his full name as it appears on his license or renewal certificate issued by the board, or his commonly used name, outside the primary entry of each location at which he practices dentistry. (6) If the names of auxiliary personnel, such as dental hygienists or dental assistants, are displayed in any manner or in any advertising, the auxiliary personnel must be clearly identified by title, along with the name of a supervising dentist. (b) Name of Practice. (1) Each dental office shall post at or near the entrance of the office in an area visible to the public, the name of, each professional degree received by and each school attended by each dentist practicing in the office. (2) The name of the owner shall be prominently displayed and only the names of the dentists who are engaged in the practice of the profession at a particular location shall be used. (3) The name of a deceased or retired dentist leaving a practice shall not be used at such location more than one (1) year following departure from the practice. The name of a dentist leaving a location for any other reason or transferring his or her practice shall not be used at such location or practice for more than forty (40) days following departure from the location. However, if the transferring dentist remains actively engaged in the practice of dentistry in the transferred practice, the acquiring dentist may continue using the name of the transferring dentist. (4) A licensed Texas dentist, in any professional communication concerning dental services, shall include the dentist's dental degree; the words "general dentist" or "general dentistry;" or an ADA approved dental specialty if the dentist is a specialist in the field designated. (5) A licensed Texas dentist who is also authorized to practice medicine in Texas may use the initials "M.D." or "D.O." along with the dentist's dental degree. (c) Use of Trade Name. (1) A dentist may practice under his or her own name, or use a corporation, company, association or trade name as provided by §259.003 of the Texas Occupations Code. (2) A dentist practicing under a corporation, company, association or trade name shall give each patient the name and license number of the treating dentist, in writing, either before or after each office visit, upon request of a patient. (3) An advertisement under a corporation, company, association or trade name must include prominently the name of the owner(s) and at least one dentist actually engaged in the practice of dentistry under that trade name at each location advertised. This provision does not apply to location signage. (4) Each dentist practicing under a corporation, company, association or trade name shall file notice with the board of every corporation, company, association or trade name under which that dentist practices upon initial application for licensure and annual license renewal. (5) Since the name under which a dentist conducts his or her practice may be a factor in the selection process of the patient, the use of a trade name or an assumed name that is false or misleading in any material respect is unethical. (d) Responsibility. The responsibility for the form and content of an advertisement offering services or goods by a dentist shall be jointly and severally that of each licensed professional who is an owner, principal, partner, or officer of the firm or entity identified in the advertisement. Source Note: The provisions of this §108.52 adopted to be effective May 1, 2013, 37 TexReg 9637; amended to be effective December 28, 2014, 39 TexReg 10015

If the name of a dental hygienist or dental auxiliary is to be displayed in any manner, it should be conspicuously differentiated by title from that of the dentist.

(a) Each dental office shall post at or near the entrance of the office the name of, each degree received by, and each school attended by each dentist practicing in the office. (b) A dentist shall practice only under his or her own name, a company name or a trade name as set forth in Section 259.003 of the Occupations Code. If a dentist uses a trade name, or a company name, in his or her practice then each patient shall be given the name of the treating dentist in writing, either prior to or after each office visit. (c) Only the names of the dentists who are actually engaged in the practice of their profession at a particular location may be used. (d) The name of a deceased or retired dentist shall not be used at such location more than one (1) year after the death or retirement of the dentist. The name of a dentist leaving a location for any other reason or transferring his or her practice shall not be used at such location or practice for more than forty (40) days following departure from the location. However, if the transferring dentist remains actively engaged in the practice of dentistry in the transferred practice, the acquiring dentist may continue using the name of the transferring dentist. (e) If the names of auxiliary personnel, such as dental hygienists, dental assistants, etc., are displayed in any manner, the auxiliary personnel must be clearly identified by title, along with the name of the supervising dentist. Source Note: The provisions of this §108.4 adopted to be effective February 20, 2001, 26 TexReg 1494; amended to be effective December 28, 2014, 39 TexReg 10015

It is required that the name, degree, and school of each dentist practicing in an office will be posted at or near the office entrance.

(a) Each dental office shall post at or near the entrance of the office the name of, each degree received by, and each school attended by each dentist practicing in the office. (b) A dentist shall practice only under his or her own name, a company name or a trade name as set forth in Section 259.003 of the Occupations Code. If a dentist uses a trade name, or a company name, in his or her practice then each patient shall be given the name of the treating dentist in writing, either prior to or after each office visit. (c) Only the names of the dentists who are actually engaged in the practice of their profession at a particular location may be used. (d) The name of a deceased or retired dentist shall not be used at such location more than one (1) year after the death or retirement of the dentist. The name of a dentist leaving a location for any other reason or transferring his or her practice shall not be used at such location or practice for more than forty (40) days following departure from the location. However, if the transferring dentist remains actively engaged in the practice of dentistry in the transferred practice, the acquiring dentist may continue using the name of the transferring dentist. (e) If the names of auxiliary personnel, such as dental hygienists, dental assistants, etc., are displayed in any manner, the auxiliary personnel must be clearly identified by title, along with the name of the supervising dentist. Source Note: The provisions of this §108.4 adopted to be effective February 20, 2001, 26 TexReg 1494; amended to be effective December 28, 2014, 39 TexReg 10015

The name of a deceased or retired dentist at a group practice must be removed from the sign within:

(a) Each dental office shall post at or near the entrance of the office the name of, each degree received by, and each school attended by each dentist practicing in the office. (b) A dentist shall practice only under his or her own name, a company name or a trade name as set forth in Section 259.003 of the Occupations Code. If a dentist uses a trade name, or a company name, in his or her practice then each patient shall be given the name of the treating dentist in writing, either prior to or after each office visit. (c) Only the names of the dentists who are actually engaged in the practice of their profession at a particular location may be used. (d) The name of a deceased or retired dentist shall not be used at such location more than one (1) year after the death or retirement of the dentist. The name of a dentist leaving a location for any other reason or transferring his or her practice shall not be used at such location or practice for more than forty (40) days following departure from the location. However, if the transferring dentist remains actively engaged in the practice of dentistry in the transferred practice, the acquiring dentist may continue using the name of the transferring dentist. (e) If the names of auxiliary personnel, such as dental hygienists, dental assistants, etc., are displayed in any manner, the auxiliary personnel must be clearly identified by title, along with the name of the supervising dentist. Source Note: The provisions of this §108.4 adopted to be effective February 20, 2001, 26 TexReg 1494; amended to be effective December 28, 2014, 39 TexReg 10015

Falsification of a continuing education attestation is not a violation of the Dental Practice Act and is not subject to disciplinary action.

(a) Each licensee and registrant shall attest during the annual renewal process that he/she is in compliance with the statutory requirements for continuing education. (b) Falsification of a continuing education attestation is a violation of the Dental Practice Act and such false certification or the failure to attend and complete the required number of continuing education hours shall subject the licensee/registrant to disciplinary action. (c) If it appears that the licensee/registrant has falsified the attestation, that matter will be referred to the Director of Enforcement of the State Board of Dental Examiners for proceeding as set forth in §107.100 of this title, §107.101 of this title and the Dental Practice Act. Source Note: The provisions of this §104.4 adopted to be effective March 1, 1996, 21 TexReg 1422; amended to be effective June 28, 1998, 23 TexReg 6440; amended to be effective April 16, 2000, 25 TexReg 3250; amended to be effective February 2, 2010, 35 TexReg 630

Any dentist applying for licensure by credentials must successfully pass a background check for criminal or fraudulent activities. scrollable

(a) In addition to the general qualifications for licensure contained in §101.1 of this chapter (relating to General Qualifications for Licensure), an applicant for licensure by credentials must present proof that the applicant: (1) Has graduated and received either the "DDS" or "DMD" degree from a dental school accredited by the Commission on Dental Accreditation of the American Dental Association (CODA); (2) Is currently licensed as a dentist in good standing in another state, the District of Columbia, or a territory of the United States, provided that such licensure followed successful completion of a general dentistry clinical examination administered by another state or regional examining board; (3) Has practiced dentistry: (A) For a minimum of three years out of the five years immediately preceding application to the Board, pursuant to section 256.101(a-1) of the Dental Practice Act; or (B) As a dental educator at a CODA-accredited dental or dental hygiene school for a minimum of five years immediately preceding application to the Board; (4) Is endorsed by the state board of dentistry in the jurisdiction in which the applicant practices at the time of the application. Such endorsement is established by providing a copy under seal of the applicant's current license and by a certified statement that the applicant has current good standing in said jurisdiction; (5) Has taken and passed the examination for dentists given by the American Dental Association Joint Commission on National Dental Examinations; (6) Has met the requirements of §101.8 of this title (relating to Persons with Criminal Backgrounds) and has completed background checks for criminal or fraudulent activities, to include information from: the National Practitioner Data Bank, the Healthcare Integrity and Protection Data Bank and/or the American Association of Dental Boards (AADB) Clearinghouse for Disciplinary Action. Additionally, no more than six months before submitting an application to the Board, an applicant under this section shall make application with the Professional Background Information Services (PBIS), requesting Level II verification, paying the required fees, and requesting verification be sent to the Board for determination of successful background verification; and (7) Has completed 12 hours of continuing education taken within the 12 months preceding the date the licensure application is received by the Board. All hours shall be taken in accordance with the requirements for continuing education as mandated by Chapter 104 of this title (relating to Continuing Education). (b) Practice experience described in subsection (a)(3) of this section must be subsequent to applicant having graduated from a CODA-accredited dental school. Source Note: The provisions of this §101.3 adopted to be effective May 10, 2004, 29 TexReg 4473; amended to be effective October 7, 2009, 34 TexReg 6849; amended to be effective May 19, 2010, 35 TexReg 3814; amended to be effective December 22, 2010, 35 TexReg 11253; amended to be effective May 29, 2013, 38 TexReg 3344; amended to be effective June 11, 2014, 39 TexReg 4427; amended to be effective December 28, 2014, 39 TexReg 10013

Prosthetic identification may be omitted from:

(a) It shall be the duty of the licensed dentist to insure that all removable prosthetic devices or removable orthodontic appliances delivered to a patient under his or her care bear a permanent identification marking suitable to determine that the prosthetic device or removable orthodontic appliance belongs to that patient. (b) A suitable marking shall be defined as one that includes the patient's last name and first initial, and/or social security number. This marking shall be placed in the denture base of the removable prosthetic device or acrylic portion of the removable orthodontic appliance in such a manner as not to compromise the aesthetics of the restoration. (c) The licensed dentist shall install this identification marking or shall request on the prescription to a registered dental laboratory that the laboratory place the identification marking in the removable prosthetic device or removable orthodontic appliance. (d) Nothing in this rule shall preclude a dental laboratory from charging a fee for this service. (e) This rule shall not apply to any removable prosthetic device or removable orthodontic appliance that contains no acrylic, vinyl or plastic denture base, or if said appliance is too small to reasonably accomplish this procedure. (f) A dental laboratory that is required to register with the State Board of Dental Examiners shall clearly label or certify in writing to the prescribing dentist that the prosthesis or appliance being delivered to the prescribing dentist was either: (1) manufactured entirely by the SBDE registered dental laboratory; (2) manufactured in part or whole by a domestic laboratory inside of the United States; or, (3) manufactured in part or whole by a foreign laboratory outside of the United States and clearly identify the country in which the dental laboratory work was performed. (g) A dental laboratory that is required to register with the State Board of Dental Examiners may return to the dentist who issued the prescription written certification of all materials utilized in the prosthesis or appliance, including the percentage of each ingredient used in the fabrication of the prosthesis or appliance. Source Note: The provisions of this §116.10 adopted to be effective May 26, 2005, 30 TexReg 3020; amended to be effective February 26, 2009, 34 TexReg 1247; amended to be effective December 22, 2010, 35 TexReg 11257

A licensee must accept the recommendations of an Informal Settlement Conference.

