Standards Of Practice

Link to law: http://arcweb.sos.state.or.us/pages/rules/oars_800/oar_818/818_012.html
Published: 2015

The Oregon Administrative Rules contain OARs filed through November 15, 2015

 

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OREGON BOARD OF DENTISTRY

 

DIVISION 12
STANDARDS OF PRACTICE

818-012-0005
Scope of Practice
(1) No dentist may perform any of the procedures
listed below:
(a) Rhinoplasty;
(b) Blepharoplasty;
(c) Rhydidectomy;
(d) Submental liposuction;
(e) Laser resurfacing;
(f) Browlift, either open or
endoscopic technique;
(g) Platysmal muscle plication;
(h) Otoplasty;
(i) Dermabrasion;
(j) Lip augmentation;
(k) Hair transplantation, not
as an isolated procedure for male pattern baldness; and
(l) Harvesting bone extra orally
for dental procedures, including oral and maxillofacial procedures.
(2) Unless the dentist:
(a) Has successfully completed
a residency in Oral and Maxillofacial Surgery accredited by the American Dental
Association, Commission on Dental Accreditation (CODA), and
(b) Has successfully completed
a clinical fellowship, of at least one continuous year in duration, in esthetic
(cosmetic) surgery recognized by the American Association of Oral and Maxillofacial
Surgeons or by the American Dental Association Commission on Dental Accreditation,
or
(c) Holds privileges either:
(A) Issued by a credentialing
committee of a hospital accredited by the Joint Commission on Accreditation of Healthcare
Organizations (JCAHO) to perform these procedures in a hospital setting; or
(B) Issued by a credentialing
committee for an ambulatory surgical center licensed by the State of Oregon and
accredited by either the JCAHO or the Accreditation Association for Ambulatory Health
Care (AAAHC).
(3) A dentist may utilize Botulinum
Toxin Type A to treat a condition that is within the scope of the practice of dentistry
after completing a minimum of 16 hours in a hands on clinical course(s) in which
the provider is approved by the Academy of General Dentistry Program Approval for
Continuing Education (AGD PACE) or by the American Dental Association Continuing
Education Recognition Program (ADA CERP).
Stat. Auth.: ORS 679 & 680
Stats. Implemented: ORS 679.010(2),
679.140(1)(c), 679.140(2), 679.170(6) & 680.100
Hist.: OBD 6-2001, f. &
cert. ef. 1-8-01; OBD 1-2013, f. 5-15-13, cert. ef. 7-1-13; OBD 3-2013, f. 10-24-13,
cert. ef. 1-1-14; OBD 1-2014, f. 7-2-14, cert. ef. 8-1-14
818-012-0010
Unacceptable Patient Care
The Board finds, using the criteria set forth in ORS 679. 140(4), that a licensee engages in or permits the performance of unacceptable patient care if the licensee does or permits any person to:
(1) Provide treatment which exposes a patient to risk of harm when equivalent or better treatment with less risk to the patient is available.
(2) Fail to seek consultation whenever the welfare of a patient would be safeguarded or advanced by having recourse to those who have special skills, knowledge and experience; provided, however, that it is not a violation of this section to omit to seek consultation if other competent licensees in the same locality and in similar circumstances would not have sought such consultation.
(3) Fail to provide or arrange for emergency treatment for a patient currently receiving treatment.
(4) Fail to exercise supervision required by the Dental Practice Act over any person or permit any person to perform duties for which the person is not licensed or certified.
(5) Render services which the licensee is not licensed to provide.
(6) Fail to comply with ORS 453.605 to 453.755 or rules adopted pursuant thereto relating to the use of x-ray machines.
(7) Fail to maintain patient records in accordance with OAR 818-012-0070.
(8) Fail to provide goods or services in a reasonable period of time which are due to a patient pursuant to a contract with the patient or a third party.
(9) Attempt to perform procedures which the licensee is not capable of performing due to physical or mental disability.
(10) Perform any procedure for which the patient or patient's guardian has not previously given informed consent provided, however, that in an emergency situation, if the patient is a minor whose guardian is unavailable or the patient is unable to respond, a licensee may render treatment in a reasonable manner according to community standards.
(11) Use the behavior management technique of Hand Over Mouth (HOM) without first obtaining informed consent for the use of the technique.
(12) Use the behavior management technique of Hand Over Mouth Airway Restriction (HOMAR) on any patient.
Stat. Auth.: ORS 679 & ORS 680

