CHAPTER 258. PRACTICE BY DENTIST

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OCCUPATIONS CODE

TITLE 3. HEALTH PROFESSIONS

SUBTITLE D. DENTISTRY

CHAPTER 258. PRACTICE BY DENTIST

SUBCHAPTER A. DELEGATION BY DENTIST

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

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;

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

Board.

Acts 1999, 76th Leg., ch. 388, Sec. 1, eff. Sept. 1, 1999.

Amended by:

Acts 2007, 80th Leg., R.S., Ch.

889, Sec. 37, eff. September 1, 2007.

Sec. 258.002. DELEGATION TO DENTAL ASSISTANT. (a) A licensed

dentist may delegate to a qualified and trained dental assistant

acting under the dentist's general or direct supervision any

dental act that a reasonable and prudent dentist would find is

within the scope of sound dental judgment to delegate if:

(1) in the opinion of the delegating dentist, the act:

(A) can be properly and safely performed by the person to whom

the dental act is delegated; and

(B) is performed in a customary manner and is not in violation

of this subtitle or any other statute;

(2) the person to whom the dental act is delegated does not

represent to the public that the person is authorized to practice

dentistry; and

(3) the person to whom the dental act is delegated holds the

appropriate certificate, if a certificate is required to perform

the act.

(b) Repealed by Acts 2009, 81st Leg., R.S., Ch. 476, Sec. 8(1),

eff. September 1, 2009.

types of dental acts that may be properly or safely delegated by

a dentist, including a determination of which delegated dental

acts, if any, require competency testing before a person may

perform the act.

Acts 1999, 76th Leg., ch. 388, Sec. 1, eff. Sept. 1, 1999.

Amended by Acts 2001, 77th Leg., ch. 1470, Sec. 4.01, eff. Sept.

1, 2001; Acts 2003, 78th Leg., ch. 1144, Sec. 1, eff. June 20,

2003.

Amended by:

Acts 2009, 81st Leg., R.S., Ch.

476, Sec. 1, eff. September 1, 2009.

Acts 2009, 81st Leg., R.S., Ch.

476, Sec. 8(1), eff. September 1, 2009.

Sec. 258.003. RESPONSIBILITY OF DELEGATING DENTIST. A

delegating dentist is responsible for a dental act performed by

the person to whom the dentist delegates the act.

Acts 1999, 76th Leg., ch. 388, Sec. 1, eff. Sept. 1, 1999.

SUBCHAPTER B. GENERAL PRACTICE PROVISIONS

Sec. 258.051. DENTIST RECORDS. (a) The records of a diagnosis

made and treatment performed for and on a dental patient are the

property of the dentist performing the dental service.

(b) A dentist's records may not be sold, pledged as collateral,

or transferred to any person other than the patient unless the

transfer is made in compliance with Subchapter C and board rules.

records to an insurance company to determine benefits when

consent for the disclosure has been granted under Section

258.104.

Acts 1999, 76th Leg., ch. 388, Sec. 1, eff. Sept. 1, 1999.

Amended by Acts 2001, 77th Leg., ch. 1420, Sec. 14.086(a), eff.

Sept. 1, 2001.

Sec. 258.0511. ACCESS TO DENTAL RECORDS. (a) An owner,

shareholder, partner, or executive officer of a clinic or other

entity that provides dental services for the public shall

designate a license holder as the dental custodian of records to

provide records to the board or a dentist who has provided dental

treatment and to comply with other law regulating dental patient

records.

(b) On demand, the dental custodian of records shall give access

to the board and produce for the board all records or other

evidence related to the investigation or prosecution of an

alleged violation of this subtitle or another law regulating the

practice of dentistry in this state.

duties of a dental custodian of records.

(d) Section 264.101 applies to a violation of this section.

Added by Acts 2007, 80th Leg., R.S., Ch.

1119, Sec. 1, eff. September 1, 2007.

Sec. 258.052. CASE HISTORIES AND PHYSICAL EVALUATIONS. (a) A

dentist may take a complete case history and perform a complete

physical evaluation that may be used to admit a patient to a

hospital for the practice of dentistry if the activity is

necessary in the exercise of due care in the practice of

dentistry.

(b) A dentist is not automatically entitled to membership on a

hospital's medical staff or to exercise clinical privileges at a

hospital solely because the dentist is licensed in this state or

because the dentist is authorized to take a case history and

perform a physical evaluation.

medical staff or the right to the exercise of clinical privileges

at a hospital solely because the person is a dentist rather than

a physician.