(a) Policy. It is the Board's policy to encourage, where appropriate, the resolution and early settlement of contested disciplinary matters and internal disputes through informal disposition and mediation. (b) Informal Disposition. Under Texas Occupations Code §263.0065, the Board may delegate the authority to dismiss or enter into agreed settlement for the resolution of certain complaints prior to an informal settlement conference. Texas Occupations Code §263.007 and §263.0073 authorize the Board to resolve complaints by review at an informal settlement conference. (c) Scheduling of Informal Settlement Conference. (1) Not later than the 180th day after the date the Board's official investigation of a complaint is commenced, the Board shall schedule an informal settlement conference unless good cause is shown by the Board for not scheduling the conference by that date. The following justifications represent good cause for Board staff to postpone scheduling an informal settlement conference: (A) an expert reviewer's delinquency in reviewing and submitting a report to the Board under Texas Occupations Code §255.0067; (B) a temporary suspension of the license holder's license under Texas Occupations Code §263.004; (C) the filing of a contested case against the licensee with the State Office of Administrative Hearings to resolve the complaint; (D) a pending contested case against the licensee with the State Office of Administrative Hearings where Board staff's requested sanction is license suspension or revocation; (E) proposed resolution of the complaint through delegation pursuant to Texas Occupations Code §263.0065; (F) a delay for a final judgment resulting from federal or state criminal charges filed against the licensee for conduct relevant to the complaint, if conviction for such charges would represent grounds for license suspension or revocation under the Texas Occupations Code or Board rules; (G) a request for delay from federal, state, or local law enforcement to allow investigation of potential criminal charges against the licensee for conduct relevant to the complaint, if conviction for such charges would represent grounds for license suspension or revocation under the Texas Occupations Code or Board rules; (H) delay of the investigation due to Board staff's inability to locate the licensee or complainant, or licensee's inability or refusal to provide relevant records for the Board's investigation; or (I) the existence of pending complaints from prior fiscal years which require resolution at an informal settlement conference. (2) Requests to reschedule the informal settlement conference by a licensee must be in writing and shall be referred to the General Counsel for consideration. To avoid undue disruption of the informal settlement conference schedule, the following requirements shall be applied. A request by a licensee to reschedule an informal settlement conference must be in writing and may be granted only if the licensee provides satisfactory evidence of the following requirements: (A) The request must be received by the agency within five business days after the licensee received notice of the date of the informal settlement conference, must provide details showing that the licensee has a conflicting event that was scheduled prior to receipt of notice of the informal settlement conference, and must show the licensee has made reasonable efforts to reschedule such event but a conflict cannot reasonably be avoided. (B) A request received by the agency more than five business days after the licensee received notice of the date of the informal settlement conference must provide details showing that an extraordinary event or circumstance has arisen since receipt of the notice that will prevent the licensee from attending the informal settlement conference. The request must show that the request is made within five business days after the licensee first becomes aware of the event or circumstance. Unavailability of the licensee's counsel for the informal settlement conference date shall not be adequate to show an extraordinary event or circumstance if the unavailability is due to scheduling conflicts with counsel's other clients or matters not related to counsel's representation of the licensee. (3) A request by a licensee to reschedule an informal settlement conference based on the failure of the agency to send timely notice before the date scheduled for the informal settlement conference shall be granted, provided that the request is received by the Board within five business days after the late notice is received by the licensee and the licensee provides sufficient proof that the notice was not timely delivered to the licensee's address of record on file with the Board. (d) Informal Settlement Conference. (1) Two or more members of the Board or the Dental Review Committee shall represent the full Board at the informal settlement conference, and at least one panelist must be a dentist. At least one member of the representative panel shall be present in person, but other members of the panel may appear via teleconference. (A) Notwithstanding subsection (d)(1) of this section, an informal settlement conference may be conducted by one panelist if the license holder who is the subject of the complaint waives the requirement that at least two panelists conduct the conference. If the license holder waives that requirement, the panelist may be a dentist, a dental hygienist, or a member who represents the public. If the licensee attends the scheduled informal settlement conference and, after being informed of the requirements of Texas Occupations Code §263.0072, does not object during the scheduled time of the conference to the lack of two panel members, the licensee shall have waived the requirement for purposes of that complaint's proceedings. (B) Pursuant to Texas Occupations Code §263.0072(e), an informal settlement conference conducted under Texas Occupations Code §263.007 to show compliance with a Board order or remedial plan of the Board may be conducted by one panelist. (2) The Board will provide the licensee notice in writing of the time, date, and place of the settlement conference not later than the 45th day before the date the conference is held. Such notification shall inform the licensee: of the specific allegations against the licensee and the information board staff intends to use at the informal settlement conference; that he or she may be represented by legal counsel; that the licensee may offer a rebuttal to the allegations, including the exhibits or the testimony of such witnesses as he or she may desire; that the Board will be represented by one or more of its members and by legal counsel; and that he or she may request that the matter be considered by the Board according to procedures described in Texas Occupations Code §263.007. The Board's rules or policies relating to the informal disposition of cases shall be enclosed with the notice of the settlement conference. Notice of the settlement conference, with enclosures, shall be sent by first class United States Mail or overnight courier to the address of record of the licensee on file with the Board or the licensee's attorney of record. An electronic copy of the notice and enclosures may be provided if the license holder or the license holder's representative consents to such electronic notice. A settlement conference may be rescheduled if Board staff does not provide adequate notice as required by this subsection. Delivery of the notice is presumed to have occurred three business days after the deposit of the notice with the United States Postal Service, one business day after deposit of the notice with an overnight courier, or immediately upon sending if the notice is provided electronically. (3) The licensee must provide to Board staff his rebuttal not later than the 15th day before the date of the conference in order for that information to be considered at the conference. (4) The settlement conference shall be informal and will not follow the procedure established in State Office of Administrative Hearing (SOAH) rules for contested cases. The settlement conference will be conducted by representatives of the Board. The Board's representatives may call upon the Board's attorney at any time for assistance in conducting the settlement conference. The licensee, his or her attorney, representative(s) of the Board, and Board staff may question witnesses, make relevant statements, present affidavits or statements of persons not in attendance, and may present such other evidence as may be appropriate. (5) The Board's representatives may prohibit or limit access to the Board's investigative file by the licensee, his or her attorney, and the complainant and his or her representative. (6) The Board's representatives shall exclude from the settlement conference all persons except the patient or other witnesses; the licensee and his or her attorney; the complainant; Board members; and Board staff. Complainants and licensees shall not be present in the informal settlement conference at the same time unless both parties consent, and the Board's representatives may exclude parties at any time to ensure the conference proceeds efficiently and with appropriate decorum. (7) At the conclusion of the settlement conference, the Board's representatives shall make recommendations for resolution or correction of any alleged violations of the Dental Practice Act or of the Board rules. Such recommendations may include any disciplinary actions authorized by Texas Occupations Code §263.002 or a remedial plan authorized by §263.0077 of the Dental Practice Act. The Board's representatives may, on the basis that a violation of the Dental Practice Act or the Board's rules has not been established, dismiss the complaint. Dismissal of a complaint by the Board's representatives shall be adopted after presentation to the full Board for an affirmative vote. A recommendation to dismiss a complaint requires no further action by the Respondent. (8) Board staff shall draft a proposed settlement agreement or remedial plan reflecting the settlement recommendations, which the licensee shall either accept or reject. To accept the settlement recommendations, the licensee must sign the proposed agreed settlement order or remedial plan and return it to the Board. Inaction by the licensee shall constitute rejection. If the licensee rejects the proposed agreed settlement order or remedial plan, the matter shall be referred to SOAH for a contested case hearing. (9) Following acceptance and execution of the proposed agreed settlement order or remedial plan by the licensee, said proposed order shall be submitted to the entire Board for approval. (10) On request of the licensee, Board staff shall make a recording of the conference. The recording is part of the investigative file and may not be released to a third party. Board staff may charge the licensee a fee to cover the cost of recording the conference. Board staff shall provide a copy of the recording to the licensee on the licensee's request. (e) Use of Mediation in Contested Disciplinary Matters. (1) The Executive Director or General Counsel may refer a contested disciplinary matter to a mediation process to seek resolution or correction of any alleged violations of the Dental Practice Act or of the Board rules. Such mediation processes may include any procedure described in the SOAH Rules of Procedure. Referral to mediation may occur prior to or simultaneous with a contested case filed at SOAH. (2) Any agreement or recommendation resulting from the application of a mediation process to a contested disciplinary matter shall be documented in written form and signed by the licensee, and a representative of the Board and/or the Executive Director. Such an agreement or recommendation may include any actions authorized by Chapter 263 of the Dental Practice Act. (3) If the mediation process results in no agreement or recommendation, the matter shall be referred to SOAH for a contested case hearing. (f) Consideration by the Board. (1) All proposed agreed settlement orders, remedial plans, agreements or other recommendations shall be reviewed by the full Board for approval. (2) Upon an affirmative majority vote, the Board shall enter an order approving the proposed agreed settlement order, remedial plan, agreement, or recommendation. Said order shall bear the signature of the Presiding Officer and Board Secretary, or of the officer presiding at such meeting. (3) If the Board does not approve a proposed settlement order, remedial plan, agreement, or recommendation, the licensee shall be so informed. The matter shall be referred by the Board to the Board Secretary and Executive Director for consideration of appropriate action. (g) Restitution. (1) The Board may order a licensee to pay restitution to a patient as provided in a proposed agreed settlement order or other agreement or recommendation, instead of or in addition to any administrative penalty. (2) The amount of restitution ordered may not exceed the amount the patient paid to the licensee for the service or services from which the complaint arose. The Board shall not require payment of other damages or make an estimation of harm in any order for restitution. Source Note: The provisions of this §107.63 adopted to be effective July 18, 1989, 14 TexReg 2952; amended to be effective April 19, 1998, 23 TexReg 3831; amended to be effective November 30, 1999, 24 TexReg 10547; amended to be effective May 10, 2004, 29 TexReg 4473; amended to be effective February 24, 2008, 33 TexReg 1546; amended to be effective February 2, 2010, 35 TexReg 631; amended to be effective September 14, 2010, 35 TexReg 8342; amended to be effective December 10, 2013, 38 TexReg 8831; amended to be effective March 23, 2015, 40 TexReg 1707; amended to be effective September 24, 2018, 43 TexReg 6274

Complaints may be resolved by:

