COLORADO STATE BOARD OF DENTAL EXAMINERS
Rulemaking Hearing, October 24, 2007

Proposed Changes with Statement of Basis, Purpose, and Authority

Basis and Purpose:  To define appropriate advertising practices for dentists and dental hygienists in order to protect the consumer from misrepresentation.

Statement of Authority:	Pursuant to CRS 12-35-107 (1) (b), Make, publish, declare, and periodically review such reasonable rules as may be necessary to carry out and make effective the powers and duties of the board as vested in it by this article. Rules of the board may include but shall not be limited to: 

(I) The examination of applicants for licensing as dentists and dental hygienists; 

(II) The practices of dentistry and dental hygiene; 

(III) The tasks and procedures that may be assigned to dental assistants and dental hygienists; and 

(IV) The specification of essential instructions to be included in a laboratory work order.

Rule XXVI - Advertising (Effective August 1, 2000)
(Temporarily Expired December 2, 2002)
(Effective July 1, 2003; Amended October 27, 2004)
(Amended October 26, 2006 and Effective December 31, 2006)
(Amended April 25, 2007 and Effective July 1, 2007)
(Amended October 24, 2007 and Effective December 31, 2007)

C. Practitioners who advertise dentistry or dental hygiene shall not make any misleading, deceptive, or false claims to a patient or the general public in any advertisement, business card, letterhead, or envelope, of any recognition, accomplishments, levels of attainment, diplomate status, fellowship status, teaching credentials, or any other form of recognition from an unaccredited school or organization or continuing education program. Accreditation relating to dentistry and dental hygiene may only come from the Commission on Dental Accreditation. Any advertisement stating recognition from an unaccredited school, or organization or continuing education program must include a disclaimer that the school, organization or continuing education program is not accredited by the Commission on Dental Accreditation.

C.  PRACTITIONERS WHO ADVERTISE DENTISTRY OR DENTAL HYGIENE SHALL NOT MAKE ANY MISLEADING, DECEPTIVE, OR FALSE CLAIMS TO A PATIENT OR THE GENERAL PUBLIC IN ANY ADVERTISEMENT, BUSINESS CARD, LETTERHEAD, OR ENVELOPE:

1.  OF ANY RECOGNITION, ACCOMPLISHMENTS, LEVELS OF ATTAINMENT, DIPLOMATE STATUS, TEACHING CREDENTIALS, OR ANY OTHER FORM OF RECOGNITION FROM AN UNACCREDITED SCHOOL, ORGANIZATION, OR CONTINUING EDUCATION PROGRAM.  ACCREDITATION RELATING TO DENTISTRY AND DENTAL HYGIENE MAY ONLY COME FROM THE COMMISSION ON DENTAL ACCREDITATION OR A DENTAL ORGANIZATION THAT IS A BONA-FIDE CREDENTIALING ORGANIZATION WITH OBJECTIVELY CLEAR, RIGOROUS, AND VERIFIABLE STANDARDS. 

2.  A MEMBER OF A BONA-FIDE CREDENTIALING ORGANIZATION MAY ADVERTISE THE CREDENTIALS EARNED IN THAT ORGANIZATION.  THE DESIGNATION OF SUCH CREDENTIALS MUST BE STATED SEPARATELY FROM ANY DESIGNATION OF DEGREE EARNED AT A SCHOOL ACCREDITED BY THE COMMISSION ON DENTAL ACCREDITATION.  THE NAME OF THE ORGANIZATION AND THE STATUS OBTAINED BY THE MEMBER MUST BE FULLY SPELLED OUT AND MAY NOT BE RECITED BY INITIALS FOLLOWING A DESIGNATION OF DEGREE EARNED AT A SCHOOL ACCREDITED BY THE COMMISSION ON DENTAL ACCREDITATION.    

3. ANY ADVERTISEMENT STATING RECOGNITION FROM AN UNACCREDITED SCHOOL OR CONTINUING EDUCATION PROGRAM MUST INCLUDE A DISCLAIMER THAT THE SCHOOL, ORGANIZATION, OR CONTINUING EDUCATION PROGRAM IS NOT ACCREDITED BY THE COMMISSION ON DENTAL ACCREDITATION.

COLORADO STATE BOARD OF DENTAL EXAMINERS
Rulemaking Hearing, October 24, 2007

Proposed Changes with Statement of Basis, Purpose, and Authority

Basis and Purpose:   To recognize that pediatric cases may require special case management, and that pediatric and special needs patients may need specialized care in order to prevent injury and to protect the health and safety of the patients, the dentist, and the dental staff.