Acts 1999, 76th Leg., ch. 388, Sec. 1, eff. Sept. 1, 1999.

Sec. 258.053. USE OF CERTAIN DRUGS. (a) In this section,

"narcotic drugs," "dangerous drugs," and "controlled substances"

have the meanings defined or recognized by federal law or the law

of this state.

(b) A dentist may not:

(1) prescribe, provide, obtain, order, administer, possess,

dispense, give, or deliver to or for any person a narcotic drug,

dangerous drug, or controlled substance:

(A) that is not necessary or required; or

(B) the use or possession of which would promote addiction to

the drug or substance; or

(2) aid, abet, or cause another person to engage in an action

described by Subdivision (1).

Acts 1999, 76th Leg., ch. 388, Sec. 1, eff. Sept. 1, 1999.

Sec. 258.054. USE OF X-RAY EQUIPMENT. (a) A dentist may

authorize a qualified person to perform beam calibration and

characterization, quality assurance, instrument specification,

acceptance testing, shielding design, or protection analysis on

radiation-emitting equipment or radiopharmaceuticals for a

procedure that involves the diagnosis or treatment of disease or

another dental condition in humans.

(b) A dentist's authorization and the performance of authorized

activities by a qualified person does not constitute the practice

of medical physics under Chapter 602.

dental x-ray unless the dental assistant holds an x-ray

certificate issued under Section 265.005.

Acts 1999, 76th Leg., ch. 388, Sec. 1, eff. Sept. 1, 1999.

Amended by:

Acts 2005, 79th Leg., Ch.

810, Sec. 5, eff. September 1, 2005.

SUBCHAPTER C. DENTAL PRIVILEGE

Sec. 258.101. DEFINITIONS. In this subchapter:

(1) "Dental record" means dental information about a patient:

(A) created or maintained by a dentist; and

(B) relating to the history or treatment of the patient.

(2) "Dentist" means a person licensed to practice dentistry.

(3) "Patient" means a person who consults with a dentist to

receive dental care.

(4) "Privilege" means the confidentiality privilege created by

this subchapter.

Added by Acts 2001, 77th Leg., ch. 1420, Sec. 14.086(b), eff.

Sept. 1, 2001.

Sec. 258.102. SCOPE OF PRIVILEGE. (a) The following

information is privileged and may not be disclosed except as

provided by this subchapter:

(1) a communication between a dentist and a patient that relates

to a professional service provided by the dentist; and

(2) a dental record.

(b) The privilege described by this section applies regardless

of when the patient received the professional service from the

dentist.

Added by Acts 2001, 77th Leg., ch. 1420, Sec. 14.086(b), eff.

Sept. 1, 2001.

Sec. 258.103. HOLDER OF PRIVILEGE. (a) The patient is the

holder of the privilege.

(b) The following persons may claim the privilege on the

patient's behalf:

(1) a person authorized to act on the patient's behalf;

(2) a dentist acting on the patient's behalf; and

(3) an agent or employee of a person listed in Subdivision (1)

or (2).

the absence of evidence to the contrary.

Added by Acts 2001, 77th Leg., ch. 1420, Sec. 14.086(b), eff.

Sept. 1, 2001.

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;

(D) Subtitle D, Title 7, Health and Safety Code;

(E) Subtitle E, Title 7, Health and Safety Code;

(F) Chapter V, Texas Probate Code; or

(G) any other law; or

(5) a personal representative of the patient, if the patient is

deceased.

(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.

Sec. 258.105. EXCEPTION TO PRIVILEGE FOR CERTAIN PROCEEDINGS.

(a) The privilege does not apply in a court or administrative

proceeding if the proceeding is:

(1) brought by the patient against a dentist, including a

malpractice, criminal, or license revocation proceeding, and the

disclosure is relevant to a claim or defense of the dentist; or

(2) to collect on a claim for dental services rendered to the

patient.

(b) The privilege does not apply to the disclosure of a dental

record:

(1) to the board in a disciplinary investigation or proceeding

against a dentist conducted under this subtitle; or

(2) in a criminal investigation or proceeding against a dentist

in which the board is participating or assisting by providing a

record obtained from the dentist.

dental record is disclosed under Subsection (b).