Stats. Implemented: ORS 679.140(1)(e), ORS 679.140(4) & ORS 680.100

Hist.: DE 6, f. 8-9-63, ef. 9-11-63; DE 14, f. 1-20-72, ef. 2-10-72; DE 5-1980, f. & ef. 12-26-80; DE 2-1982, f. & ef. 3-19-82; DE 5-1982, f. & ef. 5-26-82; DE 9-1984, f. & ef. 5-17-84; Renumbered from 818-010-0080; DE 3-1986, f. & ef. 3-31-86; DE 1-1988, f. 12-28-88, cert. ef. 2-1-89, DE 1-1989, f. 1-27-89, cert. ef. 2-1-89; Renumbered from 818-011-0020; DE 2-1997, f. & cert. ef. 2-20-97; DE 3-1997, f. & cert. ef. 8-27-97; OBD 7-2001, f. & cert. ef. 1-8-01
818-012-0015
Licensee to Notify Board of Certain Events
Licensees shall report to the Board incidents of mortality that occur in the course of the licensee's practice.
(1) The licensee performing the dental procedure must submit a written detailed report to the Board within five working days of the incident along with the patient's complete original dental records. The detailed report(s) must include:
(a) Name, age and address of patient;
(b) Name of the licensee and other persons present during the incident;
(c) Address where the incident took place;
(d) Type of anesthesia and dosages of drugs administered to the patient; and
(e) A narrative description of the incident including approximate times and evolution of symptoms.
(2) Reports filed with the Board under this rule are confidential and are only subject to public disclosure pursuant to ORS 192.502(2).
Stat. Auth.: ORS 679 & ORS 680

Stats. Implemented: ORS 679.250(7)

Hist.: OBD 10-2001, f. & cert. ef. 1-8-01
818-012-0020
Additional Methods of Discipline for Unacceptable Patient Care
In addition to other discipline, the Board may order a licensee who engaged in or permitted unacceptable patient care to:
(1) Make restitution to the patient in an amount to cover actual costs in correcting the unacceptable care.
(2) Refund fees paid by the patient with interest.
(3) Complete a Board-approved course of remedial education.
(4) Discontinue practicing in specific areas of dentistry or hygiene.
(5) Practice under the supervision of another licensee.
Stat. Auth.: ORS 679 & 680

