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  The Gatekeeper

The Voice of the General Dentist   

November 2013
In this issue...
Required TSBDE Survey
Sleep Medicine Rule Postponed
Stabilization of Pediatric Patients
Complaint Process Overhauled
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TSBDE Survey Responses Required 


A survey gathering data about dental practices to comply with requirements in HB 3201 passed earlier this year by the Legislature has been posted on the Texas State Board of Dental Examiners web site at  


Technically, the deadline for responses is at the time of the individual's license renewal. However, TSBDE is encouraging dentists to answer the survey as soon as possible. 


In addition to being posted on the web site, an announcement will be included with all online renewals and an email campaign will be sent to all dentists.  There will be a penalty (either a citation or board order for an administrative penalty) for non-compliance if a dentist does not answer the survey by the time of renewal.  


Sleep Medicine Rule Postponed 


At the recent state board meeting, the TSBDE received testimony on the proposed sleep medicine rule until the Board's next meeting, which is scheduled for February 28.  


At that time, the Board indicated that the discussion will focus on the version of the rule that was published in the September 13 edition of the Texas Register.  


TAGD has a task force chaired by Dr. Marc Worob of Austin that has been studying this issue and submitted comments in support of the rule, as published. Clinicians for Healthy Sleep also testified in support of the proposed rule.  However, several physicians presented public comments in opposition to the proposed rule, raising concerns that any treatment of sleep disorders, whether snoring, OSA or UARS is the practice of medicine and should be done only after the patient has been evaluated by a physician.  

Here's the text of the proposed rule as it currently stands:  

�108.12.Dental Treatment of Sleep Disorders.

(a) A dentist may diagnose, treat, operate, or prescribe for a disease, pain, injury, deficiency, deformity, or physical condition of the human teeth, oral cavity, alveolar process, gums and jaws, and provide surgical and adjunctive treatment for directly related and adjacent masticatory structures.

(b) A dentist may diagnose and treat any dental comorbidity related to snoring or upper airway resistance syndrome (UARS). A dentist shall not diagnose a patient for obstructive sleep apnea (OSA) or independently treat an OSA patient without collaboration with a Texas licensed physician.

(c) A dentist may screen a dental patient for a sleep disorder by using subjective and objective screening tools. A dentist may order a sleep study, which must be interpreted by a Texas licensed physician.

(d) A dentist may fabricate an oral appliance for treatment of a dental comorbidity related to snoring or UARS without the need for collaboration with a Texas licensed physician. A dentist may fabricate an oral appliance for treatment of OSA only in collaboration with a Texas licensed physician. A dentist shall be responsible for monitoring and maintaining the oral appliance to ensure the patient's dental health, while the physician should be responsible for monitoring the patient's medical condition.

(e) A dentist treating a sleep disorder patient shall comply with the Dental Practice Act and Board rules, including but not limited to provisions related to fair dealing, standard of care, records, and business promotion.

(f) A dentist shall maintain records as required by the Dental Practice Act and Board rules including but not limited to records related to treatment planning, recommendations and options, informed consent, consultations and recommended referrals, and post treatment recommendations.

Stabilization of Pediatric Patients


At the Board meeting, member Dr. Tammy Gough indicated that she is leading an effort to develop a TSBDE rule addressing stabilization of pediatric dental patients.  


While guidelines developed by the American Academy of Pediatric Dentists (AAPD) have typically been considered the standard of care, it was felt that it was necessary to develop a TSBDE rule because the Board has received complaints on this topic.  In addition the AAPD guidelines were updated earlier this year.  


A copy of the new AAPD guidelines can be accessed here.


Dr. Gough stated her intent to bring a proposed rule for initial consideration by the Board at their meeting in February 2014.  According to comments at the Board meeting, Colorado is the only state that currently requires special training for behavior management and pediatric stabilization.

Complaint Process Overhaul Approved  


At the meeting, the Board approved new rules implementing the use of expert review panels to  review complaints, rather than relying on Board members. This process was modeled on a process used by the Texas Board of Medical Examiners.


HB 3201, which was passed by the Legislature this year, overhauled the way TSBDE will review complaints. 


Effective January 1, if after a preliminary inquiry of a complaint related to professional competency TSBDE staff finds that there is sufficient cause to justify further investigation, the complaint will be referred to an expert panel.  If the panel determines that a violation of the Dental Practice Act occurred, the TSBDE Board shall take appropriate action. 


In evaluating a complaint, each expert panel shall include an initial reviewer whose findings will then be considered by a second reviewer.  If the reviewers are in agreement, the first reviewer will issue a final written report.  If the two reviewers are not in agreement, a third reviewer will review the preliminary report and make a determination.

TAGD and other groups in organized dentistry supported the bill.  


As part of this process, the Board approved the appointment of the initial members of the Expert Review Panel.   However, the selection of expert reviewers will be an ongoing process.  


More information and a copy of the application can be found here.


There are also expert reviewers for dental hygienists.  


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Craig Armstrong, DDS, MAGD


Texas AGD Winner of the 2012 AGD Advocacy Award


Rio Grande Valley AGD for winning the Golden Root Award for outstanding grassroot advocacy efforts. 


Dr. Susan Putthoff for winning the Advocacy Award of Excellence

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