(d) Privileged information is discoverable in a criminal

prosecution if:

(1) the patient is a victim, witness, or defendant; and

(2) the court in which the prosecution is pending rules, after

an in camera review, that the information is relevant for

discovery purposes.

(e) Privileged information is admissible in a criminal

prosecution if:

(1) the patient is a victim, witness, or defendant; and

(2) the court in which the prosecution is pending rules, after

an in camera review, that the information is relevant.

(f) The privilege does not apply to a grand jury subpoena.

Added by Acts 2001, 77th Leg., ch. 1420, Sec. 14.086(b), eff.

Sept. 1, 2001.

Sec. 258.106. EXCEPTION TO PRIVILEGE FOR CERTAIN DISCLOSURES BY

DENTIST. (a) The privilege does not apply to the disclosure of

information by a dentist to:

(1) a governmental agency, if:

(A) the disclosure is required by another law; and

(B) the agency agrees to keep confidential the identity of a

patient whose dental record is disclosed;

(2) medical or law enforcement personnel, if the dentist

determines that it is more likely than not that the following

will occur:

(A) imminent physical injury to the patient, the dentist, or

others; or

(B) immediate mental or emotional injury to the patient;

(3) a person in relation to a management or financial audit,

program evaluation, or research, if the person agrees to keep

confidential the identity of a patient whose dental record is

disclosed;

(4) a person involved in the payment or collection of fees for

services rendered by a dentist, if necessary; or

(5) another dentist, or a person under the direction of the

dentist, who participates in the diagnosis, evaluation, or

treatment of the patient.

(b) A person who receives information under Subsection (a)(3)

may not disclose a patient's identity in writing.

may be disclosed only when necessary in the collection of fees

for a service provided by a dentist, professional association, or

other entity qualified to provide or arrange for a service.

Added by Acts 2001, 77th Leg., ch. 1420, Sec. 14.086(b), eff.

Sept. 1, 2001.

Sec. 258.107. EXCEPTION TO PRIVILEGE FOR CERTAIN LEGISLATIVE

INQUIRIES. A state hospital or state school may disclose a

dental record if:

(1) the state hospital or state school created the record;

(2) an inquiry authorized by the legislature requests the

information; and

(3) the entity receiving the record agrees not to disclose a

patient's identity.

Added by Acts 2001, 77th Leg., ch. 1420, Sec. 14.086(b), eff.

Sept. 1, 2001.

Sec. 258.108. LIMIT ON DISCLOSURE. A person who receives

privileged information may disclose the information to another

person only to the extent consistent with the purpose for which

the information was obtained.

Added by Acts 2001, 77th Leg., ch. 1420, Sec. 14.086(b), eff.

Sept. 1, 2001.

Sec. 258.109. REQUEST FOR DENTAL RECORD: TIMING; EXCEPTION. (a)

If disclosure of a dental record is authorized under this

subchapter, a dentist shall disclose the dental record within a

reasonable period after it is requested but not later than:

(1) the 30th day after the date on which it is requested from

the dentist; or

(2) a date ordered by a court.

(b) A dentist may refuse to disclose the requested record if the

dentist determines that providing the information would be

harmful to the physical, mental, or emotional health of the

patient, except that requests from the board may not be refused.

If the dentist determines that disclosing the record would be

harmful, the dentist shall notify the person requesting the

record and explain why the information would be harmful. The

person requesting the record may challenge in court the dentist's

refusal to disclose the record. If the court finds that the

dentist made the refusal in bad faith, the court may order the

disclosure of the record and award costs and attorney's fees

incurred by the person to obtain the information.

shall redact privileged information about another person.

(d) A dentist may charge a reasonable fee for providing a dental

record under this section. For purposes of this subsection, a fee

established under Section 241.154, Health and Safety Code, is a

reasonable fee.

Added by Acts 2001, 77th Leg., ch. 1420, Sec. 14.086(b), eff.

Sept. 1, 2001.

SUBCHAPTER D. ENTERAL ADMINISTRATION OF ANESTHESIA

Sec. 258.151. DEFINITION. In this subchapter, "enteral" means

any technique of administering anesthesia in which the anesthetic

is absorbed through the gastrointestinal tract or oral mucosa.

Examples of enterally administering anesthesia include

administering an anesthetic orally, rectally, sublingually, or

intranasally.

Added by Acts 2001, 77th Leg., ch. 349, Sec. 1, eff. Sept. 1,

2001.