Stats. Implemented: ORS 679.140(5)(h) & 680.100

Hist.: DE 3-1986, f. & ef. 3-31-86; DE 1-1988, f. 12-28-88, cert. ef. 2-1-89, DE 1-1989, f. 1-27-89, cert. ef. 2-1-89; Renumbered from 818-001-0045
818-012-0030
Unprofessional Conduct
The Board finds that in addition to the
conduct set forth in ORS 679.140(2), a licensee engages in unprofessional conduct
if the licensee does or permits any person to:
(1) Attempt to obtain a fee
by fraud or misrepresentation.
(2) Obtaining a fee by fraud
or misrepresentation.
(a) A licensee obtains a fee
by fraud if the licensee obtains a fee by knowingly making or permitting any person
to make a material, false statement intending that a recipient who is unaware of
the truth rely upon the statement.
(b) A licensee obtains a fee
by misrepresentation if the licensee obtains a fee through making or permitting
any person to make a material, false statement.
(c) Giving cash discounts and
not disclosing them to third party payors is not fraud or misrepresentation.
(3) Offer rebates, split fees,
or commissions for services rendered to a patient to any person other than a partner,
employee, or employer.
(4) Accept rebates, split fees,
or commissions for services rendered to a patient from any person other than a partner,
employee, or employer.
(5) Initiate, or engage in,
with a patient, any behavior with sexual connotations. The behavior can include
but is not limited to, inappropriate physical touching; kissing of a sexual nature;
gestures or expressions, any of which are sexualized or sexually demeaning to a
patient; inappropriate procedures, including, but not limited to, disrobing and
draping practices that reflect a lack of respect for the patient's privacy; or initiating
inappropriate communication, verbal or written, including, but not limited to, references
to a patient's body or clothing that are sexualized or sexually demeaning to a patient;
and inappropriate comments or queries about the professional's or patient's sexual
orientation, sexual performance, sexual fantasies, sexual problems, or sexual preferences.
(6) Engage in an unlawful trade
practice as defined in ORS 646.605 to 646.608.
(7) Fail to present a treatment
plan with estimated costs to a patient upon request of the patient or to a patient's
guardian upon request of the patient's guardian.
(8) Misrepresent any facts to
a patient concerning treatment or fees.
(9)(a) Fail to provide a patient
or patient's guardian within 14 days of written request:
(A) Legible copies of records;
and
(B) Duplicates of study models
and radiographs, photographs or legible copies thereof if the radiographs, photographs
or study models have been paid for.
(b) The dentist may require
the patient or guardian to pay in advance a fee reasonably calculated to cover the
costs of making the copies or duplicates. The dentist may charge a fee not to exceed
$30 for copying 10 or fewer pages of written material and no more than $0.50 per
page for pages 11 through 50 and no more than $0.25 for each additional page (including
records copied from microfilm), plus any postage costs to mail copies requested
and actual costs of preparing an explanation or summary of information, if requested.
The actual cost of duplicating x-rays may also be charged to the patient. Patient
records or summaries may not be withheld from the patient because of any prior unpaid
bills, except as provided in (9)(a)(B) of this rule.
(10) Fail to identify to a patient,
patient's guardian, or the Board the name of an employee, employer, contractor,
or agent who renders services.
(11) Use prescription forms
pre-printed with any Drug Enforcement Administration number, name of controlled
substances, or facsimile of a signature.
(12) Use a rubber stamp or like
device to reproduce a signature on a prescription form or sign a blank prescription
form.
(13) Order drugs listed on Schedule
II of the Drug Abuse Prevention and Control Act, 21 U.S.C. Sec. 812, for office
use on a prescription form.
(14) Violate any Federal or
State law regarding controlled substances.
(15) Becomes addicted to, or
dependent upon, or abuses alcohol, illegal or controlled drugs, or mind altering
substances.
(16) Practice dentistry or dental
hygiene in a dental office or clinic not owned by an Oregon licensed dentist(s),
except for an entity described under ORS 679.020(3) and dental hygienists practicing
pursuant to ORS 680.205(1)(2).
(17) Make an agreement with
a patient or person, or any person or entity representing patients or persons, or
provide any form of consideration that would prohibit, restrict, discourage or otherwise
limit a person's ability to file a complaint with the Oregon Board of Dentistry;