(a) Policy. It is the Board's policy to encourage, where appropriate, the resolution and early settlement of contested disciplinary matters and internal disputes through informal disposition and mediation. (b) Informal Disposition. Under Texas Occupations Code §263.0065, the Board may delegate the authority to dismiss or enter into agreed settlement for the resolution of certain complaints prior to an informal settlement conference. Texas Occupations Code §263.007 and §263.0073 authorize the Board to resolve complaints by review at an informal settlement conference. (c) Scheduling of Informal Settlement Conference. (1) Not later than the 180th day after the date the Board's official investigation of a complaint is commenced, the Board shall schedule an informal settlement conference unless good cause is shown by the Board for not scheduling the conference by that date. The following justifications represent good cause for Board staff to postpone scheduling an informal settlement conference: (A) an expert reviewer's delinquency in reviewing and submitting a report to the Board under Texas Occupations Code §255.0067; (B) a temporary suspension of the license holder's license under Texas Occupations Code §263.004; (C) the filing of a contested case against the licensee with the State Office of Administrative Hearings to resolve the complaint; (D) a pending contested case against the licensee with the State Office of Administrative Hearings where Board staff's requested sanction is license suspension or revocation; (E) proposed resolution of the complaint through delegation pursuant to Texas Occupations Code §263.0065; (F) a delay for a final judgment resulting from federal or state criminal charges filed against the licensee for conduct relevant to the complaint, if conviction for such charges would represent grounds for license suspension or revocation under the Texas Occupations Code or Board rules; (G) a request for delay from federal, state, or local law enforcement to allow investigation of potential criminal charges against the licensee for conduct relevant to the complaint, if conviction for such charges would represent grounds for license suspension or revocation under the Texas Occupations Code or Board rules; (H) delay of the investigation due to Board staff's inability to locate the licensee or complainant, or licensee's inability or refusal to provide relevant records for the Board's investigation; or (I) the existence of pending complaints from prior fiscal years which require resolution at an informal settlement conference. (2) Requests to reschedule the informal settlement conference by a licensee must be in writing and shall be referred to the General Counsel for consideration. To avoid undue disruption of the informal settlement conference schedule, the following requirements shall be applied. A request by a licensee to reschedule an informal settlement conference must be in writing and may be granted only if the licensee provides satisfactory evidence of the following requirements: (A) The request must be received by the agency within five business days after the licensee received notice of the date of the informal settlement conference, must provide details showing that the licensee has a conflicting event that was scheduled prior to receipt of notice of the informal settlement conference, and must show the licensee has made reasonable efforts to reschedule such event but a conflict cannot reasonably be avoided. (B) A request received by the agency more than five business days after the licensee received notice of the date of the informal settlement conference must provide details showing that an extraordinary event or circumstance has arisen since receipt of the notice that will prevent the licensee from attending the informal settlement conference. The request must show that the request is made within five business days after the licensee first becomes aware of the event or circumstance. Unavailability of the licensee's counsel for the informal settlement conference date shall not be adequate to show an extraordinary event or circumstance if the unavailability is due to scheduling conflicts with counsel's other clients or matters not related to counsel's representation of the licensee. (3) A request by a licensee to reschedule an informal settlement conference based on the failure of the agency to send timely notice before the date scheduled for the informal settlement conference shall be granted, provided that the request is received by the Board within five business days after the late notice is received by the licensee and the licensee provides sufficient proof that the notice was not timely delivered to the licensee's address of record on file with the Board. (d) Informal Settlement Conference. (1) Two or more members of the Board or the Dental Review Committee shall represent the full Board at the informal settlement conference, and at least one panelist must be a dentist. At least one member of the representative panel shall be present in person, but other members of the panel may appear via teleconference. (A) Notwithstanding subsection (d)(1) of this section, an informal settlement conference may be conducted by one panelist if the license holder who is the subject of the complaint waives the requirement that at least two panelists conduct the conference. If the license holder waives that requirement, the panelist may be a dentist, a dental hygienist, or a member who represents the public. If the licensee attends the scheduled informal settlement conference and, after being informed of the requirements of Texas Occupations Code §263.0072, does not object during the scheduled time of the conference to the lack of two panel members, the licensee shall have waived the requirement for purposes of that complaint's proceedings. (B) Pursuant to Texas Occupations Code §263.0072(e), an informal settlement conference conducted under Texas Occupations Code §263.007 to show compliance with a Board order or remedial plan of the Board may be conducted by one panelist. (2) The Board will provide the licensee notice in writing of the time, date, and place of the settlement conference not later than the 45th day before the date the conference is held. Such notification shall inform the licensee: of the specific allegations against the licensee and the information board staff intends to use at the informal settlement conference; that he or she may be represented by legal counsel; that the licensee may offer a rebuttal to the allegations, including the exhibits or the testimony of such witnesses as he or she may desire; that the Board will be represented by one or more of its members and by legal counsel; and that he or she may request that the matter be considered by the Board according to procedures described in Texas Occupations Code §263.007. The Board's rules or policies relating to the informal disposition of cases shall be enclosed with the notice of the settlement conference. Notice of the settlement conference, with enclosures, shall be sent by first class United States Mail or overnight courier to the address of record of the licensee on file with the Board or the licensee's attorney of record. An electronic copy of the notice and enclosures may be provided if the license holder or the license holder's representative consents to such electronic notice. A settlement conference may be rescheduled if Board staff does not provide adequate notice as required by this subsection. Delivery of the notice is presumed to have occurred three business days after the deposit of the notice with the United States Postal Service, one business day after deposit of the notice with an overnight courier, or immediately upon sending if the notice is provided electronically. (3) The licensee must provide to Board staff his rebuttal not later than the 15th day before the date of the conference in order for that information to be considered at the conference. (4) The settlement conference shall be informal and will not follow the procedure established in State Office of Administrative Hearing (SOAH) rules for contested cases. The settlement conference will be conducted by representatives of the Board. The Board's representatives may call upon the Board's attorney at any time for assistance in conducting the settlement conference. The licensee, his or her attorney, representative(s) of the Board, and Board staff may question witnesses, make relevant statements, present affidavits or statements of persons not in attendance, and may present such other evidence as may be appropriate. (5) The Board's representatives may prohibit or limit access to the Board's investigative file by the licensee, his or her attorney, and the complainant and his or her representative. (6) The Board's representatives shall exclude from the settlement conference all persons except the patient or other witnesses; the licensee and his or her attorney; the complainant; Board members; and Board staff. Complainants and licensees shall not be present in the informal settlement conference at the same time unless both parties consent, and the Board's representatives may exclude parties at any time to ensure the conference proceeds efficiently and with appropriate decorum. (7) At the conclusion of the settlement conference, the Board's representatives shall make recommendations for resolution or correction of any alleged violations of the Dental Practice Act or of the Board rules. Such recommendations may include any disciplinary actions authorized by Texas Occupations Code §263.002 or a remedial plan authorized by §263.0077 of the Dental Practice Act. The Board's representatives may, on the basis that a violation of the Dental Practice Act or the Board's rules has not been established, dismiss the complaint. Dismissal of a complaint by the Board's representatives shall be adopted after presentation to the full Board for an affirmative vote. A recommendation to dismiss a complaint requires no further action by the Respondent. (8) Board staff shall draft a proposed settlement agreement or remedial plan reflecting the settlement recommendations, which the licensee shall either accept or reject. To accept the settlement recommendations, the licensee must sign the proposed agreed settlement order or remedial plan and return it to the Board. Inaction by the licensee shall constitute rejection. If the licensee rejects the proposed agreed settlement order or remedial plan, the matter shall be referred to SOAH for a contested case hearing. (9) Following acceptance and execution of the proposed agreed settlement order or remedial plan by the licensee, said proposed order shall be submitted to the entire Board for approval. (10) On request of the licensee, Board staff shall make a recording of the conference. The recording is part of the investigative file and may not be released to a third party. Board staff may charge the licensee a fee to cover the cost of recording the conference. Board staff shall provide a copy of the recording to the licensee on the licensee's request. (e) Use of Mediation in Contested Disciplinary Matters. (1) The Executive Director or General Counsel may refer a contested disciplinary matter to a mediation process to seek resolution or correction of any alleged violations of the Dental Practice Act or of the Board rules. Such mediation processes may include any procedure described in the SOAH Rules of Procedure. Referral to mediation may occur prior to or simultaneous with a contested case filed at SOAH. (2) Any agreement or recommendation resulting from the application of a mediation process to a contested disciplinary matter shall be documented in written form and signed by the licensee, and a representative of the Board and/or the Executive Director. Such an agreement or recommendation may include any actions authorized by Chapter 263 of the Dental Practice Act. (3) If the mediation process results in no agreement or recommendation, the matter shall be referred to SOAH for a contested case hearing. (f) Consideration by the Board. (1) All proposed agreed settlement orders, remedial plans, agreements or other recommendations shall be reviewed by the full Board for approval. (2) Upon an affirmative majority vote, the Board shall enter an order approving the proposed agreed settlement order, remedial plan, agreement, or recommendation. Said order shall bear the signature of the Presiding Officer and Board Secretary, or of the officer presiding at such meeting. (3) If the Board does not approve a proposed settlement order, remedial plan, agreement, or recommendation, the licensee shall be so informed. The matter shall be referred by the Board to the Board Secretary and Executive Director for consideration of appropriate action. (g) Restitution. (1) The Board may order a licensee to pay restitution to a patient as provided in a proposed agreed settlement order or other agreement or recommendation, instead of or in addition to any administrative penalty. (2) The amount of restitution ordered may not exceed the amount the patient paid to the licensee for the service or services from which the complaint arose. The Board shall not require payment of other damages or make an estimation of harm in any order for restitution. Source Note: The provisions of this §107.63 adopted to be effective July 18, 1989, 14 TexReg 2952; amended to be effective April 19, 1998, 23 TexReg 3831; amended to be effective November 30, 1999, 24 TexReg 10547; amended to be effective May 10, 2004, 29 TexReg 4473; amended to be effective February 24, 2008, 33 TexReg 1546; amended to be effective February 2, 2010, 35 TexReg 631; amended to be effective September 14, 2010, 35 TexReg 8342; amended to be effective December 10, 2013, 38 TexReg 8831; amended to be effective March 23, 2015, 40 TexReg 1707; amended to be effective September 24, 2018, 43 TexReg 6274

A dentist is required to give a patient copies of his/her patient records within 30 days of the patient request.

