Dentistry Rules + Regulation Changes in Texas

Texas has rolled out some regulations and rule changes that dentists need to stay on top of. From controlled substance CE changes and equipment performance evaluations to medical emergency preparedness training and sedation inspections—we cover it all in this episode of Talking with the Toothcop. Don’t miss it!

Outline of This Episode

[0:21] A trip down memory lane
[4:41] Controlled Substance CE changes
[13:57] Controlled Substances: EPCS + patient query
[19:11] The Human Trafficking Course requirement
[21:30] X-ray equipment performance evaluations
[25:02] Step-wedge test + medical emergency preparedness training
[27:30] What dentists are getting busted for in sedation inspections
[34:17] Mail Bag: Does your office need to use respirators?
[37:13] Georgetown Dental’s violations

Changes to Controlled Substances Regulations

A lot of controlled Substance CE changes came out in 2016. Some dentists still aren’t in compliance with these rules. Rule 111.1 is a CE requirement for every dentist in Texas with a DEA registration. Up until 9/1/2020, dentists were required to complete a two-hour CE course on opioids and the use of controlled substances in the dental practice. Now you’re required to do an additional two-hour course on monitoring and prescribing practices for controlled substances.

This takes effective As of January 1st, 2021 all dentists with direct patient-care responsibilities are required to complete a pain management CE (Rule 104.1 ). It is a two-hour CE course that you must complete annually. Some CE requirements are annual OR every other year. I.e. the human-trafficking course must be completed per renewal period or every two years.

NOTE: A dentist is NOT required to have a DEA registration if you’re not prescribing. But moving forward, the only way you can prescribe any controlled substance will have to be done through Electronic Prescribing of Controlled Substances (EPCS).

Controlled Substances: EPCS + patient query

Under rule 111.2, any dentist with a DEA registration is required to login to the PMP (Prescription Monitoring Program) and complete a self-query to review your prescribing history. Even if you don’t prescribe controlled substances, you still have to log in and perform the search. Luckily, there’s no need to document it. They monitor the keystrokes and searches you perform when you log in—which is why you have to do it.

Before issuing a prescription for a controlled substance to a patient, you’re required to check the patient’s history in the PMP (Rule 111.3). If you’re administering a controlled substance from an office supply (and not ordering it or prescribing it) you don’t need to do the search.

Rule 111.4 allows the state board to monitor dentists prescribing practices. In Texas, it’s managed by the State Board of Pharmacy. Some dentists have disciplinary actions on their license for failure to comply with these rules—so we aren’t just saying them to say them. They are important.

X-ray equipment performance evaluations (EPE)

The most common thing dentists get busted for is not having equipment performance evaluations (EPE) completed in time. It’s simply a calibration check that must be performed by an outside party. The state requires it for two-dimensional x-rays every 4 years from the date of the last EPE. It’s such a common violation that half to most dental offices have been busted for this. They don’t give second warnings—you’ll get a $4,000 fine after your first warning. This is one of the easiest rules to comply with. NOTE: If you have a three-dimensional x-ray machine, it must be checked annually.

What dentists are getting busted for in sedation inspections

The first thing dentists get busted for is expired AED pads OR not having pediatric AED pads. You have to have pediatric appropriate equipment if you administer nitrous to children under 13.

Another thing is not checking vital signs intraoperative or perioperative. That includes blood pressure, heart rate, O2 Sats, and respiratory rate every 10 minutes. I know dentists who are in hot water right now because they’ve failed multiple times. Don’t let something so silly leave a black spot on your record.

Pull up your Pre-Op Sedation/Anesthesia Checklist and look at rule 110.3. Make sure your pre-op checklist has everything that’s required and it’s titled “Pre-Op Sedation/Anesthesia Checklist.” No joke—if it doesn’t say that, they will make you fix it. This is true for level 1 and Nitrous Oxide only as well.

Mail Bag: Does your office need to use respirators?

When most people hear the word “respirator” they automatically think of elastomeric respirators (i.e. a Darth Vader type mask). Dental offices do wear N-95 masks, but it’s actually called a face-filtering respirator. It’s still a type of respirator—just not what you think of. Texas (Rule 108.7 Subsection 16) requires the use of an N-95 REspirator mask when working within 6 feet of aerosol-generating procedures (anything where you use a handpiece). It applies to dentistry in Texas and other states.

Why you HAVE to follow the rules

OSHA reported that since the pandemic, there has been $1.4 million in fines issued to healthcare providers. There was only one dental office on that list—Georgetown Dental in Massachusetts. They were busted for over 7 violations, but here are a few:

1910.134(c)(1) – No Written Respiratory Protection Program. You need a written plan.
1910.134(e)(1) – No Medical Evaluations for Employees. You must provide them a medical evaluation to make sure they can use a respirator.
1910.134(f)(2) – No fit testing. They must be fit-tested before initial use of the respirator.
1910.134(k)(1). Employee training. The employer shall ensure that each employee can demonstrate knowledge of how to use, maintain, and store the respirator.

Any dental office needs to make sure they comply with these rules. To get the full details on all of the rules and regulations that have changed, give the whole episode a listen—and take notes.

Resources & People Mentioned

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