to truthfully and fully answer any questions posed by an agent or representative
of the Board; or to participate as a witness in a Board proceeding.
(18) Fail to maintain at a minimum
a current BLS for Healthcare Providers certificate or its equivalent. (Effective
January 2015).
[Publications: Publications referenced
are available from the agency.]
Stat. Auth.: ORS 679 &
680
Stats. Implemented: ORS 679.140(1)(c),
679.140(2), 679.170(6) & 680.100
Hist.: DE 6, f. 8-9-63, ef.
9-11-63; DE 14, f. 1-20-72, ef. 2-10-72; DE 5-1980, f. & ef. 12-26-80; DE 2-1982,
f. & ef. 3-19-82; DE 5-1982, f. & ef. 5-26-82; DE 9-1984, f. & ef. 5-17-84;
Renumbered from 818-010-0080; DE 3-1986, f. & ef. 3-31-86; DE 1-1988, f. 12-28-88,
cert. ef. 2-1-89; DE 1-1989, f. 1-27-89, cert. ef. 2-1-89; Renumbered from 818-011-0020;
DE 1-1990, f. 3-19-90, cert. ef. 4-2-90; DE 2-1997, f. & cert. ef. 2-20-97;
OBD 3-1999, f. 6-25-99, cert. ef. 7-1-99; OBD 1-2006, f. 3-17-06, cert. ef. 4-1-06;
OBD 1-2007, f. & cert. ef. 3-1-07; OBD 3-2007, f. & cert. ef. 11-30-07;
OBD 1-2008, f. 11-10-08, cert. ef. 12-1-08; OBD 2-2009, f. 10-21-09, cert. ef. 11-1-09;
OBD 1-2014, f. 7-2-14, cert. ef. 8-1-14; OBD 3-2015, f. 9-8-15, cert. ef. 10-1-15
818-012-0040
Infection Control Guidelines
In determining what constitutes unacceptable
patient care with respect to infection control, the Board may consider current infection
control guidelines such as those of the Centers for Disease Control and Prevention
and the American Dental Association. Additionally, licensees must comply with the
following requirements:
(1) Disposable gloves shall
be worn whenever placing fingers into the mouth of a patient or when handling blood
or saliva contaminated instruments or equipment. Appropriate hand hygiene shall
be performed prior to gloving.
(2) Masks and protective eyewear
or chin-length shields shall be worn by licensees and other dental care workers
when spattering of blood or other body fluids is likely.
(3) Between each patient use,
instruments or other equipment that come in contact with body fluids shall be sterilized.
(4) Heat sterilizing devices
shall be tested for proper function by means of a biological monitoring system that
indicates micro-organisms kill each calendar week in which scheduled patients are
treated. Testing results shall be retained by the licensee for the current calendar
year and the two preceding calendar years.
(5) Environmental surfaces that
are contaminated by blood or saliva shall be disinfected with a chemical germicide
which is mycobactericidal at use.
(6) Impervious backed paper,
aluminum foil, or plastic wrap may be used to cover surfaces that may be contaminated
by blood or saliva and are difficult or impossible to disinfect. The cover shall
be replaced between patients.
(7) All contaminated wastes
and sharps shall be disposed of according to any governmental requirements.
Stat. Auth.: ORS 679.120, 679.250(7),
680.075 & 680.150
Stats. Implemented: ORS 679.140,
679.140(4) & 680.100
Hist.: DE 1-1988, f. 12-28-88,
cert. ef. 2-1-89; DE 1-1989, f. 1-27-89, cert. ef. 2-1-89; DE 2-1992, f. & cert.
ef. 6-24-92; OBD 1-2004, f. 5-27-04, cert. ef. 6-1-04; OBD 1-2008, f. 11-10-08,
cert. ef. 12-1-08; OBD 3-2013, f. 10-24-13, cert. ef. 1-1-14; OBD 1-2014, f. 7-2-14,
cert. ef. 8-1-14
818-012-0060
Failure to Cooperate with Board
No licensee shall:
(1) Fail to report to the Board violations of the Dental Practice Act.
(2) Use threats or harassment to delay or obstruct any person in providing evidence in any investigation, contested case, or other legal action instituted by the Board.
(3) Discharge an employee based primarily on the employee's attempt to comply with or aid in the compliance with the Dental Practice Act.
(4) Use threats or harassment to obstruct or delay the Board in carrying out its functions under the Dental Practice Act.
(5) Deceive or attempt to deceive the Board with respect to any matter under investigation including altering or destroying any records.
(6) Make an untrue statement on any document, letter, or application submitted to the Board.
(7) Fail to temporarily surrender custody of original patient records to the Board when the Board makes a written request for the records. For purposes of this rule, the term records includes, but is not limited to, the jacket, treatment charts, models, radiographs, photographs, health histories, billing documents, correspondence and memoranda. No person shall:
(8) Deceive or attempt to deceive the Board with respect to any matter under investigation including altering or destroying any records.
(9) Make an untrue statement on any document, letter, or application submitted to the Board.
Stat. Auth.: ORS 679 & 680

