“Making a List

Checking it Twice

Gonna Find Out Who’s Naughty or Nice…”

This ain’t no Christmas song, it’s a real thing!

Earlier this month the Texas State Board of Dental Examiners published new Rules 111.3 and 111.4.

111.3 will require dentists to review their patients’ prescribing history with the Prescription Monitoring Program prior to prescribing or dispensing opioids, benzodiazepines, barbiturates, or carisoprodol (Soma®). EFFECTIVE DATE 09/01/2019

Fortunately, checking the PMP can be delegated to employees, as Designated Agents of the dentist. This access shall be limited to the dentist and their agents. HIPAA (HB300) still applies and dentists are held accountable for misuse of the PMP. If you don’t need the information you should not access or obtain the information (HIPAA’s Minimum Necessary principle).

Be aware, the Texas State Board of Pharmacy, the agency that maintains the PMP database, keeps track of logins and searches of the PMP. Abuses of the PMP are reportable to the dental board and attorney general’s office for violations of the Texas Medical Privacy Act (HB300).

111.4 specifies three things:

  1. The Board shall periodically access a dentist’s prescription information through the Prescription Monitoring Program to determine whether they are engaging in potentially harmful prescribing patterns or practices. This determination will be based on: (1) the number of times a dentist prescribes opioids, benzodiazepines, barbiturates, or carisoprodol (Soma®); and (2) patterns of prescribing combinations of those drugs and other dangerous combinations identified by the Texas State Board of Pharmacy.

  2. The Board shall notify a dentist if the agency discovers that the dentist may be engaging in potentially harmful prescribing patterns or practices.

  3. The Board may open a complaint against a dentist if the agency finds evidence during a periodic check that the dentist is engaging in conduct that violates any laws or rules related to the practice of dentistry.


This means big brother is watching (more than ever) and you may well have to justify your decisions, as the board may stick their nose in your business if your prescribing practices seem indicative of a problem. For most dentists this is of no concern, as you may administer, but not prescribe controlled substances. What about those of you who do write prescriptions? How many is too many before you find yourself having to justify your prescriptions to the Board? Are you screwed if you happen to have a string of patients present in a month or quarterly who have legitimate needs for management of acute pain? I am certain there will be no magic number of scripts in a month/quarter/year that dentists will be able to write before drawing suspicion. Then again, is the lack of a magic number a good thing or bad thing?

Will dentists have to defend themselves against mere hunches by an administrative technician at the Pharmacy or Dental Board?

Will oral surgeons and periodontists receive more scrutiny since they tend to write more scripts than dentists of other disciplines?

What will the threshold be for the Board to initiate a complaint and open a case against a dentist?

Is there anything in place to protect dentists from the use of this tool as a political witch hunt?

Am I wrong to be concerned about this?

I don’t fault the pharmacy or dental board for doing their jobs, but it’s a shame they have to create so many rules because of the actions of the bad actors that exist.

On another note – the SBDE adopted 111.1 and 111.2 effective 12/25/2016. Here they are for your review:

111.1 required dentists who hold a DEA registration to complete two (2) hours of continuing education every three (3) years regarding the abuse and misuse of controlled substances, opioids prescription practices, and/or pharmacology. This training DOES count toward a dentist’s annual 12-hour CE requirement.






111.2 required dentists who hold a DEA registration to self-query the Prescription Monitoring Program at once a year.


Lastly, on March 26, 2018 DrBicuspid announced the ADA’s new opioid policy, which has three key components:

  1. CE requirements for those prescribing opioids and other controlled substances
  2. Dentists prescribing no more than 7-days’ supply of controlled substances for treatment of acute pain
  3. Dentists’ use of state Prescription Monitoring Programs for monitoring patient consumption histories related to controlled substances

Here’s a link to the article:

These key components seem quite reasonable, but dentists don’t like change, so this is sure to ruffle some feathers.

Did You Know? Every state except Missouri maintains a Prescription Monitoring Program. As recently as last year Missouri’s legislators resisted pressure by the feds to establish a PMP. Will Missouri cave in 2018? 2019? Show me, Missouri!

Examples of barbituates:Brevital, Nembutal, Pentothal, Mephobarbital (methylophenobarbital), Methohexital, Pentobarbital, Phenobarbital, Primidone

Examples of benzodiazepines: alprazolam (Xanax®), clonazepam (Klonopin®), diazepam (Valium®), lorazepam (Ativan®), and midazolam (Versed®)

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