The Texas State Board of Dental Examiners (TSBDE) is the state agency in Texas that licenses and regulates dentists and dental hygienists. Complaints against dentists, including those that stem from administering sedation to patients, can result in disciplinary proceedings.
Disciplinary proceedings can sometimes lead to significant sanctions, including losing dental licenses. If you are facing a complaint that someone has filed with TSBDE alleging that you have violated a law or rule related to your profession, you likely need the advice and counsel of an experienced dental license defense attorney.
Anesthesia Permits Under Texas Law
Under 22 Tex. Admin. Code §110.2, dentists also must have anesthesia permits to administer nitrous oxide/oxygen inhalation sedation, Level 2 Moderate sedation limited to enteral routes of administration, Level 3 Moderate sedation, which includes parenteral routes of administration, and Level 4 Deep sedation or general anesthesia.
Nonetheless, a dentist is not required to get a permit to administer Schedule II drugs for pain control or post-operative care.
22 Tex. Admin. Code §108.7(16) also requires that dentists hold a Level 1 permit, or a Minimal Sedation permit, issued by the TSBDE before prescribing and/or administering Halcion (triazolam) and should administer the drug only in an in-office setting.
As a condition of receiving any anesthesia permits, TSBDE may enlist an anesthesia consultant to examine the dental office and the dentist’s credentials.
Furthermore, the dentist must have passed the anesthesia/sedation section of the jurisprudence exam within one year of applying for the relevant permit.
Nitrous Oxide/Oxygen Inhalation Sedation Requirements
Under 22 Tex. Admin. Code §110.3, a dentist must meet at least one of the following educational/professional criteria to obtain a permit for nitrous oxide/oxygen inhalation sedation:
- Satisfactory completion of a comprehensive training program consistent with that described for nitrous oxide/oxygen inhalation sedation administration in the American Dental Association (ADA) Guidelines for Teaching Pain Control and Sedation to Dentists and Dental Students;
- Satisfactory completion of an ADA/CODA approved or recognized pre-doctoral dental or postdoctoral dental training program that affords comprehensive training necessary to administer and manage nitrous oxide/oxygen inhalation sedation; or
- Be a Texas-licensed dentist, have a current Board-issued nitrous oxide/oxygen inhalation sedation permit, and have been using nitrous oxide/oxygen inhalation sedation in a competent manner immediately before implementing this law on June 1, 2011.
This section also outlines the standard of care for use of this form of anesthesia, which includes continuously supervising and maintaining auxiliary personnel who can reasonably assist should problems occur with anesthesia.
Auxiliary personnel must also be certified in Basic Life Support (BLS) for Healthcare Providers. Dentists also must have the proper permit for the sedative being administered to supervise a certified registered nurse anesthetist (CRNA) with a permit to do so, under 22 Tex. Admin. Code §110.3.
Furthermore, dentists must follow specific clinical requirements to provide this form of anesthesia. These requirements relate to patient evaluations, pre-procedure preparations and informed consent, personnel and equipment requirements, monitoring, documentation, emergency management, and management of children.
Other Sedation Requirements
As with nitrous oxide/oxygen inhalation sedation, dentists are subject to certain educational/professional eligibility, standard of care, and clinical requirements.
22 Tex. Admin. §110.4 addresses requirements to administer minimal sedation, 22 Tex. Admin. §110.5 addresses moderate sedation, and 22 Tex. Admin. §110.6 addresses deep sedation or general anesthesia.
Furthermore, if a dentist is going to provide any sedation at more than one location, all locations must be properly staffed and meet all other requirements.
Under 22 Tex. Admin. §110.13, dentists must prepare and utilize a detailed preoperative sedation/anesthesia checklist for each patient receiving any type of sedation or anesthesia.
They also must have written emergency preparedness policies and procedures specific to the practice setting that they review and update annually under 22 Tex. Admin. §110.14. Under 22 Tex. Admin. §110.15, dentists must maintain minimum emergency preparedness standards for anesthesia/sedation administration. 22 Tex. Admin. §§110.16 and 110.17 address anesthesia/sedation of high-risk and pediatric patients, respectively.
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Level 4 Permits – Deep Sedation or General Anesthesia
A dentist administering certain types of anesthetics must have a Level 4 permit for deep sedation or general anesthesia under 22 Tex. Admin. §110.10.
These drugs include short-acting barbiturates, short-acting analogues of fentanyl, alkylphenols, etomidate, dissociative anesthetics such as ketamine, volatile inhalation anesthetics, and similarly acting drugs. Additionally, a dentist may have no more than one person under general anesthesia at a time.
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Inspection of Anesthesia / Sedation Providers
Under 22 Tex. Admin. §110.18, TSBDE may conduct inspections of dentists providing anesthesia/sedation to patients to ensure compliance with the rules related to these services. Unless in connection with an ongoing investigation that might be jeopardized, dentists must receive at least ten days’ notice of on-site inspections.
Generally, all Level 2, 3, and 4 permit holders must have an on-site inspection within a year of initially receiving their permits. The initial inspection is a compliance Tier 1 inspection that follows a set checklist for the highest level of sedation administered at that office.
If any violations are found, the dentist must cease providing anesthesia/sedation services until providing satisfactory proof of correction and payment of a mandatory fee of no more than $500.
However, if the dentist fails to correct the violation within 30 days, TSBDE will conduct a risk-based Tier 2 inspection. This type of inspection also can occur upon a referral from the TSBDE informal settlement conference panel. Any violation found can result in disciplinary action.
Get the Advice You Need About Your Dental License
When you face the potential loss of your career because of misconduct allegations, you cannot risk navigating this complex situation alone. The dental license defense lawyers at Bertolino LLP, helps professionals like you defend themselves against disciplinary proceedings by their licensing boards.
We can examine your circumstances and help you devise the most effective strategy to protect your license. Call us today at (512) 980-3751 or get more information about us online.
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