Statement of Authority:	Pursuant to CRS 12-35-107 (1) (b), Make, publish, declare, and periodically review such reasonable rules as may be necessary to carry out and make effective the powers and duties of the board as vested in it by this article. Rules of the board may include but shall not be limited to: 

(I) The examination of applicants for licensing as dentists and dental hygienists; 

(II) The practices of dentistry and dental hygiene; 

(III) The tasks and procedures that may be assigned to dental assistants and dental hygienists; and 

(IV) The specification of essential instructions to be included in a laboratory work order.

Rule XXIX. Medical Immobilization/Protective Stabilization
PEDIATRIC CASE MANAGEMENT; MEDICAL IMMOBILIZATION/PROTECTIVE STABILIZATION
(Amended October 24, 2007 and Effective December 31, 2007)

A. Within this rule, the terms medical immobilization and protective stabilization are used interchangeably. These terms refer to partial or complete immobilization of the patient necessary to protect the patient, practitioner, and other dental staff from injury while providing care. Immobilization can be performed by the dentist, staff, or legal guardian with or without the aid of an immobilization devise. 

A.  THE PURPOSE OF THIS RULE IS TO RECOGNIZE THAT PEDIATRIC CASES MAY REQUIRE SPECIAL CASE MANAGEMENT, AND THAT PEDIATRIC AND SPECIAL NEEDS PATIENTS MAY NEED SPECIALIZED CARE IN ORDER TO PREVENT INJURY AND TO PROTECT THE HEALTH AND SAFETY OF THE PATIENTS, THE DENTIST, AND THE DENTAL STAFF.  IN ADDITION TO PATIENT MANAGEMENT OF THE PEDIATRIC AND SPECIAL NEEDS PATIENT, IT MAY BE NECESSARY TO MEDICALLY IMMOBILIZE THE PEDIATRIC AND SPECIAL NEEDS PATIENTS TO PREVENT INJURY AND TO PROTECT THE HEALTH AND SAFETY OF THE PATIENTS, THE DENTIST, AND THE DENTAL STAFF.  TO ACHIEVE EFFECTIVE PEDIATRIC PATIENT MANAGEMENT, IT IS IMPORTANT TO BUILD A TRUSTING RELATIONSHIP BETWEEN THE DENTIST, THE DENTAL STAFF, THE PATIENT, AND THE PARENT OR GUARDIAN.  THIS NECESSITATES THAT THE DENTIST ESTABLISHES COMMUNICATION WITH THEM AND PROMOTES A POSITIVE ATTITUDE TOWARDS ORAL AND DENTAL HEALTH IN ORDER TO ALLEVIATE FEAR AND ANXIETY AND TO DELIVER QUALITY DENTAL CARE.

B. The purpose of this rule is to recognize the fact that pediatric and special needs patients may need to be medically immobilized in order to prevent injury and to protect the health and safety of the patients, the dentist, and the dental staff. To achieve this, it is important to build a trusting relationship between the dentist, the dental staff, the patient, and the parent or guardian. This necessitates that the dentist establishes communication with them and promotes a positive attitude towards oral and dental health in order to alleviate fear and anxiety and to deliver quality dental care. 

B.  PEDIATRIC CASE MANAGEMENT

1.  PARENTS OR LEGAL GUARDIANS CANNOT BE DENIED ACCESS TO THE PATIENT DURING TREATMENT IN THE DENTAL OFFICE UNLESS THE HEALTH AND SAFETY OF THE PATIENT, PARENT OR GUARDIAN, OR DENTAL STAFF WOULD BE AT RISK.  THE PARENT OR GUARDIAN SHALL BE INFORMED OF THE REASON THEY ARE DENIED ACCESS TO THE PATIENT AND BOTH THE INCIDENT OF THE DENIAL AND THE REASON FOR THE DENIAL SHALL BE DOCUMENTED IN THE PATIENT’S DENTAL RECORD.

2.  THIS PROVISION SHALL NOT APPLY TO DENTAL CARE DELIVERED IN AN ACCREDITED HOSPITAL OR ACUTE CARE FACILITY.

C. Training requirement. Prior to utilizing medical immobilization, the dentist shall have received training beyond basic dental education through a residency program or graduate program that contained content and experiences in advanced behavior management or a continuing education course of no less than 6 hours in advanced behavior management that involves both didactic and demonstration components. This training requirement will be effective October 1, 2006. 