(a) The term dental records includes, but is not limited to: identification of the practitioner providing treatment; medical and dental history; limited physical examination; oral pathology 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. (b) A Texas dental licensee practicing dentistry in Texas shall make, maintain, and keep adequate dental records for and upon each dental patient for reference, identification, and protection of the patient and the dentist. Records shall be kept for a period of not less than five years from the last date of treatment by the dentist. If a patient was younger than 18 years of age when last treated by the dentist, the records shall be maintained by the dentist until the patient reaches age 21 or for five years from the date of last treatment, whichever is longer. Dentists shall retain records for a longer period of time when mandated by other federal or state statute or regulation. Records must include documentation of the following: (1) Patients name; (2) Date of visit; (3) Reason for visit; (4) Vital signs, including but not limited to blood pressure and heart rate when applicable in accordance with §108.7 of this title. (5) If not recorded, an explanation why vital signs were not obtained. (c) Further, records must include documentation of the following when services are rendered: (1) Written review of medical history and limited physical evaluation; (2) Findings and charting of clinical and radiographic oral examination: (A) Documentation of radiographs taken and findings deduced from them, including radiograph films or digital reproductions. (B) Use of radiographs, at a minimum, should be in accordance with ADA guidelines. (C) Documentation of the findings of a tactile and visual examination of the soft and hard tissues of the oral cavity; (3) Diagnosis(es); (4) Treatment plan, recommendation, and options; (5) Treatment provided; (6) Medication and dosages given to patient; (7) Complications; (8) Written informed consent that meets the provisions of §108.7(7) of this title; (9) The dispensing, administering, or prescribing of all medications to or for a dental patient shall be made a part of such patient's dental record. The entry in the patient's dental record shall be in addition to any record keeping requirements of the DPS or DEA prescription programs; (10) All records pertaining to Controlled Substances and Dangerous Drugs shall be maintained in accordance with the Texas Controlled Substances Act; (11) Confirmable identification of provider dentist, and confirmable identification of person making record entries if different from provider dentist; (12) When any of the items in paragraphs (1) - (11) of this subsection are not indicated, the record must include an explanation why the item is not recorded. (d) Dental records are the sole property of the dentist who performs the dental service. However, ownership of original dental records may be transferred as provided in this section. Copies of dental records shall be made available to a dental patient in accordance with this section. (e) A dentist who leaves a location or practice, whether by retirement, sale, transfer, termination of employment or otherwise, shall maintain all dental records belonging to him or her, make a written transfer of records to the succeeding dentist, or make a written agreement for the maintenance of records. (1) A dentist who continues to maintain the dental records belonging to him or her shall maintain the dental records in accordance with the laws of the State of Texas and this chapter. (2) A dentist who enters into a written transfer of records agreement shall notify the State Board of Dental Examiners in writing within fifteen (15) days of a records transfer agreement. The notification shall include, at a minimum, the full names of the dentists involved in the agreement, include the locations involved in the agreement, and specifically identify what records are involved in the agreement. The agreement shall transfer ownership of the records. A transfer of records agreement may be made by agreement at any time in an employment or other working relationship between a dentist and another entity. Such transfer of records may apply to all or any part of the dental records generated in the course of the relationship, including future dental records. A dentist who assumes ownership of the records pursuant to this paragraph shall maintain the records in a manner consistent with this section and is responsible for complying with subsections (f) and (g) of this section. (3) A dentist who enters into a records maintenance agreement shall notify the State Board of Dental Examiners within fifteen (15) days of such event. The notification shall include the full names of the dentists involved in the agreement, the locations involved in the agreement, and shall identify what records are involved in the agreement. A maintenance agreement shall not transfer ownership of the dental records, but shall require that the dental records be maintained in accordance with the laws of the State of Texas and the Rules of the State Board of Dental Examiners. The agreement shall require that the dentist(s) performing the dental service(s) recorded in the records have access to and control of the records for purposes of copying and recording. The dentist transferring the records in a records maintenance agreement shall maintain a copy of the records involved in the records maintenance agreement. Such an agreement may be made by written agreement by the parties at any time in an employment or other working relationship between a dentist and another entity. A records maintenance agreement may apply to all or any part of the dental records generated in the course of the relationship, including future dental records. (f) Dental records shall be made available for inspection and reproduction on demand by the officers, agents, or employees of the State Board of Dental Examiners. The patient's privilege against disclosure does not apply to the Board in a disciplinary investigation or proceeding under the Dental Practice Act. Copies of dental records submitted to the Board on demand of the officers, agents, or employees of the Board shall be legible and all copies of dental x-rays shall be of diagnostic quality. Non-diagnostic quality copies of dental x-rays and illegible copies of patient records submitted to the Board shall not fulfill the requirements of this section. (g) A dentist shall furnish copies of dental records to a patient who requests his or her dental records. At the patient's option, the copies may be submitted to the patient directly or to another Texas dental licensee who will provide treatment to the patient. Requested copies, including radiographs, shall be furnished within 30 days of the date of the request. The copies may be withheld until copying costs have been paid. Records shall not be withheld based on a past due account for dental care or treatment previously rendered to the patient. Copies of dental records submitted in accordance with a request under this section shall be legible and all copies of dental x-rays shall be of diagnostic quality. Non-diagnostic quality copies of dental x-rays shall not fulfill the requirements of this section. (1) A dentist providing copies of patient dental records is entitled to a reasonable fee for copying which shall be no more than $25 for the first 20 pages and $0.15 per page for every copy thereafter. (2) Fees for radiographs, which if copied by an radiograph duplicating service, may be equal to actual cost verified by invoice. (3) Reasonable costs for radiographs duplicated by means other than by a radiograph duplicating service shall not exceed the following charges: (A) a full mouth radiograph series: $15.00; (B) a panoramic radiograph: $15.00; (C) a lateral cephalometric radiograph: $15.00; (D) a single extra-oral radiograph: $5.00; (E) a single intra-oral radiograph: $5.00. (4) State agencies and institutions will provide copies of dental health records to patients who request them following applicable agency rules and directives. Source Note: The provisions of this §108.8 adopted to be effective February 20, 2001, 26 TexReg 1494; amended to be effective December 30, 2001, 26 TexReg 10570; amended to be effective February 2, 2010, 35 TexReg 634; amended to be effective September 14, 2010, 35 TexReg 8344; amended to be effective June 10, 2012, 37 TexReg 4043; amended to be effective May 29, 2013, 38 TexReg 3346; amended to be effective June 11, 2014, 39 TexReg 4428; amended to be effective September 3, 2014, 39 TexReg 6855

A dentist is required to provide patient records to the State Board of Dental Examiners for inspection and reproduction upon demand.

(a) The term dental records includes, but is not limited to: identification of the practitioner providing treatment; medical and dental history; limited physical examination; oral pathology 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. (b) A Texas dental licensee practicing dentistry in Texas shall make, maintain, and keep adequate dental records for and upon each dental patient for reference, identification, and protection of the patient and the dentist. Records shall be kept for a period of not less than five years from the last date of treatment by the dentist. If a patient was younger than 18 years of age when last treated by the dentist, the records shall be maintained by the dentist until the patient reaches age 21 or for five years from the date of last treatment, whichever is longer. Dentists shall retain records for a longer period of time when mandated by other federal or state statute or regulation. Records must include documentation of the following: (1) Patients name; (2) Date of visit; (3) Reason for visit; (4) Vital signs, including but not limited to blood pressure and heart rate when applicable in accordance with §108.7 of this title. (5) If not recorded, an explanation why vital signs were not obtained. (c) Further, records must include documentation of the following when services are rendered: (1) Written review of medical history and limited physical evaluation; (2) Findings and charting of clinical and radiographic oral examination: (A) Documentation of radiographs taken and findings deduced from them, including radiograph films or digital reproductions. (B) Use of radiographs, at a minimum, should be in accordance with ADA guidelines. (C) Documentation of the findings of a tactile and visual examination of the soft and hard tissues of the oral cavity; (3) Diagnosis(es); (4) Treatment plan, recommendation, and options; (5) Treatment provided; (6) Medication and dosages given to patient; (7) Complications; (8) Written informed consent that meets the provisions of §108.7(7) of this title; (9) The dispensing, administering, or prescribing of all medications to or for a dental patient shall be made a part of such patient's dental record. The entry in the patient's dental record shall be in addition to any record keeping requirements of the DPS or DEA prescription programs; (10) All records pertaining to Controlled Substances and Dangerous Drugs shall be maintained in accordance with the Texas Controlled Substances Act; (11) Confirmable identification of provider dentist, and confirmable identification of person making record entries if different from provider dentist; (12) When any of the items in paragraphs (1) - (11) of this subsection are not indicated, the record must include an explanation why the item is not recorded. (d) Dental records are the sole property of the dentist who performs the dental service. However, ownership of original dental records may be transferred as provided in this section. Copies of dental records shall be made available to a dental patient in accordance with this section. (e) A dentist who leaves a location or practice, whether by retirement, sale, transfer, termination of employment or otherwise, shall maintain all dental records belonging to him or her, make a written transfer of records to the succeeding dentist, or make a written agreement for the maintenance of records. (1) A dentist who continues to maintain the dental records belonging to him or her shall maintain the dental records in accordance with the laws of the State of Texas and this chapter. (2) A dentist who enters into a written transfer of records agreement shall notify the State Board of Dental Examiners in writing within fifteen (15) days of a records transfer agreement. The notification shall include, at a minimum, the full names of the dentists involved in the agreement, include the locations involved in the agreement, and specifically identify what records are involved in the agreement. The agreement shall transfer ownership of the records. A transfer of records agreement may be made by agreement at any time in an employment or other working relationship between a dentist and another entity. Such transfer of records may apply to all or any part of the dental records generated in the course of the relationship, including future dental records. A dentist who assumes ownership of the records pursuant to this paragraph shall maintain the records in a manner consistent with this section and is responsible for complying with subsections (f) and (g) of this section. (3) A dentist who enters into a records maintenance agreement shall notify the State Board of Dental Examiners within fifteen (15) days of such event. The notification shall include the full names of the dentists involved in the agreement, the locations involved in the agreement, and shall identify what records are involved in the agreement. A maintenance agreement shall not transfer ownership of the dental records, but shall require that the dental records be maintained in accordance with the laws of the State of Texas and the Rules of the State Board of Dental Examiners. The agreement shall require that the dentist(s) performing the dental service(s) recorded in the records have access to and control of the records for purposes of copying and recording. The dentist transferring the records in a records maintenance agreement shall maintain a copy of the records involved in the records maintenance agreement. Such an agreement may be made by written agreement by the parties at any time in an employment or other working relationship between a dentist and another entity. A records maintenance agreement may apply to all or any part of the dental records generated in the course of the relationship, including future dental records. (f) Dental records shall be made available for inspection and reproduction on demand by the officers, agents, or employees of the State Board of Dental Examiners. The patient's privilege against disclosure does not apply to the Board in a disciplinary investigation or proceeding under the Dental Practice Act. Copies of dental records submitted to the Board on demand of the officers, agents, or employees of the Board shall be legible and all copies of dental x-rays shall be of diagnostic quality. Non-diagnostic quality copies of dental x-rays and illegible copies of patient records submitted to the Board shall not fulfill the requirements of this section. (g) A dentist shall furnish copies of dental records to a patient who requests his or her dental records. At the patient's option, the copies may be submitted to the patient directly or to another Texas dental licensee who will provide treatment to the patient. Requested copies, including radiographs, shall be furnished within 30 days of the date of the request. The copies may be withheld until copying costs have been paid. Records shall not be withheld based on a past due account for dental care or treatment previously rendered to the patient. Copies of dental records submitted in accordance with a request under this section shall be legible and all copies of dental x-rays shall be of diagnostic quality. Non-diagnostic quality copies of dental x-rays shall not fulfill the requirements of this section. (1) A dentist providing copies of patient dental records is entitled to a reasonable fee for copying which shall be no more than $25 for the first 20 pages and $0.15 per page for every copy thereafter. (2) Fees for radiographs, which if copied by an radiograph duplicating service, may be equal to actual cost verified by invoice. (3) Reasonable costs for radiographs duplicated by means other than by a radiograph duplicating service shall not exceed the following charges: (A) a full mouth radiograph series: $15.00; (B) a panoramic radiograph: $15.00; (C) a lateral cephalometric radiograph: $15.00; (D) a single extra-oral radiograph: $5.00; (E) a single intra-oral radiograph: $5.00. (4) State agencies and institutions will provide copies of dental health records to patients who request them following applicable agency rules and directives. Source Note: The provisions of this §108.8 adopted to be effective February 20, 2001, 26 TexReg 1494; amended to be effective December 30, 2001, 26 TexReg 10570; amended to be effective February 2, 2010, 35 TexReg 634; amended to be effective September 14, 2010, 35 TexReg 8344; amended to be effective June 10, 2012, 37 TexReg 4043; amended to be effective May 29, 2013, 38 TexReg 3346; amended to be effective June 11, 2014, 39 TexReg 4428; amended to be effective September 3, 2014, 39 TexReg 6855

Records of diagnosis and treatment performed are the patients property.

