The Texas Board of Veterinary Medical Examiners adopts new §573.17, regarding dentistry, with minimal changes to the proposed text as published in the February 18, 2011, issue of the Texas Register (36 TexReg 906). The text of the rule will be republished.
The minimal changes were changing the title of the definition of "animal teeth floating" to "equine teeth floating" in subsection (a)(2) as well as subsection (c). In addition, within that definition, the board changed the definition of "equine teeth floating" to be the "smoothing, filing and polishing of the sharp projections" from the proposed language "the rasping or cutting of the long projections". And finally, the board added language in subsection (b) to clarify and point back to language in board rules stating the supervision requirements of other dental activities are as determined by §573.10 of this title (relating to Supervision of Non-Licensed Employees).
The rule will become effective on July 1, 2011.
Section 801.002(7) of the Veterinary Licensing Act (Act) defines the practice of veterinary medicine to include dentistry, as set out in Texas Occupations Code, Chapter 801. The new board rule defines dentistry and states that dentistry includes: preventive dental procedures, equine teeth floating and operative dentistry/oral surgery, and provides definitions for those terms as well. Though the Texas Veterinary Licensing Act includes dentistry within the definition of the practice of veterinary medicine, no previous definition of dentistry was set out in rule or in statute. The new rule states that the definition of dentistry includes the use of sedation or anesthesia to accomplish a dental procedure by a licensed veterinarian. The use of sedation or anesthesia on horses by unlicensed individuals is currently prohibited by §801.002(5) of the Act. No distinction is made in the definition of dentistry between the floating of teeth of animals with handheld, non-motorized, non-air-powered files or rasps and the use of a motorized or air-powered file. The new rule states any non-licensee may perform animal teeth floating only if they are under the supervision of a licensed veterinarian. The level of supervision required is left up to the judgment of the supervising veterinarian. The new rule also states the licensed veterinarian supervising the non-licensee will be held responsible for the non-licensee to provide the same standard of care to the public as the licensed veterinarian would be required to provide to the public. This is set forth as the public would expect the same standard of care whether a licensed veterinarian provides the service or a non-licensed equine dental practitioner under any level of supervision provides the service.
The new rule does not change that a non-licensee who is employed by a veterinarian may perform dentistry, with certain exceptions, under any level of supervision the licensed veterinarian approves, as set forth in 22 TAC §573.10. The new rule states that a non-licensee who practices dental procedures on animals in a manner inconsistent with this rule is in violation of the rule and the Texas Veterinary Licensing Act.
The board believes that a rule is needed because the unlicensed practice of equine dentistry has become more prevalent in the past few years. Therefore, there was increased concern regarding the possible public health problems occurring with the increase in unlicensed equine dental providers. The public health benefit from the new rule is the reduction of the potential occurrences of complications or injury/harm to animals from non-licensed individuals practicing dentistry, including motorized or powered teeth floating. Protection of the public welfare required action be taken to clarify who may lawfully perform equine dental services and allow additional practitioners under supervision to provide this service to the general public, while ensuring adequate veterinary supervision for the use of sedatives and any other complications resulting from the practice of teeth floating with power tools.
The state of the art procedure for teeth floating in Texas today is the use of power tools to accomplish teeth floating. For a great majority of horses, a practitioner could not use power tools in the mouth of an equine without a sedative, due to the flight nature of equines. Only a licensed veterinarian is legally authorized to possess, administer and/or dispense a legend drug, which includes sedatives. With the use of power tools the potential for complications is increased because it is more likely for injury to occur to the horses' teeth, including invading the pulp, which may cause permanent damage to the horses' teeth. Testimony was provided by licensed veterinarians, including photos, of damage done to horses' teeth, including invading the dental pulp and causing ulcers in the mouth, specifically from power tools used in teeth floating, at the public hearing on a version of this rule on August 20, 2010. Complaints have been filed with the board that include injuries to horses by lay equine teeth floaters. The board determined that the protection of public welfare requires the supervision by a licensed veterinarian. The board heard testimony that a licensed veterinarian needs to be on the premises when motorized or powered teeth floating is performed due to the likelihood and, in fact, the necessity of sedatives being used and the potential for complications implicit with the use of sedatives, or any other complications resulting from the practice of teeth floating.