C.  MEDICAL IMMOBILIZATION/PROTECTIVE STABILIZATION

1.  WITHIN THIS RULE, THE TERMS MEDICAL IMMOBILIZATION AND PROTECTIVE STABILIZATION ARE USED INTERCHANGEABLY.  THESE TERMS REFER TO PARTIAL OR COMPLETE IMMOBILIZATION OF THE PATIENT NECESSARY TO PROTECT THE PATIENT, PRACTITIONER, AND OTHER DENTAL STAFF FROM INJURY WHILE PROVIDING CARE.  IMMOBILIZATION CAN BE PERFORMED BY THE DENTIST, STAFF, OR PARENT OR LEGAL GUARDIAN WITH OR WITHOUT THE AID OF AN IMMOBILIZATION DEVICE.

2.  	TRAINING REQUIREMENT.  PRIOR TO UTILIZING MEDICAL IMMOBILIZATION, THE DENTIST SHALL HAVE RECEIVED TRAINING BEYOND BASIC DENTAL EDUCATION THROUGH A RESIDENCY PROGRAM OR GRADUATE PROGRAM THAT CONTAINS CONTENT AND EXPERIENCES IN ADVANCED BEHAVIOR MANAGEMENT OR A CONTINUING EDUCATION COURSE OF NO LESS THAN 6 HOURS IN ADVANCED BEHAVIOR MANAGEMENT THAT INVOLVES BOTH DIDACTIC AND DEMONSTRATION COMPONENTS.  THIS TRAINING REQUIREMENT WILL BE EFFECTIVE OCTOBER 1, 2006.

3.  PRE-IMMOBILIZATION REQUIREMENTS

a.  PRIOR TO UTILIZING MEDICAL IMMOBILIZATION, THE DENTIST SHALL CONSIDER EACH OF THE FOLLOWING:

1.	OTHER ALTERNATIVE LESS RESTRICTIVE BEHAVIORAL MANAGEMENT METHODS;

2.  THE DENTAL NEEDS OF THE PATIENT;

3.  THE EFFECT ON THE QUALITY OF DENTAL CARE;

4.  THE PATIENT’S EMOTIONAL DEVELOPMENT; AND

5.  THE PATIENT’S PHYSICAL CONDITION; AND

6.  THE SAFETY OF THE PATIENT, DENTIST, AND STAFF.

b.  PRIOR TO USING MEDICAL IMMOBILIZATION, THE DENTIST SHALL OBTAIN WRITTEN INFORMED CONSENT FOR THE SPECIFIC TECHNIQUE OF IMMOBILIZATION FROM THE PARENT OR LEGAL GUARDIAN  AND DOCUMENT SUCH CONSENT IN THE DENTAL RECORD, UNLESS THE PARENT OR LEGAL GUARDIAN IS IMMOBILIZING THE PATIENT.  CONSENT INVOLVING SOLELY THE PRESENTATION OR DESCRIPTION OF A LISTING OF VARIOUS BEHAVIOR MANAGEMENT TECHNIQUES IS NOT CONSIDERED TO CONSTITUTE INFORMED CONSENT FOR MEDICAL IMMOBILIZATION.  THE PARENT OR GUARDIAN MUST BE INFORMED OF THE ADVANTAGES AND DISADVANTAGED OF THE TECHNIQUE(S) OF IMMOBILIZATION BEING UTILIZED AND/OR CONSIDERED.

4.  MEDICAL IMMOBILIZATION OR PROTECTIVE STABILIZATION

a.  IMMOBILIZATION CAN BE PERFORMED BY THE DENTIST, STAFF, OR PARENT OR LEGAL GUARDIAN WITH OR WITHOUT THE AID OF AN IMMOBILIZATION DEVICE.

b.  IMMOBILIZATION MUST CAUSE NO SERIOUS OR PERMANENT INJURY AND THE LEAST POSSIBLE DISCOMFORT.

c.  INDICATION.  PARTIAL OR COMPLETE IMMOBILIZATION MAY BE USED FOR REQUIRED DIAGNOSIS AND/OR TREATMENT IF THE PATIENT CANNOT COOPERATE DUE TO LACK OF MATURITY, MENTAL OR PHYSICAL HANDICAP, FAILURE TO COOPERATE AFTER OTHER BEHAVIOR MANAGEMENT TECHNIQUES HAVE FAILED AND/OR WHEN THE SAFETY OF THE PATIENT, DENTIST OR DENTAL STAFF WOULD BE AT RISK WITHOUT USING PROTECTIVE STABILIZATION.  THIS METHOD CAN ONLY BE USED TO REDUCE OR ELIMINATE UNTOWARD MOVEMENT, PROTECT THE PATIENT AND STAFF FROM INJURY, AND TO ASSIST IN THE DELIVERY OF QUALITY DENTAL TREATMENT.