(a) The term dental records includes, but is not limited to: identification of the practitioner providing treatment; medical and dental history; limited physical examination; oral pathology 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. (b) A Texas dental licensee practicing dentistry in Texas shall make, maintain, and keep adequate dental records for and upon each dental patient for reference, identification, and protection of the patient and the dentist. Records shall be kept for a period of not less than five years from the last date of treatment by the dentist. If a patient was younger than 18 years of age when last treated by the dentist, the records shall be maintained by the dentist until the patient reaches age 21 or for five years from the date of last treatment, whichever is longer. Dentists shall retain records for a longer period of time when mandated by other federal or state statute or regulation. Records must include documentation of the following: (1) Patients name; (2) Date of visit; (3) Reason for visit; (4) Vital signs, including but not limited to blood pressure and heart rate when applicable in accordance with §108.7 of this title. (5) If not recorded, an explanation why vital signs were not obtained. (c) Further, records must include documentation of the following when services are rendered: (1) Written review of medical history and limited physical evaluation; (2) Findings and charting of clinical and radiographic oral examination: (A) Documentation of radiographs taken and findings deduced from them, including radiograph films or digital reproductions. (B) Use of radiographs, at a minimum, should be in accordance with ADA guidelines. (C) Documentation of the findings of a tactile and visual examination of the soft and hard tissues of the oral cavity; (3) Diagnosis(es); (4) Treatment plan, recommendation, and options; (5) Treatment provided; (6) Medication and dosages given to patient; (7) Complications; (8) Written informed consent that meets the provisions of §108.7(7) of this title; (9) The dispensing, administering, or prescribing of all medications to or for a dental patient shall be made a part of such patient's dental record. The entry in the patient's dental record shall be in addition to any record keeping requirements of the DPS or DEA prescription programs; (10) All records pertaining to Controlled Substances and Dangerous Drugs shall be maintained in accordance with the Texas Controlled Substances Act; (11) Confirmable identification of provider dentist, and confirmable identification of person making record entries if different from provider dentist; (12) When any of the items in paragraphs (1) - (11) of this subsection are not indicated, the record must include an explanation why the item is not recorded. (d) Dental records are the sole property of the dentist who performs the dental service. However, ownership of original dental records may be transferred as provided in this section. Copies of dental records shall be made available to a dental patient in accordance with this section. (e) A dentist who leaves a location or practice, whether by retirement, sale, transfer, termination of employment or otherwise, shall maintain all dental records belonging to him or her, make a written transfer of records to the succeeding dentist, or make a written agreement for the maintenance of records. (1) A dentist who continues to maintain the dental records belonging to him or her shall maintain the dental records in accordance with the laws of the State of Texas and this chapter. (2) A dentist who enters into a written transfer of records agreement shall notify the State Board of Dental Examiners in writing within fifteen (15) days of a records transfer agreement. The notification shall include, at a minimum, the full names of the dentists involved in the agreement, include the locations involved in the agreement, and specifically identify what records are involved in the agreement. The agreement shall transfer ownership of the records. A transfer of records agreement may be made by agreement at any time in an employment or other working relationship between a dentist and another entity. Such transfer of records may apply to all or any part of the dental records generated in the course of the relationship, including future dental records. A dentist who assumes ownership of the records pursuant to this paragraph shall maintain the records in a manner consistent with this section and is responsible for complying with subsections (f) and (g) of this section. (3) A dentist who enters into a records maintenance agreement shall notify the State Board of Dental Examiners within fifteen (15) days of such event. The notification shall include the full names of the dentists involved in the agreement, the locations involved in the agreement, and shall identify what records are involved in the agreement. A maintenance agreement shall not transfer ownership of the dental records, but shall require that the dental records be maintained in accordance with the laws of the State of Texas and the Rules of the State Board of Dental Examiners. The agreement shall require that the dentist(s) performing the dental service(s) recorded in the records have access to and control of the records for purposes of copying and recording. The dentist transferring the records in a records maintenance agreement shall maintain a copy of the records involved in the records maintenance agreement. Such an agreement may be made by written agreement by the parties at any time in an employment or other working relationship between a dentist and another entity. A records maintenance agreement may apply to all or any part of the dental records generated in the course of the relationship, including future dental records. (f) Dental records shall be made available for inspection and reproduction on demand by the officers, agents, or employees of the State Board of Dental Examiners. The patient's privilege against disclosure does not apply to the Board in a disciplinary investigation or proceeding under the Dental Practice Act. Copies of dental records submitted to the Board on demand of the officers, agents, or employees of the Board shall be legible and all copies of dental x-rays shall be of diagnostic quality. Non-diagnostic quality copies of dental x-rays and illegible copies of patient records submitted to the Board shall not fulfill the requirements of this section. (g) A dentist shall furnish copies of dental records to a patient who requests his or her dental records. At the patient's option, the copies may be submitted to the patient directly or to another Texas dental licensee who will provide treatment to the patient. Requested copies, including radiographs, shall be furnished within 30 days of the date of the request. The copies may be withheld until copying costs have been paid. Records shall not be withheld based on a past due account for dental care or treatment previously rendered to the patient. Copies of dental records submitted in accordance with a request under this section shall be legible and all copies of dental x-rays shall be of diagnostic quality. Non-diagnostic quality copies of dental x-rays shall not fulfill the requirements of this section. (1) A dentist providing copies of patient dental records is entitled to a reasonable fee for copying which shall be no more than $25 for the first 20 pages and $0.15 per page for every copy thereafter. (2) Fees for radiographs, which if copied by an radiograph duplicating service, may be equal to actual cost verified by invoice. (3) Reasonable costs for radiographs duplicated by means other than by a radiograph duplicating service shall not exceed the following charges: (A) a full mouth radiograph series: $15.00; (B) a panoramic radiograph: $15.00; (C) a lateral cephalometric radiograph: $15.00; (D) a single extra-oral radiograph: $5.00; (E) a single intra-oral radiograph: $5.00. (4) State agencies and institutions will provide copies of dental health records to patients who request them following applicable agency rules and directives. Source Note: The provisions of this §108.8 adopted to be effective February 20, 2001, 26 TexReg 1494; amended to be effective December 30, 2001, 26 TexReg 10570; amended to be effective February 2, 2010, 35 TexReg 634; amended to be effective September 14, 2010, 35 TexReg 8344; amended to be effective June 10, 2012, 37 TexReg 4043; amended to be effective May 29, 2013, 38 TexReg 3346; amended to be effective June 11, 2014, 39 TexReg 4428; amended to be effective September 3, 2014, 39 TexReg 6855

A licensed Texas dentist, who is also authorized to practice another profession such as medicine, may not use the other degree along with his/her dental degree.

(a) This rule prohibits conduct which violates §§102.001 - 102.011 and §259.008(8), of the Texas Occupations Code. A licensee shall not offer, give, dispense, distribute or make available to any third party or aid or abet another so to do, any cash, gift, premium, chance, reward, ticket, item, or thing of value for securing or soliciting patients. A licensee may offer, give, dispense, distribute or make available directly to a potential patient, a non-cash gift valued at no more than ten dollars to secure or solicit the potential patient. (b) This rule shall not be construed to prohibit a licensee from offering, giving, dispensing, distributing or making available to any patient of record any cash premium, chance, reward, ticket, item or thing of value for the continuation of that relationship as a patient of that licensee. The cash premium, chance, reward, ticket, item or thing of value cannot be for the purpose of soliciting new patients. (c) This rule shall not be construed to prohibit remuneration for advertising, marketing, or other services that are provided for the purpose of securing or soliciting patients, provided the remuneration is set in advance, is consistent with the fair market value of the services, and is not based on the volume or value of any patient referrals. Source Note: The provisions of this §108.58 adopted to be effective May 1, 2013, 37 TexReg 9637

A dentist may provide a prescription for a patient of another dentist if he/she is on call for that dentist, and the prescribing dentist determines the patient's name, basic medical history, when last seen, services rendered, and if prescriptions were written.

A licensed dentist shall conduct his practice on the highest plane of honesty, integrity, and fair dealing. In order to safeguard the dental health and welfare of the public and the dentist-patient relationship and fix professional responsibility for dental services, no dentist or any other licensee or certificate holder of the Board shall: (1) circumvent or attempt to circumvent any provision of the Texas Dental Practice Act or any rule, regulation, or order of the Board; (2) participate, directly or indirectly in any plan, scheme, or arrangement attempting or having as its purpose or result the evasion of any provision of the Texas Dental Practice Act or any rule, regulation, or order of the Board; (3) fail to exercise reasonable diligence to prevent partners, associates, and employees from engaging in conduct which would violate any provisions of the Texas Dental Practice Act or any rule, regulation, or order of the Board; (4) permit or allow himself, his practice of dentistry, his professional identification, or his services to be used or made use of, directly or indirectly, or in any manner whatsoever, so as to create or tend to create the opportunity for the unauthorized or unlawful practice of dentistry by any person, firm, or corporation or for the practice of dentistry in violation of any provision of the Texas Dental Practice Act or any rule, regulation, or order of the Board; (5) associate with or permit or allow the use of a dentist's name, professional identification, office, or practice in any business, commercial, or mercantile venture, project, or enterprise which the dentist or licensee knows or by the exercise of reasonable diligence should have known is engaged in acts, practices, or omissions which violate any provision of the Texas Dental Practice Act or any rule, regulation, or order of the Board; (6) divide, share, split, or allocate, either directly or indirectly, any fee for dental services, appliances, or materials with another dentist or with a physician, except upon a division of services or responsibility and with the prior knowledge and approval of the patient; provided, however, this section shall not be construed to prohibit partnerships for the practice of dentistry. (7) provide prescriptions for any medications to patients of other dentists, who are part of an after hours call agreement with the license holder, without first taking steps to determine that the individual is in fact a patient of the other dentist. Such steps shall include determination of patient's basic medical history, including name, when last seen by patient's doctor, service performed and prescriptions written, if any. Source Note: The provisions of this §108.1 adopted to be effective February 20, 2001, 26 TexReg 1494

An applicant for licensure to practice dentistry must be at least:

Sec. 256.002. MINIMUM QUALIFICATIONS OF DENTAL APPLICANT. (a) An applicant for a license to practice dentistry must: (1) be at least 21 years of age; and (2) present proof of: (A) graduation from a dental school accredited by the Commission on Dental Accreditation of the American Dental Association; or (B) graduation from a dental school that is not accredited by the commission and successful completion of training in an American Dental Association approved specialty in an education program accredited by the commission that consists of at least two years of training as specified by the Council on Dental Education. (b) The board shall grant a dental license to an applicant who: (1) meets the qualifications of this section; (2) pays an application fee set by the board; and (3) satisfactorily passes the examination required by the board. Acts 1999, 76th Leg., ch. 388, Sec. 1, eff. Sept. 1, 1999. Amended by Acts 2001, 77th Leg., ch. 1420, Sec. 14.079(a), eff. Sept. 1, 2001. Amended by: Acts 2017, 85th Leg., R.S., Ch. 295 (S.B. 313), Sec. 9, eff. September 1, 2017.