Sec. 258.152. APPLICABILITY. Rules adopted by the board under

this subchapter do not apply to:

(1) the regional injection of an anesthetic to reduce or

eliminate sensation, especially pain, in one part of the body; or

(2) the administration of anxiolytics and analgesics that are

not being used in conjunction with the administration of nitrous

oxide and that are administered in doses that do not have the

probability of placing the dental patient at risk for loss of the

dental patient's life-preserving protective reflexes.

Added by Acts 2001, 77th Leg., ch. 349, Sec. 1, eff. Sept. 1,

2001.

Sec. 258.153. RULES. (a) The board shall establish by rule the

minimum standards for the enteral administration of anesthesia by

a dentist.

(b) The rules must be designed to protect the health, safety,

and welfare of the public and must include requirements relating

to:

(1) the methods used to enterally administer an anesthetic and

the anesthetic agents that may be used;

(2) dental patient evaluation, diagnosis, counseling, and

preparation;

(3) dental patient monitoring to be performed and equipment to

be used during a procedure and during postprocedure monitoring;

(4) emergency procedures, drugs, and equipment, including

education, training, and certification of personnel, as

appropriate, and including protocols for transfers to a hospital;

(5) the documentation necessary to demonstrate compliance with

this subchapter; and

(6) the period in which protocols or procedures covered by rules

of the board shall be reviewed, updated, or amended.

Added by Acts 2001, 77th Leg., ch. 349, Sec. 1, eff. Sept. 1,

2001.

Sec. 258.154. COMPLIANCE WITH ANESTHESIA RULES. (a) On and

after August 31, 2002, a dentist who practices dentistry in this

state and who enterally administers anesthesia or performs a

procedure for which anesthesia is enterally administered shall

comply with the rules adopted under this subchapter.

(b) The board may require a dentist to submit and comply with a

corrective action plan to remedy or address any current or

potential deficiencies with the dentist's enteral administration

of anesthesia in accordance with this subtitle or rules of the

board.

Added by Acts 2001, 77th Leg., ch. 349, Sec. 1, eff. Sept. 1,

2001.

Sec. 258.155. ANNUAL PERMIT. (a) Not later than September 1,

2002, the board shall require each dentist who enterally

administers anesthesia or performs a procedure for which

anesthesia is enterally administered to annually obtain a permit

from the board by completing a form prescribed by the board. The

board shall set and impose a fee for the permit in an amount

designed to recover the costs of regulating a permit holder under

this subchapter.

(b) The board shall coordinate the times at which a permit must

be renewed with the times at which a dentist's license must be

renewed under Chapter 257 so that the times of registration,

payment, notice, and imposition of penalties for late payment are

similar and provide a minimum of administrative burden to the

board and to dentists.

Added by Acts 2001, 77th Leg., ch. 349, Sec. 1, eff. Sept. 1,

2001.

Sec. 258.156. INSPECTIONS. (a) The board may conduct

inspections to enforce this subchapter, including inspections of

an office site and of documents of a dentist's practice that

relate to the enteral administration of anesthesia. The board may

contract with another state agency or qualified person to conduct

these inspections.

(b) Unless it would jeopardize an ongoing investigation, the

board shall provide at least five business days' notice before

conducting an on-site inspection under this section.

inspection of a dentist's office.

Added by Acts 2001, 77th Leg., ch. 349, Sec. 1, eff. Sept. 1,

2001.

Sec. 258.157. REQUESTS FOR INSPECTION AND ADVISORY OPINION. (a)

The board may consider a request by a dentist for an on-site

inspection. The board may, in its discretion and on payment of a

fee in an amount established by the board, conduct the inspection

and issue an advisory opinion.

(b) An advisory opinion issued by the board under this section

is not binding on the board, and the board, except as provided by

Subsection (c), may take any action under this subtitle in

relation to the situation addressed by the advisory opinion that

the board considers appropriate.

the board may use the opinion as mitigating evidence in an action

or proceeding to impose an administrative or civil penalty under

this subtitle. The board or court, as appropriate, shall take

proof of reliance on an advisory opinion into consideration and

mitigate the imposition of administrative or civil penalties

accordingly.

Added by Acts 2001, 77th Leg., ch. 349, Sec. 1, eff. Sept. 1,

2001.

State Codes and Statutes

State Codes and Statutes

State Codes and Statutes

State Codes and Statutes

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