The board determined that the level of supervision should be decided by the supervising veterinarian, as it would be the supervising veterinarian that would be responsible to the board for any violations of the standard of care because the lay equine dentists are not regulated by any licensing board.
The Texas Veterinary Medical Association (TVMA) provided a comment on the new rule with suggested changes that included the minimal changes added to the rule as stated above. However, TVMA also suggested that the rule should require direct supervision by a licensed veterinarian over the non-licensed equine dental practitioners. The board respectfully disagrees because the board believes the supervising veterinarian should be allowed to determine the level of supervision for any non-licensed equine dental practitioner he or she decides to supervise. TVMA also suggested the board include language within the definition of equine teeth floating to include the term "above the gum line." The board respectfully disagrees as the board believed this term was redundant as one would not be able to smooth, file or polish below the gun line. TVMA did not say whether they were for or against the proposed rule. One comment was received from a veterinarian with a hypothetical situation regarding a non-licensed non-equine dental practitioner providing anesthesia-free dental cleanings under direct supervision of the licensed veterinarian. The board does not believe this rule applies to such conduct. This commenter did not say whether he was for or against the proposed rule. No other comments were received during the comment period regarding the adoption of the new rule.
The board previously received hundreds of comments on a similar version of the rule published in the July 23, 2010, issue of the Texas Register (35 TexReg 6430). The board previously considered and responded to those comments which informed its decision-making process while debating and modifying the current rule.
The new rule is adopted under the authority of the Veterinary Licensing Act, Occupations Code, §801.151(a) which states that the Board may adopt rules necessary to administer the chapter; §801.151(b) of the Act which states that the Board may adopt rules of professional conduct appropriate to establish and maintain a high standard of integrity, skills, and practice in the veterinary medicine profession; and §801.002(7) which includes dentistry within the definition of veterinary medicine.
§573.17.Dentistry.
(a) Definitions. Dentistry is the practice of veterinary medicine and means the application or use of any instrument or device to any portion of any animal's tooth, gum or any related tissue for the prevention, cure or relief of any wound, fracture, injury, disease or other condition of an animal's tooth, gum or related tissue. Dentistry may include the use of sedation or anesthesia to accomplish a dental procedure by a licensed veterinarian. Dentistry includes, but is not limited to:
(1) "Preventive dental procedures" including, but not limited to, the removal of calculus, soft deposits, plaque, and stains, above the gum line or the smoothing, filing or polishing of tooth surfaces above the gum line;
(2) "Equine teeth floating" defined as the smoothing, filing and polishing of the sharp projections or points of the teeth of animals;
(3) "Operative dentistry/oral surgery" or any other dental procedure that invades the hard or soft oral tissue including a procedure that alters the structure of one or more teeth, or repairs damaged and diseased teeth, or the deliberate extraction of one or more teeth.
(b) Supervision. Any non-licensee may perform animal teeth floating only if they are under the appropriate level of supervision of a licensed veterinarian as determined by the licensed veterinarian. The Supervision requirements of other dental activities are as determined by §573.10 of this title (relating to Supervision of Non-Licensed Employees).
(c) Responsibility. When equine teeth floating is performed by a non-licensee, the board will hold the licensee supervising the non-licensee responsible for the standard of care provided by the non-licensee. The board expects the non-licensee to practice at the same standard of care the licensed veterinarian would be required to provide to the public.
(d) Prohibited acts. Any non-licensee who practices any other dental procedures on animals in a manner inconsistent with this rule shall be in violation of this rule and the Texas Veterinary Licensing Act.
This agency hereby certifies that the adoption has been reviewed by legal counsel and found to be a valid exercise of the agency's legal authority.
Filed with the Office of the Secretary of State on April 25, 2011.
TRD-201101558
Loris Jones
Executive Assistant
Texas Board of Veterinary Medical Examiners
Effective date: July 1, 2011
Proposal publication date: February 18, 2011
For further information, please call: (512) 305-7563