The minimum age to practice dental hygiene in the State of Texas is:

Sec. 256.053. ELIGIBILITY FOR LICENSE. (a) An applicant for a license to practice dental hygiene in this state must be: (1) at least 18 years of age; (2) a graduate of an accredited high school or hold a certificate of high school equivalency; and (3) a graduate of a recognized school of dentistry or dental hygiene accredited by the Commission on Dental Accreditation of the American Dental Association and approved by the board or an alternative dental hygiene training program. (b) A school of dentistry or dental hygiene described by Subsection (a)(3) must include at least two full academic years of instruction or its equivalent at the postsecondary level. Acts 1999, 76th Leg., ch. 388, Sec. 1, eff. Sept. 1, 1999. Amended by Acts 2001, 77th Leg., ch. 1420, Sec. 14.080(a), eff. Sept. 1, 2001; Acts 2001, 77th Leg., ch. 1470, Sec. 3.01, eff. Sept. 1, 2001. Amended by: Acts 2017, 85th Leg., R.S., Ch. 295 (S.B. 313), Sec. 10, eff. September 1, 2017.

Gaining licensure to practice dentistry or dental hygiene in the State of Texas may be obtained by:

Sec. 256.101. ISSUANCE OF LICENSE TO CERTAIN OUT-OF-STATE APPLICANTS. (a) The board shall issue a license to practice dentistry to a reputable dentist or a license to practice dental hygiene to a reputable dental hygienist who: (1) pays the fee set by the board; (2) is licensed in good standing as a dentist or dental hygienist in another state that has licensing requirements substantially equivalent to the requirements of this subtitle; (3) has not been the subject of a final disciplinary action and is not the subject of a pending disciplinary action in any jurisdiction in which the dentist or dental hygienist is or has been licensed; (4) has graduated from a dental or dental hygiene school accredited by the Commission on Dental Accreditation of the American Dental Association and approved by the board under board rule; (5) has passed a national or other examination relating to dentistry or dental hygiene and recognized by the board; (6) has passed the board's jurisprudence examination; (7) has submitted documentation of current cardiopulmonary resuscitation certification; (8) has practiced dentistry or dental hygiene: (A) for at least the three years preceding the date of application for a license under this section; or (B) as a dental educator at a dental school or dental hygiene school accredited by the Commission on Dental Accreditation of the American Dental Association for at least the five years preceding the date of application for a license under this section; (9) has been endorsed by the board of dentistry in the jurisdiction in which the applicant practices at the time of application; and (10) meets any additional criteria established by board rule. (a-1) The board by rule shall specify the circumstances under which the board may waive the requirement under Subsection (a)(8) that an applicant for a license under this section has been continuously engaged in the practice of dentistry or dental hygiene during the period required by that subsection if the applicant has engaged in the practice of dentistry or dental hygiene for a cumulative total of at least three years before the date of application for a license under this section. (b) If the board does not complete the processing of an application under this section before the 181st day after the date all documentation and examination results required by this section have been received, the board shall issue a license to the applicant. Acts 1999, 76th Leg., ch. 388, Sec. 1, eff. Sept. 1, 1999. Amended by Acts 2001, 77th Leg., ch. 1249, Sec. 4, 5, eff. Sept. 1, 2001; Acts 2003, 78th Leg., ch. 17, Sec. 13, eff. Sept. 1, 2003.

If an individual's license or certificate has expired for one year or longer, the person may not renew it.

Sec. 257.002. LICENSE RENEWAL. (a) A person required to hold a license as a practitioner under this subtitle who fails or refuses to apply for renewal of a license and pay the required fee on or before the specified date is: (1) suspended from practice; and (2) subject to the penalties imposed by law on any person unlawfully engaging in a practice regulated under this subtitle. (b) A person who is otherwise eligible to renew a license may renew an unexpired license by paying the required renewal fee to the board before the expiration date of the license. A person whose license has expired may not engage in activities that require a license until the license has been renewed. (c) A person whose license has been expired for 90 days or less may renew the license by paying to the board a renewal fee that is equal to 1-1/2 times the normally required renewal fee. (c-1) A person whose license has been expired for more than 90 days but less than one year may renew the license by paying to the board a renewal fee that is equal to two times the normally required renewal fee. (d) Except as provided by Subsection (d-1) or (d-2), a person whose license has been expired for one year or more may not renew the license. The person may obtain a new license by complying with the requirements and procedures, including the examination requirements, for obtaining an original license. (d-1) A person who was licensed in this state, moved to another state, and is currently licensed and has been in practice in the other state for the two years preceding the date of application may obtain a new license without reexamination. The person must pay to the board a fee that is equal to two times the normally required renewal fee for the license. (d-2) The board may renew the license of a person whose license has been expired for one year or more without requiring the person to comply with the requirements and procedures for an original license if the person places the person's renewed license on retired status and confines the person's practice solely to voluntary charity care under Section 256.102(f). (e) Not later than the 30th day before the date a person's license is scheduled to expire, the board shall send written notice of the impending expiration to the person at the person's last known address according to the board's records. (f) The requirements prescribed by this section relating to the payment of license fees and penalties for the failure to timely renew a license do not apply to license holders who are on active duty with the armed forces of the United States and are not engaged in private or civilian practice. Acts 1999, 76th Leg., ch. 388, Sec. 1, eff. Sept. 1, 1999. Amended by Acts 2001, 77th Leg., ch. 1420, Sec. 14.084(a), eff. Sept. 1, 2001; Acts 2003, 78th Leg., ch. 17, Sec. 15, eff. Sept. 1, 2003. Amended by: Acts 2007, 80th Leg., R.S., Ch. 456 (H.B. 643), Sec. 1, eff. September 1, 2007. Acts 2017, 85th Leg., R.S., Ch. 295 (S.B. 313), Sec. 14, eff. September 1, 2017.

A dentist may delegate to a dental assistant the taking of an impression for a final restoration.

Sec. 258.001. IMPERMISSIBLE DELEGATIONS. A dentist may not delegate: (1) an act to an individual who, by board order, is prohibited from performing the act; (2) any of the following acts to a person not licensed as a dentist or dental hygienist: (A) the removal of calculus, deposits, or accretions from the natural and restored surfaces of exposed human teeth and restorations in the human mouth; (B) root planing or the smoothing and polishing of roughened root surfaces or exposed human teeth; or (C) any other act the delegation of which is prohibited by board rule; (3) any of the following acts to a person not licensed as a dentist: (A) comprehensive examination or diagnosis and treatment planning; (B) a surgical or cutting procedure on hard or soft tissue; (C) the prescription of a drug, medication, or work authorization; (D) the taking of an impression for a final restoration, appliance, or prosthesis; (E) the making of an intraoral occlusal adjustment; (F) direct pulp capping, pulpotomy, or any other endodontic procedure; (G) the final placement and intraoral adjustment of a fixed or removable appliance; or (H) the placement of any final restoration; or (4) the authority to an individual to administer a local anesthetic agent, inhalation sedative agent, parenteral sedative agent, or general anesthetic agent if the individual is not licensed as: (A) a dentist with a permit issued by the board for the procedure being performed, if a permit is required; (B) a certified registered nurse anesthetist licensed by the Texas Board of Nursing, only if the delegating dentist holds a permit issued by the board for the procedure being performed, if a permit is required; or (C) a physician anesthesiologist licensed by the Texas Medical Board. Acts 1999, 76th Leg., ch. 388, Sec. 1, eff. Sept. 1, 1999. Amended by: Acts 2007, 80th Leg., R.S., Ch. 889 (H.B. 2426), Sec. 37, eff. September 1, 2007.

An out-of-state dentist not holding a Texas license may advertise dental services in Texas.

Sec. 259.007. UNLAWFUL ADVERTISING: OUT-OF-STATE PROVIDER. A person who is not domiciled and located in this state and subject to the laws of this state may not advertise or cause or permit to be advertised, published, directly or indirectly, printed, or circulated in this state a notice, statement, or offer of any service, drug, or fee relating to the practice of dentistry, unless the advertising conspicuously discloses that the person is not licensed to practice dentistry in this state. Acts 1999, 76th Leg., ch. 388, Sec. 1, eff. Sept. 1, 1999.

A dentist may legally delegate to a qualified and properly trained dental assistant the following procedures:

Sec. 258.001. IMPERMISSIBLE DELEGATIONS. A dentist may not delegate: (1) an act to an individual who, by board order, is prohibited from performing the act; (2) any of the following acts to a person not licensed as a dentist or dental hygienist: (A) the removal of calculus, deposits, or accretions from the natural and restored surfaces of exposed human teeth and restorations in the human mouth; (B) root planing or the smoothing and polishing of roughened root surfaces or exposed human teeth; or (C) any other act the delegation of which is prohibited by board rule; (3) any of the following acts to a person not licensed as a dentist: (A) comprehensive examination or diagnosis and treatment planning; (B) a surgical or cutting procedure on hard or soft tissue; (C) the prescription of a drug, medication, or work authorization; (D) the taking of an impression for a final restoration, appliance, or prosthesis; (E) the making of an intraoral occlusal adjustment; (F) direct pulp capping, pulpotomy, or any other endodontic procedure; (G) the final placement and intraoral adjustment of a fixed or removable appliance; or (H) the placement of any final restoration; or (4) the authority to an individual to administer a local anesthetic agent, inhalation sedative agent, parenteral sedative agent, or general anesthetic agent if the individual is not licensed as: (A) a dentist with a permit issued by the board for the procedure being performed, if a permit is required; (B) a certified registered nurse anesthetist licensed by the Texas Board of Nursing, only if the delegating dentist holds a permit issued by the board for the procedure being performed, if a permit is required; or (C) a physician anesthesiologist licensed by the Texas Medical Board. Acts 1999, 76th Leg., ch. 388, Sec. 1, eff. Sept. 1, 1999. Amended by: Acts 2007, 80th Leg., R.S., Ch. 889 (H.B. 2426), Sec. 37, eff. September 1, 2007.

