As a licensed dentist, you should be aware of the rules concerning the delegation of procedures and other duties to other dental professionals, such as dental hygienists and dental assistants. Tex. Occ. Code §§ § 258.001 – 258.003 govern the the delegation of duties by dentists. Failure to follow these rules could result in potential sanctions against your license by the Texas State Board of Dental Examiners (TSBDE). An experienced dental license defense attorney at Bertolino LLP can defend you against complaints that may lead to disciplinary proceedings before the TSBDE.
Impermissible Delegations
Tex. Occ. Code §258.001 places very specific limits on what procedures or duties a dentist may delegate to others. For instance, a dentist may not delegate the following duties to anyone other than another licensed dentist (who does not have a TSBDE order preventing them from doing so) or a licensed dental hygienist. These acts include:
- The removal of calculus, deposits, or accretions from the natural and restored surfaces of exposed human teeth and restorations in the human mouth;
- Root planing or the smoothing and polishing of roughened root surfaces or exposed human teeth; or
- Any other act, the delegation of which is prohibited by TSBDE rule.
Furthermore, a dentist may not delegate certain duties or procedures to anyone other than a licensed dentist, including comprehensive examinations, diagnosis and treatment planning, surgical procedures, and prescribing drugs, medications, or work authorization. This code section also lists specific procedures that are permitted only for licensed dentists, as well as restrictions on the administration of anesthetics to dental patients.
Delegation of Duties to Dental Assistants
Tex. Occ. Code § 258.002 states that a licensed dentist may only delegate dental acts to qualified and trained dental assistants under certain circumstances. First, the dental assistant must be acting under the dentist’s general or direct supervision. The dentist may delegate any dental act that a reasonable and prudent dentist would find to be within the scope of sound dental judgment to delegate, if, in the opinion of the delegating dentist, the following are true:
- The act can be properly and safely performed by the person to whom the dental act is delegated; and
- The act is performed customarily and is not in violation of this subtitle or any other statute.
Furthermore, the person to whom the dental act is delegated may not represent to the public that the person is authorized to practice dentistry and must be registered under §265.001 if registration is required to perform the delegated act. §265.001 requires a dental assistant to register to make a dental x-ray or monitor the administration of nitrous oxide. However, a dental assistant hired for the first time and not previously issued a registration to make dental x-rays may make dental x-rays without registration until the first anniversary of the date of hire.
- 265.003 outlines the permissible dental acts that a licensed dentist can delegate to a dental assistant who is not registered under §265.001. Under the direct supervision, direction, and responsibility of the dentist, the dental assistant can perform one or more delegated duties, including the application of fluoride varnish. Furthermore, under the general supervision, direction, and responsibility of the dentist, the dental assistant may:
- Make dental X-rays in compliance with Section 265.001(d); and
- Provide interim treatment for a minor dental emergency to an existing patient of the treating dentist.
However, if the dentist delegates the provision of interim treatment of a minor emergency dental condition to a dental assistant, the dentist must:
- Delegate the procedure orally or in writing before the dental assistant performs the procedure;
- Retain responsibility for the procedure; and
- Schedule a follow-up appointment with the patient within a reasonable time.
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Whether a dental assistant is registered or not, the delegating dentist remains responsible for any acts that the dental assistant performs. The dental assistant also may not represent to the public that they are authorized to practice dentistry or dental hygiene.
Responsibilities of Delegating Dentists
As per §258.003, a delegating dentist is responsible for all dental acts performed by persons to whom the dentist has delegated them. A delegating dentist has special responsibilities when delegating acts to dental assistants. §265.002 states that a dental assistant is under the direct supervision, direction, and responsibility of a dentist if the dentist:
- Employs the dental assistant or is in charge of the dental assistant; and
- Is physically present in the dental office when the dental assistant performs a delegated dental act. However, 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.
However, a dental assistant is under the general supervision, direction, and responsibility of a dentist if the dentist:
- Employs the dental assistant or is in charge of the dental assistant; and
- Is responsible for supervising the services that the dental assistant will be performing.
What Procedures and Services May Only Licensed Dentists Provide?
Only licensed dentists can provide the following services:
- Comprehensive examination or diagnosis and treatment planning;
- A surgical or cutting procedure on hard or soft tissue;
- The prescription of a drug, medication, or work authorization;
- The taking of an impression for a final restoration, appliance, or prosthesis;
- The making of an intraoral occlusal adjustment;
- Direct pulp capping, pulpotomy, or any other endodontic procedure;
- The final placement and intraoral adjustment of a fixed or removable appliance; or
- The placement of any final restoration.
What Are the Requirements for a Dental Assistant to be Registered?
The TSBDE establishes the eligibility requirements for dental assistants to register, which, under §265.0015, include a high school diploma or its equivalent, completion of a TSBDE-approved educational program with certain content, and successful completion of an examination.
When Can a Licensed Dentist Delegate Services to a Licensed Dental Assistant?
A licensed dentist can delegate the following services to a licensed dental assistant IF the assistant is under the direct or general supervision of the dentist, as required:
- Any dental act that a reasonable and prudent dentist would find to be within the scope of sound dental judgment to delegate if, in the opinion of the delegating dentist:
- The act can be properly and safely performed by the person to whom the dental act is delegated; and
- The act is performed customarily and is not in violation of this subtitle or any other statute.
A dental assistant can make a dental x-ray or monitor the administration of nitrous oxide if properly registered.
An unregistered dental assistant may make dental x-rays in compliance with Section 265.001(d) and provide interim treatment of a minor emergency dental condition to an existing patient of the treating dentist, so long as the treating dentist provides certain follow-up services.
Allow Bertolino LLP to Help You with Your Professional Disciplinary Case
Understanding the rules that govern the profession and the potential consequences of disciplinary proceedings for licensed dentists can be crucial. Disciplinary proceedings can lead to adverse consequences such as suspension or revocation of your dental license. When you face disciplinary proceedings, you need an experienced dental professional license defense attorney to assist you. Contact Bertolino LLP today at (512) 980-3751 or visit us online.
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