Current through September 24, 2024
(1) Policy
Statement - The scope of the practice of dentistry in Tennessee is broadly
defined and includes many aspects which if not particularly regulated could
lead to serious ramifications for the consuming public. This rule is to
designate specific areas in the practice of dentistry for regulation, the
violation of which may result in disciplinary action pursuant to T.C.A.
§§
63-5-124(a)(1),
63-5-124(3),
63-5-124(4),
63-5-124(7),
63-5-124(8),
63-5-124(16)
or 63-5-124(18).
(2) Prescribing, Dispensing, or Otherwise
Distributing Pharmaceuticals
(a) Dentists who
elect to dispense pharmaceuticals for compensation or otherwise distribute
pharmaceuticals must comply with the following:
1. All Federal Regulations ( 21 CFR 1304
through 1308) for the dispensing of controlled substances.
2. Requirements for dispensing of
non-controlled drugs are as follows:
(i)
Drugs are to be dispensed in an appropriate container labeled with at least,
the following:
(I) Patient's name
(II) Date
(III) Complete directions for usage
(IV) The dentist's name and address
(V) A unique number, or the name and strength
of the medication
(b) Dentists may prescribe, dispense or
otherwise distribute the controlled substances listed in Schedules II, III, IV,
and V, as provided in 21 C.F.R. Chapter 2, 1308.12 through .15, only to
individuals with whom they have established a dentist/patient relationship and
for whom they have provided dental services. For purposes of this provision, a
"dentist/patient" relationship exists where a dentist has provided dental
treatment to a patient on at least one (1) occasion within the preceding year,
or exists by having adequate documented knowledge of the specific patient
history.
(c) Dentists must confine
their prescription, dispensing or distributing of pharmaceuticals to those
which are directly associated with and recognized for the treatment of an
identified dental procedure, ailment or infirmity.
(d) Dentists must not prescribe, dispense or
otherwise distribute controlled substances in amounts, or for durations not
medically or dentally necessary, advisable or justified by an existing,
identifiable dental procedure, ailment or infirmity.
(e) Dentists must record in patient records
all pharmaceuticals dispensed, prescribed or otherwise distributed to patients.
A separate log must be maintained for all controlled substances dispensed by a
dentist.
(f) It is not the
intention of this rule to interfere with the individual dentist's appropriate
use of professional samples, nor to interfere in any way with the dentists
right to directly administer drugs or medicines to any patient.
(g) Dentists shall only allow licensed or
registered auxiliary staff to give/hand medications to a patient and only after
the dentist has verified that the medication about to be given is the correct
medication and correct dosage prescribed. Under no circumstances shall the
dentist allow auxiliary staff to place medications directly in the mouth of a
patient or on the patient such as actisite, nitrous oxide, any other medicated
dental material, etc., with the exception of a topical anesthetic pursuant to
T.C.A. §§
63-5-108(b) (12)
and/or (d) (3), and any other procedure authorized by Rule
0460-03-.09(1).
(h) Nothing in
these rules shall be interpreted to interfere with the ability of properly
credentialed dentists who practice in the hospital setting to reinstate,
continue, and/or rewrite for their patients all prescriptions which are
medically or dentally advisable or justified for such dental procedure(s) or
treatment(s), including prescriptions for ancillary medical conditions, so long
as:
1. such medical prescriptions are
rational to the practice of dentistry; and
2. the treating dentist only orders such
medical prescriptions in consultation with the patient's treating physician;
and
3. the treating dentist only
re-orders such medical prescriptions which already have been ordered by the
patient's treating physician and which prescription orders would remain in
effect for the patient but for the JCAHO standard against automatic
reinstatement in the hospital setting.
(3) Third Party Payor Practices. The
following acts or omissions by or on behalf of any dentist may be grounds for
disciplinary action:
(a) Abrogating the
deductible or repeatedly or regularly waving co-payment or both provisions of
any insurance contract or dental plan by forgiving any or all of a patient's
obligations for payment of said deductible or co-payment or both without first
notifying the insurance company or dental plan in writing of the intent to do
so.
(b) Rebating or repeatedly or
regularly waiving or offering to rebate to an insured any payment by the
insured's third-party payor to the licensee for services or treatments rendered
under the insured's policy, without first notifying the insurance company or
dental plan in writing of the intent to do so.
(c) Submitting to a third-party payor a claim
for a service or treatment at an inflated fee or charge or one greater than the
licensee usually charges for the service or treatment when such is rendered
without third-party reimbursement.
(d) Knowingly incorrectly reporting services
rendered, reporting incorrect treatment dates, or reporting charges for
services not rendered, or filing claims prior to completion of services for the
purpose of obtaining payment from a third-party payor unless the payor is
notified in writing at the time of filing for payment.
(4) Laboratory Work Orders
(a) A written work order must accompany all
dental laboratory work sent by a dentist to a commercial dental laboratory or
private dental laboratory technician outside the physical confines of the
ordering dentist's office.
(b) A
copy of all written work orders required by this rule must be kept on file by
the ordering dentist for a period of two (2) years from the date the order was
issued.
(c) All written work orders
required by this rule must include the following information:
1. Date signed.
2. The name and address of the commercial
dental laboratory or private dental laboratory technician.
3. The name or identification number of the
patient for whom the act or service is ordered.
4. The licensed dentist's name, address, and
license number.
5. The signature of
the licensed dentist.
6. The
description of the kind and type of appliance, process, fabrication, service,
or material ordered.
(5) Unauthorized Practice - Any dentist who
permits any dental hygienist or dental assistant to perform any acts or
services other than those specifically assignable or delegable pursuant to
T.C.A. §
63-5-108 and/or Rule 0460-03-.09
and/or 0460-04-.01 and 0460-04-.08 may be subject to discipline pursuant to
T.C.A. §
63-5-116(a).
(6) Universal Precautions for the Prevention
of HIV Transmission - The Board adopts Rules 1200-14-03-.01 through
1200-14-03-.03 inclusive, of the Department of Health, and as they may from
time to time be amended, as its rules governing the process for implementing
universal precautions for the prevention of HIV transmission for health care
workers under its jurisdiction.
Authority: T.C.A. §§
4-5-202,
4-5-204, 63-5-105, 63-5-107,
63-5-108, 63-5-109, 63-5-116, 63-5-122, and 63-5-124.