d.  CONTRAINDICATIONS.  MEDICAL IMMOBILIZATION MAY NOT BE USED FOR THE CONVENIENCE OF THE DENTIST, AS PUNISHMENT, TO PROVIDE CARE FOR A COOPERATIVE PATIENT, OR FOR A PATIENT WHO CANNOT BE IMMOBILIZED SAFELY DUE TO MEDICAL CONDITIONS.

e.  DOCUMENTATION.  THE PATIENT’S RECORDS SHOULD INCLUDE:

1. SPECIFIC WRITTEN INFORMED CONSENT FOR THE MEDICAL IMMOBILIZATION, INCLUDING THE REASON WHY IMMOBILIZATION IS REQUIRED;

2.  TYPE OF IMMOBILIZATION USED, INCLUDING IMMOBILIZATION BY A PARENT OR GUARDIAN;

3. INDICATION OR REASON FOR SPECIFIC IMMOBILIZATION;

4.  DURATION OF APPLICATION;

5.	DOCUMENTATION OF ADEQUACY OF PATIENT AIRWAY, PERIPHERAL CIRCULATION AND PROPER POSITIONING OF IMMOBILIZATION DEVICE OR TECHNIQUE IN INCREMENTS OF 15 MINUTES WHILE IMMOBILIZATION IS UTILIZED.

6.   IN ADDITION, THERE MUST BE DOCUMENTATION OF THE OUTCOME OF THE IMMOBILIZATION, INCLUDING THE OCCURRENCE OF ANY MARKS, BRUISES, INJURIES, OR COMPLICATIONS TO THE PATIENT.

f.  DURATION OF APPLICATION.

1.  THE PATIENT RECORD MUST DOCUMENT THE TIME EACH IMMOBILIZATION BEGAN AND ENDED.

2.  THE STATUS AND PROGRESS OF THE TREATMENT AND THE PLAN FOR FUTURE OR REMAINING TREATMENT WITH TREATMENT OPTIONS SHALL BE REPORTED AT LEAST HOURLY, OR MORE FREQUENTLY IF APPROPRIATE, TO THE PARENT OR LEGAL GUARDIAN.  AFTER EACH SUCH HOURLY REPORT, RENEWED CONSENT FOR CONTINUATION OF THE IMMOBILIZATION MUST BE SPECIFICALLY OBTAINED.  SUCH CONSENT MAY BE VERBAL BUT SHALL BE DOCUMENTED IN THE RECORD.

g.  IF THE TREATMENT PLAN CHANGES DURING THE PROCEDURE FROM THAT PRESENTED TO THE PARENT OR LEGAL GUARDIAN IN THE INITIAL INFORMED CONSENT DISCUSSION, THE PARENT OR LEGAL GUARDIAN SHALL BE NOTIFIED AND CONSULTED IMMEDIATELY.

h.  DENTAL HYGIENISTS AND DENTAL ASSISTANTS SHALL NOT USE MEDICAL IMMOBILIZATION BY THEMSELVES, BUT MAY ASSIST THE DENTIST AS NECESSARY.

D. Pre-Immobilization Requirements 

1.	Prior to utilizing medical immobilization, the dentist shall consider each of the following. 

a. Other alternate less restrictive behavioral management methods; 

b. The dental needs of the patient; 

c. The effect on the quality of dental care; 

d. The patient’s emotional development; and 

e. The patient’s physical condition. 

f. The safety of the patient, dentist, and staff; 

2.	Prior to utilizing medical immobilization, the dentist shall obtain written informed consent for the specific technique of immobilization from the parent or legal guardian and document such consent in the dental record, unless the parent or legal guardian is immobilizing the patient. Consent involving solely the presentation or description of a listing of various behavior management techniques is not considered to constitute informed consent for medical immobilization. The parent or guardian must be informed of the advantages and disadvantages of the technique(s) of immobilization being utilized and/or considered. 

1.	Immobilization can be performed by the dentist, staff, or legal guardian with or without the aid of an immobilization device. 