Stats. Implemented: ORS 679.060(4), 679.170(5), 679.250(8), 679.290, 679.310(1), 680.050(4) & 680.100

Hist.: DE 9-1984, f. & ef. 5-17-84; DE 1-1988, f. 12-28-88, cert. ef. 2-1-89; DE 1-1989, f. 1-27-89, cert. ef. 2-1-89; Renumbered from 818-011-0050; DE 2-1997, f. & cert. ef. 2-20-97; OBD 1-2008, f. 11-10-08, cert. ef. 12-1-08
818-012-0070
Patient Records
(1) Each licensee shall have prepared and maintained an accurate record for each person receiving dental services, regardless of whether any fee is charged. The record shall contain the name of the licensee rendering the service and include:
(a) Name and address and, if a minor, name of guardian;
(b) Date and description of examination and diagnosis;
(c) An entry that informed consent has been obtained and the date the informed consent was obtained. Documentation may be in the form of an acronym such as "PARQ" (Procedure, Alternatives, Risks and Questions) or "SOAP" (Subjective Objective Assessment Plan) or their equivalent.
(d) Date and description of treatment or services rendered;
(e) Date and description of treatment complications;
(f) Date and description of all radiographs, study models, and periodontal charting;
(g) Health history; and
(h) Date, name of, quantity of, and strength of all drugs dispensed, administered, or prescribed.
(2) Each dentist shall have prepared and maintained an accurate record of all charges and payments for services including source of payments.
(3) Each dentist shall maintain patient records and radiographs for at least seven years from the date of last entry unless:
(a) The patient requests the records, radiographs, and models be transferred to another dentist who shall maintain the records and radiographs;
(b) The dentist gives the records, radiographs, or models to the patient; or
(c) The dentist transfers the dentist's practice to another dentist who shall maintain the records and radiographs.
Stat. Auth.: ORS 679

Stats. Implemented: ORS 679.140(1)(e) & ORS 679.140(4)

Hist.: DE 9-1984, f. & ef. 5-17-84; DE 1-1988, f. 12-28-88, cert. ef. 2-1-89, DE 1-1989, f. 1-27-90, cert. ef. 2-1-90; Renumbered from 818-011-0060; DE 1-1990, f. 3-19-90, cert. ef. 4-2-90; OBD 7-2001, f. & cert. ef. 1-8-01
818-012-0075
Administration of Local Anesthesia -- Lip Color Procedures
A dentist licensed in Oregon may administer local anesthesia to a person who proposes to receive permanent lip color and/or permanent hair removal in the lip area from a permanent color technician/tattoo artist or an electrologist licensed under ORS 690.350 to 690.430. Prior to the administration of local anesthesia for this purpose, the licensed dentist shall:
(1) Receive a written order from a licensed permanent color technician/tattoo artist or a licensed electrologist, which shall be maintained in the patient record;
(2) Obtain a current health history;
(3) Perform an oral examination; and
(4) Create and maintain a patient record as required by OAR 818-012-0070.
Stat. Auth.: ORS 679