Written consent for release of privileged information must be signed by:

Sec. 258.104. CONSENT TO DISCLOSURE OF PRIVILEGED INFORMATION. (a) A person may disclose privileged information if the patient consents to the disclosure as provided in this section. (b) Consent for the release of privileged information must be in writing and be signed by: (1) the patient; (2) a parent or legal guardian of the patient, if the patient is a minor; (3) a legal guardian of the patient, if the patient has been adjudicated incompetent to manage the patient's personal affairs; (4) an attorney ad litem appointed for the patient, as authorized by: (A) Chapter 107, Family Code; (B) Subtitle B, Title 6, Health and Safety Code; (C) Subtitle C, Title 7, Health and Safety Code; (D) Subtitle D, Title 7, Health and Safety Code; (E) Subtitle E, Title 7, Health and Safety Code; (F) Chapter 1054, Estates Code; or (G) any other law; or (5) a personal representative of the patient, if the patient is deceased. (c) The consent required under this section must specify: (1) the information covered by the release; (2) the person to whom the information is to be released; and (3) the purpose for the release. (d) A person may withdraw consent granted under this section by notifying in writing the person who maintains the information. Withdrawal of consent does not affect information disclosed before the written notice of the withdrawal is delivered. Added by Acts 2001, 77th Leg., ch. 1420, Sec. 14.086(b), eff. Sept. 1, 2001. Amended by: Acts 2019, 86th Leg., R.S., Ch. 846 (H.B. 2780), Sec. 11, eff. September 1, 2019.

A dentist may use a corporation, company, association or trade name, provided that:

Sec. 259.003. USE OF TRADE NAME. (a) A person may use a corporation, company, association, or trade name, provided that each patient shall be given the name of the treating dentist, in writing, either before or after each office visit. (b) An advertisement under a corporation, company, association, or trade name must include prominently the name of at least one dentist practicing under the name. (c) A person using a business or trade name described by Subsection (b) shall file with the board a list of each dentist who practices under that name and a list of each trade name used if that name is different from the name described by Subsection (b). (d) If information provided under Subsection (c) changes, the person must file updated information with the board not later than the 30th day after the date of the change. Acts 1999, 76th Leg., ch. 388, Sec. 1, eff. Sept. 1, 1999. Amended by Acts 2001, 77th Leg., ch. 1420, Sec. 14.087(a), eff. Sept. 1, 2001.

The maximum number of offices a Texas-licensed dentist may legally maintain is:

Sec. 259.004. DUTIES OF DENTIST IN CERTAIN EMPLOYMENT OR CONTRACTUAL ARRANGEMENTS. (a) A person providing dental services under an agreement that allows another person to control or influence any aspect of the delivery of dental services, including a business or professional aspect, shall report to the board on request and in accordance with board rules: (1) information concerning the agreement; (2) the manner in which patients are billed; (3) the manner in which the dental service provider is paid and any information provided to patients concerning payment agreements; and (4) information concerning the service provider agreement provided to shareholders of organizations contracting with a dental service provider. (b) A person who practices dentistry and has another dentist practicing with or under the person is responsible for all professional acts performed under the name of the person, regardless of whether the dentist has an ownership interest or an employment or contractual relationship. This section does not affect an individual license holder's responsibilities and rights under this subtitle. (c) A statute relating to the practice of dentistry in this state may not be construed to prohibit a licensed dentist from maintaining more than one office in this state if the dentist: (1) assumes full legal responsibility and liability for the dental services provided in each office; and (2) complies with the requirements prescribed by board rules. Acts 1999, 76th Leg., ch. 388, Sec. 1, eff. Sept. 1, 1999.

A dentist cannot advertise a discount without disclosing the total fee to which the discount will apply.

Sec. 259.005. AUTHORIZED ADVERTISING RESTRICTIONS. Board rules adopted under Section 254.002 to regulate advertising may include restrictions that prohibit communications to the public that: (1) are false, misleading, or deceptive; (2) state an opinion regarding the quality of dental services; (3) appeal to an individual's anxiety in an excessive or unfair way; (4) intimidate or exert undue pressure or undue influence over a prospective patient; (5) create unjustified expectations concerning the potential result of a dental treatment; (6) refer to benefits or other attributes of dental procedures or products that involve significant risks without including realistic assessments of the safety and efficacy of those procedures or products; (7) contain statistical data, representations, or other information that is not susceptible to reasonable verification by the public; (8) refer to a fee for dental services without disclosing that additional fees may be involved in individual cases, if the possibility of additional fees may be reasonably predicted; (9) offer a discount for dental services without disclosing the total fee to which the discount will apply; or (10) fail to make truthful disclosure of the source and authorship of any message published under a dentist's byline. Acts 1999, 76th Leg., ch. 388, Sec. 1, eff. Sept. 1, 1999.

The State Board of Dental Examiners has the authority to enforce the laws and develop and enforce rules and regulations governing dentistry and dental hygiene although, for the Board to adopt a rule relating to the practice of dental hygiene, the Board must:

Sec. 262.102. RULEMAKING AUTHORITY OF BOARD. (a) The board shall adopt and enforce rules that are necessary and advisable to carry out the purposes of and to enforce this chapter, including rules relating to professional conduct for dental hygienists. (b) As necessary to protect public health and safety, the board may adopt and enforce a rule to establish the number of dental hygienists a dentist may employ. (c) Repealed by Acts 2017, 85th Leg., R.S., Ch. 295 (S.B. 313), Sec. 48(4), eff. September 1, 2017. Acts 1999, 76th Leg., ch. 388, Sec. 1, eff. Sept. 1, 1999. Amended by: Acts 2017, 85th Leg., R.S., Ch. 295 (S.B. 313), Sec. 48(4), eff. September 1, 2017.

A dental hygienist may chart existing decay in a mouth and confirm to the patient that there indeed is decay and needs treatment.

Sec. 262.151. DELEGATION OF DUTIES BY DENTIST. (a) A licensed dentist may delegate orally or in writing a service, task, or procedure to a dental hygienist who is under the supervision and responsibility of the dentist, if: (1) the dental hygienist is licensed to perform the service, task, or procedure; (2) the supervising dentist examines the patient: (A) at the time the service, task, or procedure is performed by the dental hygienist; or (B) during the 12 calendar months preceding the date of performance of the service, task, or procedure by the dental hygienist; and (3) the dental hygienist does not: (A) diagnose a dental disease or ailment; (B) prescribe a treatment or a regimen; (C) prescribe, order, or dispense medication; or (D) perform any procedure that is irreversible or involves the intentional cutting of soft or hard tissue by any means. (b) A licensed dentist may delegate to a dental hygienist any act that a dentist may delegate to a dental assistant. (c) A dentist is not required to be on the premises when the dental hygienist performs a delegated act. (d) This chapter does not prevent a dentist from authorizing a dental hygienist employed by the dentist to: (1) instruct and educate a patient in proper oral hygiene; or (2) provide to a patient a medication ordered by the dentist. (e) This chapter does not prevent a dental hygienist from incidentally removing cementum during root planing. Acts 1999, 76th Leg., ch. 388, Sec. 1, eff. Sept. 1, 1999.

A dentist must be on the premises for a dental hygienist to perform a delegated act.

Sec. 262.151. DELEGATION OF DUTIES BY DENTIST. (a) A licensed dentist may delegate orally or in writing a service, task, or procedure to a dental hygienist who is under the supervision and responsibility of the dentist, if: (1) the dental hygienist is licensed to perform the service, task, or procedure; (2) the supervising dentist examines the patient: (A) at the time the service, task, or procedure is performed by the dental hygienist; or (B) during the 12 calendar months preceding the date of performance of the service, task, or procedure by the dental hygienist; and (3) the dental hygienist does not: (A) diagnose a dental disease or ailment; (B) prescribe a treatment or a regimen; (C) prescribe, order, or dispense medication; or (D) perform any procedure that is irreversible or involves the intentional cutting of soft or hard tissue by any means. (b) A licensed dentist may delegate to a dental hygienist any act that a dentist may delegate to a dental assistant. (c) A dentist is not required to be on the premises when the dental hygienist performs a delegated act. (d) This chapter does not prevent a dentist from authorizing a dental hygienist employed by the dentist to: (1) instruct and educate a patient in proper oral hygiene; or (2) provide to a patient a medication ordered by the dentist. (e) This chapter does not prevent a dental hygienist from incidentally removing cementum during root planing. Acts 1999, 76th Leg., ch. 388, Sec. 1, eff. Sept. 1, 1999.

A dentist who is not licensed in Texas may hire a Texas-licensed dental hygienist to take x-rays and clean teeth.

Sec. 262.151. DELEGATION OF DUTIES BY DENTIST. (a) A licensed dentist may delegate orally or in writing a service, task, or procedure to a dental hygienist who is under the supervision and responsibility of the dentist, if: (1) the dental hygienist is licensed to perform the service, task, or procedure; (2) the supervising dentist examines the patient: (A) at the time the service, task, or procedure is performed by the dental hygienist; or (B) during the 12 calendar months preceding the date of performance of the service, task, or procedure by the dental hygienist; and (3) the dental hygienist does not: (A) diagnose a dental disease or ailment; (B) prescribe a treatment or a regimen; (C) prescribe, order, or dispense medication; or (D) perform any procedure that is irreversible or involves the intentional cutting of soft or hard tissue by any means. (b) A licensed dentist may delegate to a dental hygienist any act that a dentist may delegate to a dental assistant. (c) A dentist is not required to be on the premises when the dental hygienist performs a delegated act. (d) This chapter does not prevent a dentist from authorizing a dental hygienist employed by the dentist to: (1) instruct and educate a patient in proper oral hygiene; or (2) provide to a patient a medication ordered by the dentist. (e) This chapter does not prevent a dental hygienist from incidentally removing cementum during root planing. Acts 1999, 76th Leg., ch. 388, Sec. 1, eff. Sept. 1, 1999.

The decision to suspend, probate a suspension of, or reprimand a license as punishment is made by:

Sec. 263.002. GROUNDS FOR DISCIPLINARY ACTION IN GENERAL. (a) The board, after notice and hearing, may reprimand a person who holds a license issued under this subtitle, issue a warning letter to a person licensed under this subtitle, impose a fine on a person licensed under this subtitle, impose an administrative penalty under Subchapter A, Chapter 264, on a person who holds a license under this subtitle, place on probation with conditions a person whose license has been suspended, or revoke or suspend a person's license issued under this subtitle if the person: (1) is adjudged under the law to be insane; (2) is convicted of a misdemeanor involving fraud or a felony under federal law or the law of any state; (3) practices dentistry or dental hygiene in a manner that constitutes dishonorable conduct; (4) fails to treat a patient according to the standard of care in the practice of dentistry or dental hygiene; (5) engages in deception or misrepresentation in soliciting or obtaining patronage; (6) obtains a license by fraud or misrepresentation; (7) is addicted to or habitually intemperate in the use of alcoholic beverages or drugs or has improperly obtained, possessed, used, or distributed habit-forming drugs or narcotics; (8) holds a dental license and employs, permits, or has employed or permitted a person not licensed to practice dentistry to practice dentistry in an office of the dentist that is under the dentist's control or management; (9) fails to use proper diligence in the person's practice or fails to safeguard the person's patients against avoidable infections; (10) violates or refuses to comply with a law relating to the regulation of dentists or dental hygienists; (11) is physically or mentally incapable of practicing in a manner that is safe for the person's dental patients; (12) is negligent in performing dental services and that negligence causes injury or damage to a dental patient; (13) holds a license or certificate to practice dentistry or dental hygiene in another state and that state, based on an act by the person that is the same as an act described in this section: (A) reprimands the person; (B) suspends or revokes the person's license or certificate or places the person on probation; or (C) imposes another restriction on the person's practice; or (14) knowingly provides or agrees to provide dental care in a manner that violates a federal or state law that: (A) regulates a plan to provide, arrange for, pay for, or reimburse any part of the cost of dental care services; or (B) regulates the business of insurance. (b) If a person holds a license to practice dentistry or dental hygiene, the board may reprimand or impose a fine on the person, issue a warning letter to the person, place the person's license on probation, or suspend or revoke the person's license under Subsection (a)(10) only if a majority of the board determines that the person has committed an act described by Subsection (a)(10). Acts 1999, 76th Leg., ch. 388, Sec. 1, eff. Sept. 1, 1999. Amended by Acts 2001, 77th Leg., ch. 1420, Sec. 14.092(b), eff. Sept. 1, 2001.