2.	Immobilization must cause no serious or permanent injury and the least possible discomfort. 

3.	Indications. Partial or complete immobilization may be used for required diagnosis and/or treatment if the patient cannot cooperate due to lack of maturity, mental or physical handicap, failure to cooperate after other behavior management techniques have failed and/or when the safety of the patient, dentist or dental staff would be at risk without using protective stabilization. This method can only be used to reduce or eliminate untoward movement, protect the patient and staff from injury, and to assist in the delivery of quality dental treatment. 

E.	Medical Immobilization or Protective Stabilization 
a. Specific written informed consent for the medical immobilization, including the reason why immobilization is required. 

b. Type of immobilization used, including immobilization by a parent or guardian. 

c. Indication or reason for specific immobilization. 

d. Duration of application. 

e. Documentation of adequacy of patent airway, peripheral circulation, and proper positioning of immobilization device or technique in increments of 15 minutes while immobilization is utilized. 

f. In addition, there must be documentation of the outcome of the immobilization, including the occurrence of any marks, bruises, injuries, or complications to the patient. 

a. The patient record must document the time each immobilization began and ended. 

b. The status and progress of the treatment and the plan for future or remaining treatment with treatment options shall be reported at least hourly, or more frequently if appropriate, to the parent or legal guardian. After each such hourly report, renewed consent for continuation of the immobilization must be specifically obtained. Such consent may be verbal but shall be documented in the record. 

4.	Contraindications. Medical immobilization may not be used for the convenience of the dentist, as punishment, to provide care for a cooperative patient, or for a patient who cannot be immobilized safely due to medical conditions. 

5.	Documentation. The patient’s record should include 

6.	Duration of application. 

7. 	If the treatment plan changes during the procedure from that presented to the parent or legal guardian in the initial informed consent discussion, the parent and or legal guardian shall be notified and consulted immediately. 

8. 	Dental hygienists and dental assistants shall not use medical immobilization by themselves, but may assist the dentist as necessary. 

9. 	Parents or legal guardians cannot be denied access to the patient during treatment in the dental office unless the health and safety of the patient, parent or guardian, or dental staff would be at risk. The parent or guardian shall be informed of the reason they are denied access to the patient and both the incident of the denial and the reason for the denial shall be documented in the patient’s dental record. This provision shall not apply to dental care delivered in an accredited hospital or acute care facility. 

COLORADO STATE BOARD OF DENTAL EXAMINERS
Rulemaking Hearing, October 24, 2007

Proposed Changes with Statement of Basis, Purpose, and Authority

Basis and Purpose:  To ensure total disclosure of all patient records, books, papers, documentary evidence or other materials subpoenaed or requested by the Board pursuant to its statutory authority to conduct investigations and inspections.

Statement of Authority:	Pursuant to CRS 12-35-107 (1) (b), Make, publish, declare, and periodically review such reasonable rules as may be necessary to carry out and make effective the powers and duties of the board as vested in it by this article. Rules of the board may include but shall not be limited to: 

(I) The examination of applicants for licensing as dentists and dental hygienists; 

(II) The practices of dentistry and dental hygiene; 

(III) The tasks and procedures that may be assigned to dental assistants and dental hygienists; and 

(IV) The specification of essential instructions to be included in a laboratory work order.

RULE XXX – COMPLIANCE WITH BOARD SUBPOENA
(Effective December 31, 2007)

	A.  WHEN THE BOARD REQUESTS A PATIENT’S COMPLETE PATIENT RECORD, PURSUANT TO SUBPOENA, THE PATIENT CHART OR RECORD SHALL INCLUDE ALL MEDICAL HISTORIES FOR THE PATIENT, ALL PATIENT NOTES, ALL LABELED AND DATED RADIOGRAPHS, ALL BILLING AND/OR ALL INSURANCE RECORDS THAT ARE COMPILED FOR A SPECIFIC PATIENT.  

B.  IT IS THE RESPONSIBILITY OF THE LICENSED DENTIST OR DENTAL HYGIENIST TO ASSURE THAT ALL RECORDS SUBMITTED ARE LEGIBLE AND, IF NECESSARY, TO HAVE RECORDS TRANSCRIBED TO ASSURE LEGIBILITY.

C.  FAILURE  BY A LICENSED DENTIST OR DENTAL HYGIENIST TO SUBMIT THE COMPLETE PATIENT RECORD TO THE BOARD, OR ANY RELEVANT PAPERS, BOOKS, RECORDS, DOCUMENTARY EVIDENCE, AND/OR OTHER MATERIALS, AS REQUESTED PURSUANT TO SUBPOENA IS A VIOLATION OF § 12-35-129(1)(i), C.R.S.