Stats. Implemented: ORS 679.500

Hist.: OBD 6-2000, f. 6-22-00, cert. ef. 7-1-00; OBD 1-2004, f. 5-27-04, cert. ef. 6-1-04
818-012-0080
Prescription Practices
(1) In conjunction with dental treatment, a dentist may prescribe, dispense, or administer medications relevant to the care being provided.
(2) It is improper to prescribe or dispense drugs outside the scope of the practice of dentistry or in a manner that impairs the health and safety of an individual including:
(a) Prescribing or dispensing drugs in such amounts as to constitute a departure from the prevailing standards of acceptable dental practice; and
(b) Prescribing or dispensing controlled substances for persons who are not patients of record in the dentist's practice unless the dentist is acting on behalf of the dentist of record.
Stat. Auth.: ORS 679 & ORS 680

Stats. Implemented: ORS 679.140(2)(h) & ORS 680.100

Hist.: DE 9-1984, f. & ef. 5-17-84; DE 1-1988, f. 12-28-88, cert. ef. 2-1-89, DE 1-1989, f. 1-27-89, cert. ef. 2-1-89; Renumbered from 818-011-0070; OBD 13-2001, f. & cert. ef. 4-18-01
818-012-0090
Obtaining Controlled Substances
(1) No licensee shall obtain or attempt to obtain any controlled substance by any misrepresentation or subterfuge.
(2) No licensee shall prescribe any controlled substance for the licensee's personal consumption.
(3) No licensee shall purchase any controlled substance for the licensee's personal consumption other than by prescription from a licensed practitioner in conjunction with treatment to the licensee.
Stat. Auth.: ORS 679 & ORS 680

Stats. Implemented: ORS 679.140(2)(g) & ORS 680.100

Hist.: DE 1-1988, f. 12-28-88, cert. ef. 2-1-89, DE 1-1989, f. 1-27-89, cert. ef. 2-1-89
818-012-0100
Controlled Substances Record Keeping Requirements
(1) Each dentist shall have a current and constant inventory of all controlled substances.
(2) Each time a dentist dispenses any drug listed on Schedule II of the Drug Abuse Prevention and Control Act, 21 U.S.C., Sec 812, the dentist shall record the following information on a readily retrievable record of dispensing maintained separate from patient records:
(a) Name of each patient;
(b) Name, strength, and quantity of the drug dispensed; and
(c) Date the drug was dispensed.
(3) Each dentist shall:
(a) Maintain a record of any controlled substance lost, destroyed, or stolen which shall include the name and quantity of the controlled substance and the date of such loss, destruction or theft; and
(b) Report the loss, destruction, or theft to the United States Drug Enforcement Administration regional office.
[Publications: The publication(s) referred to in this rule are available from the agency.]
Stat. Auth.: ORS 679

Stats. Implemented: ORS 679.140(2)(g) & ORS 679.140(2)(h)

Hist.: DE 9-1984, f. & ef. 5-17-84; DE 1-1988, f. 12-28-88, cert. ef. 2-1-89, DE 1-1989, f. 1-27-89, cert. ef. 2-1-89; Renumbered from 818-011-0100
818-012-0110
Extension of Authority to Operate a Dental Practice
(1) Upon the death or disability of a shareholder dentist, the administrator, executor, personal representative, guardian, conservator or receiver of the former dentist shareholder shall notify the Board in writing of the management arrangement for the dental practice.
(2) At least 30 days prior to the expiration of an initial 12-month period following the creation of an ownership interest described in ORS 679.020(7), the administrator, executor, personal representative, guardian, conservator or receiver of the former dentist shareholder shall submit to the Board a written request for extension of authority to continue maintaining and operating a dental practice. One 12-month extension (for a total of 24 months) shall be automatically granted.
(3) Any request for extension beyond 24 months shall be submitted in writing to the Board at least 60 days prior to the expiration of the 24-month period. The Board on a case-by-case basis shall review such requests.
Stat. Auth.: ORS 679

Stats. Implemented: ORS 679.020

Hist.: OBD 1-2004, f. 5-27-04, cert. ef. 6-1-04

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