The State Board of Dental Examiners may not suspend a license for any reason without a due process hearing.

Sec. 263.004. TEMPORARY SUSPENSION IN EMERGENCY. (a) If the board or an executive committee of the board determines from the evidence or information presented that the continued practice by a person licensed under this subtitle, or the continued performance by a person licensed under this subtitle of a procedure for which the person holds a permit issued by the board, would constitute a clear, imminent, or continuing threat to a person's physical health or well-being, the board or the executive committee shall temporarily suspend the person's license or permit, as applicable. (b) The board may not temporarily suspend a license or permit under this section without notice or hearing unless at the time of the temporary suspension the board or the executive committee requests the State Office of Administrative Hearings to set a date for a hearing on the temporary suspension. (c) The State Office of Administrative Hearings shall hold a hearing not later than the 30th day after the date the license or permit is suspended unless the license or permit holder requests a continuance. The State Office of Administrative Hearings shall hold a second hearing on the suspension and on any other action to be taken against the license or permit holder not later than the 60th day after: (1) the date the license or permit is temporarily suspended; or (2) the date specified in the continuance requested by the license or permit holder. (d) If the State Office of Administrative Hearings does not hold a hearing within the time provided by Subsection (c), the suspended license or permit is automatically reinstated. Acts 1999, 76th Leg., ch. 388, Sec. 1, eff. Sept. 1, 1999. Amended by Acts 2001, 77th Leg., ch. 1249, Sec. 9, eff. Sept. 1, 2001. Amended by: Acts 2005, 79th Leg., Ch. 810 (S.B. 610), Sec. 6, eff. September 1, 2005.

The Dental Practice Act limits the amount of an administrative penalty the Board may assess against a license holder.

Sec. 264.002. AMOUNT OF PENALTY. (a) The amount of the administrative penalty may not exceed $5,000 for each violation. Each day a violation continues or occurs is a separate violation for purposes of imposing a penalty. (b) The executive director or a board subcommittee, of which, at least one member is a public member of the board, shall determine the amount of the penalty based on a standardized penalty schedule. The board by rule shall develop the schedule based on: (1) the seriousness of the violation, including: (A) the nature, circumstances, extent, and gravity of the violation; and (B) the hazard or potential hazard created to the health, safety, or welfare of the public; (2) the economic damage to property or the environment caused by the violation; (3) the history of previous violations; (4) the amount necessary to deter a future violation; (5) efforts made to correct the violation; and (6) any other matter that justice may require. Acts 1999, 76th Leg., ch. 388, Sec. 1, eff. Sept. 1, 1999.

Practicing dentistry in the State of Texas without a license is:

Sec. 264.151. CRIMINAL PENALTIES. (a) A person commits an offense if the person violates Section 256.001. An offense under this subsection is a felony of the third degree. Each day of a violation is a separate offense. (b) A person commits an offense if the person violates Section 256.052. An offense under this subsection is a Class A misdemeanor. If it is shown at the trial of an offense under this subsection that the defendant has previously been convicted of an offense for a violation of Section 256.052, the offense is a felony of the third degree. (c) A person commits an offense if the person violates Subchapter D, Chapter 262. An offense under this subsection is a Class A misdemeanor. Each day of a violation is a separate offense. (d) A person commits an offense if the person is a dentist or dental hygienist and violates an injunction or cease and desist order issued under Subchapter B. An offense under this subsection is a Class A misdemeanor. If it is shown at the trial of an offense under this subsection that the defendant was previously convicted of an offense for a violation of an injunction or cease and desist order issued under Subchapter B, the offense is a felony of the third degree. Each day of a violation is a separate offense. Acts 1999, 76th Leg., ch. 388, Sec. 1, eff. Sept. 1, 1999. Amended by: Acts 2009, 81st Leg., R.S., Ch. 772 (S.B. 887), Sec. 7, eff. September 1, 2009.

Dental laboratories located on premises of a dental office may conduct commercial business without a registration if the lab does not employ more than two technicians.

Sec. 266.153. APPLICATION FOR REGISTRATION; TERM. (a) An owner or manager of a dental laboratory shall: (1) apply to the board for the registration of each dental laboratory doing business in this state to which the owner or manager is connected or in which the owner or manager has an interest; and (2) pay the application fee set by the board. (b) The application must include: (1) evidence satisfactory to the board that the dental laboratory meets the requirements prescribed by Section 266.152(a), if applicable; and (2) any other information required by the board. (c) The board may issue a certificate of registration only to a dental laboratory that complies with the requirements of this section. (d) A dental laboratory registration issued under this chapter is valid for a term of one or two years, as determined by board rule. Acts 1999, 76th Leg., ch. 388, Sec. 1, eff. Sept. 1, 1999. Amended by Acts 2003, 78th Leg., ch. 1240, Sec. 4, eff. Sept. 1, 2003. Amended by: Acts 2017, 85th Leg., R.S., Ch. 295 (S.B. 313), Sec. 45, eff. September 1, 2017. Acts 2017, 85th Leg., R.S., Ch. 295 (S.B. 313), Sec. 46, eff. September 1, 2017.

Dental laboratory registrations are renewed every five years.

Sec. 266.154. REGISTRATION RENEWAL. (a) An applicant for renewal of a dental laboratory registration must provide evidence satisfactory to the board that at least one employee who works on the dental laboratory's premises: (1) has completed the minimum number of hours of continuing education during the previous registration period as required by board rule; or (2) is certified as required by Section 266.152(a), if applicable. (b) An owner or manager of a dental laboratory may renew an unexpired registration certificate for a dental laboratory if the owner or manager: (1) pays the required renewal fee to the board on or before the expiration date; and (2) complies with any other renewal requirements. (c) If the owner or manager of a dental laboratory fails to renew the dental laboratory's registration and pay the renewal fee before the date the registration expires, the board shall suspend the registration certificate of the laboratory. (d) An owner or manager of a dental laboratory whose registration certificate has been expired for 90 days or less may renew the registration certificate if the person pays to the board the required renewal fee and a fee equal to one-half of the amount of the renewal fee. If the registration certificate has been expired for more than 90 days but less than one year, the owner or manager may renew the certificate by paying to the board all unpaid renewal fees and a fee equal to the amount of the initial registration fee. (e) An owner or manager of a dental laboratory may not renew a registration certificate that has been expired for one year or more. The owner or manager may obtain a new certificate by complying with the requirements for obtaining an original certificate. Acts 1999, 76th Leg., ch. 388, Sec. 1, eff. Sept. 1, 1999. Amended by Acts 2001, 77th Leg., ch. 1420, Sec. 14.094(b), eff. Sept. 1, 2001. Amended by: Acts 2017, 85th Leg., R.S., Ch. 295 (S.B. 313), Sec. 47, eff. September 1, 2017.

A dentist shall maintain two sets of dental laboratory prescriptions: one set on premises of the dental office and one set at another location.

Sec. 266.201. PRESCRIPTION REQUIRED. (a) A dentist who orders a dental laboratory service shall prepare and deliver to the dental laboratory a prescription or work order for the service to be performed. (b) The prescription or work order must contain: (1) the signature and Texas dental license number of the dentist; (2) the date the prescription or work order is signed; (3) the patient's name; and (4) a description of the dental laboratory service ordered. (c) A dentist shall keep a copy of each prescription or work order at the dentist's office in a separate file for two years for inspection by the board's officers, agents, or employees. (d) A dentist shall label as provided by board rule a removable dental prosthesis fabricated in this state by the dentist or by a person under a prescription or work order prepared by the dentist. Acts 1999, 76th Leg., ch. 388, Sec. 1, eff. Sept. 1, 1999. Amended by Acts 2003, 78th Leg., ch. 1240, Sec. 5, eff. Sept. 1, 2003.

An individual who operates a commercial dental laboratory and is not registered with the State Board of Dental Examiners is guilty of a felony.

Sec. 266.303. CRIMINAL PENALTIES. (a) A person commits an offense if the person: (1) is a dentist and provides a dental laboratory service without being exempt under Section 266.002(2); or (2) violates Section 266.151 or 266.301. (b) An offense for a violation of Section 266.151 or Section 266.301(b) is a felony of the third degree. (c) An offense for a violation of Section 266.301(c) is a Class C misdemeanor. If it is shown on the trial of an offense under this section that the defendant has previously been convicted for an offense for a violation of Section 266.301(c), the offense is a Class A misdemeanor. (d) An offense for a violation of Section 266.301(d) is a Class B misdemeanor. If it is shown on the trial of an offense under this section that the defendant has previously been convicted of an offense for a violation of Section 266.301(d), the offense is a Class A misdemeanor. (e) Each day of a violation is a separate offense. Acts 1999, 76th Leg., ch. 388, Sec. 1, eff. Sept. 1, 1999. Amended by: Acts 2009, 81st Leg., R.S., Ch. 772 (S.B. 887), Sec. 11, eff. September 1, 2009.

A dentist may delegate to a qualified Texas-licensed dental hygienist authorization to perform dental hygiene services in nursing homes or school based health centers.

a) A dentist may delegate to a Texas licensed dental hygienist authorization to perform a service, task or procedure for patients whom the dentist has not seen within the past twelve months when conditions are met as follows: (1) The dentist provides express authorization in writing which must include: (A) the dentist's name; (B) the dental hygienist's name; (C) the patient's name; (D) the name and address of the location where service is to be provided; (E) the date of the authorization; and (F) those procedures the dentist specifically authorizes the hygienist to perform, including those procedures necessary to allow subsequent clinical evaluation by a dentist; (2) The dentist has verified that the dental hygienist has at least two years experience as a dental hygienist; and (3) The service, task or procedure must be performed in either: (A) a nursing facility as defined in the Health and Safety Code, §242.301; (B) a school-based health center established under Chapter 38, Subchapter B, Texas Education Code; or (C) a community health center as defined by §136.002, Human Resources Code. (b) The dental hygienist must refer patients treated under the provisions of this rule to a dentist by notification in writing of the dentist's name and address. Such notification must be provided to the patient or a person legally responsible for the patient, the authorizing dentist, the referral dentist, and copies to the patient's medical record. This notification must include a statement of services, tasks, and procedures performed. (c) A dental hygienist, after having performed the services, tasks or procedures under this rule, may only perform delegated services, tasks or procedures with respect to the patient for six months unless the patient has been seen by either the dentist who delegated to the hygienist the authority or by a dentist to whom the patient was referred. (d) The facility defined in subsection (a) of this section must agree to include information provided pursuant to subsection (b) of this section in the patient's medical records. Source Note: The provisions of this §115.5 adopted to be effective December 30, 2001, 26 TexReg 10573; amended to be effective February 2, 2010, 35 TexReg 641