Disclaimer: Practice guidelines provide licensees with general guidance to promote good practice. Law, rules and regulations, not guidelines, specify the requirements for practice and what may constitute professional misconduct.
Administration of General Anesthetic Agents
Education Law 6605-a provides that a licensed dentist shall not employ conscious sedation, deep sedation or general anesthesia in the practice of dentistry, at any location other than a general hospital, without a dental anesthesia certificate issued by the department. Part 61.10 of the Commissioner’s regulations provides for the issuance of different types of dental anesthesia certificates and sets forth the educational and training requirements required to obtain such certificates.
Section 61.10 (b) (2) (i) of the Commissioner’s regulations provides that certificates in dental general anesthesia authorizes a licensed dentist to employ conscious (moderate) sedation (enteral or parenteral route with or without inhalation agents), deep sedation, and general anesthesia. Due to the potential complications and patient safety concerns that may arise during the administration of deep sedation using general anesthetic agents, dentists must meet the required training, experience and certification requirements to obtain a dental general anesthesia certificate in accordance with the regulations. As a general rule, dentists must hold a current dental general anesthesia (deep sedation) certificate in order to employ deep sedation and general anesthesia through the administration of general anesthetic and deep sedation agents including but not limited to, Ketamine and Propofol, by any route of administration outside a hospital or dental school-based practice. Dentists holding dental certificates in other titles, such as dental parenteral conscious (moderate) sedation and dental enteral conscious (moderate) sedation, whether issued for patients 13 years or older or 12 years or younger, should not be utilizing or administering general anesthetic and deep sedation agents, outside a hospital or dental school-based practice, regardless of the level of sedation achieved when utilizing these agents.
A certificate in dental general anesthesia (deep sedation) may be granted based upon, among other things, the following criteria:
- completion of a 2-year post-doctoral education program in dental anesthesia (completion of a Commission on Dental Accreditation accredited residency in dental anesthesiology); or
- completion of 3- years of post-doctoral education in dental anesthesia, acceptable to the Department and accredited by an acceptable accrediting body (completion of a Commission on Dental Accreditation accredited residency in dental anesthesiology); or
- completion of a graduate level program in oral & maxillofacial surgery acceptable to the Department and accredited by an acceptable accrediting body (completion of a Commission on Dental Accreditation accredited residency in oral & maxillofacial surgery).
For more information on general anesthesia/deep sedation certificates please review New York Education Law §6605-a, Part 86.10 of the Commissioner’s Regulations and the New York State Office of Professions Dental Professions website.
November 18, 2019.
Privacy is a patient right. Dentists have an ethical and legal responsibility to safeguard patient information. Patient information includes such information as personal data, medical history, diagnosis, treatment, and financial situation.
Patient information should be shared only on a need-to-know basis with those who participate in the care of the patient. Unless disclosure is required or permitted by law, patient information should not be shared with anyone without the patient's written permission. Court orders, subpoenas and investigations by the Office of Professional Discipline are examples of disclosures that may be required even in the absence of the patient's consent.
Patient information, written or electronic, must be kept secure from loss, theft, or unauthorized access, use or disclosure. Confidential information should be kept out of plain view, and stored in a secure environment. Care should be taken not to talk about patients in public places, even if you are not using the patient's name.
Under section 29.1(b)(8) of the Regents Rules, it is unprofessional conduct to reveal personally identifiable facts, data or information obtained in a professional capacity without the prior consent of the patient or client, except as authorized or required by law. If you violate this confidentiality rule, you may be subject to charges of unprofessional conduct.
Your decision to disclose patient information must be consistent with the Health Insurance Portability and Accountability Act of 1996 (HIPAA), if it applies. More information regarding HIPAA may be found on the United States Department of Health and Human Services website.
Health professionals are required to maintain records for each patient that accurately reflect the evaluation and treatment of the patient according to section 29.2(a)(3) of the Rules of the Board of Regents. All patient records must be retained for at least six years, with the exception of records for minor patients, which must be maintained for at least six years and for one year after the minor patient reaches the age of 21.
Accurate and complete patient records serve many purposes. For example, patient records can protect both the consumer and the practitioner, guide professional treatment, and facilitate professional consultations. Patient records are important documents in matters pertaining to professional liability and professional discipline.
Practitioners and their patients should be aware that under some conditions other parties might have reason to have access to patient records. For example, in some cases, patient records may be needed by other professionals to provide requisite patient care. Your records, therefore, should be an accurate and legible account of the evaluation and treatment of the patient.
Under Section 18 of the Public Health Law, patients have the right of access to their records under most circumstances. If you deny access to records to a patient, you have an obligation to inform the patient of his/her right to appeal to the Office of Record Access of the Department of Health. Contact information is available on the New York State Department of Health website.
If you dispose of records when there is no longer any obligation or need to maintain them, they should be properly destroyed to safeguard patient confidentiality.
Dentists who retire or sell their practices must make provisions for records to be maintained and accessed, if requested. The obligation to maintain records is not changed by the retirement or sale of a practice by a dentist.
Your records may be your principal defense to charges of professional misconduct. There is no statute of limitations for charges of professional misconduct.
Dentists should also make provisions for the maintenance and destruction, as appropriate, of their patients' records in the event of the dentist's death. Patient records may be important documents in the event of a malpractice suit against the dentist's estate after his or her death.
The dentist should adequately monitor the performance of all personnel, licensed or unlicensed, that he or she supervises. The dentist is ultimately responsible for quality patient care and may be held accountable for all services provided by administrative and clinical individuals that the dentist supervises.
Section 29.2(a)(1) of the Rules of the Board of Regents defines as a basis for unprofessional conduct, "abandoning or neglecting a patient or client under and in need of immediate professional care, without making reasonable arrangements for the continuation of such care, or abandoning a professional employment by a group practice, hospital, clinic or other health care facility, without reasonable notice and under circumstances which seriously impair the delivery of professional care to patients or clients."
If a dentist becomes unexpectedly ill or disabled rendering him or her unable to continue to provide services, the discontinuation of services would generally not be considered abandonment. However, appropriate planning for such events early in the professional relationship can ensure that patients receive the essential services they need when such emergencies occur.
Dentists who surrender or lose a license as a result of a professional disciplinary action should also ensure that patients are referred to other dentists who can provide essential professional services.
Consultation with Other Professionals
Good practice often involves the need to consult with other professionals to provide quality patient care. When legally required or when consultation is otherwise appropriate, you should obtain the patient's consent before consulting with other professionals.
It is also good practice, and in certain circumstances it may be necessary, for the patient to give informed consent permitting you to reveal any personally identifiable information to a consultant.
The Office of the Professions does not negotiate or resolve fee disputes. However, fee disputes can often lead to complaints of professional misconduct including claims unrelated to the actual fee dispute, such as claims of negligence or incompetence. Even when these complaints are determined to be unfounded, the dentist will have had the inconvenience and expense sometimes associated with an investigation.
To avoid these complaints, dentists should:
- Clarify the billing conditions, including insurance coverage if applicable, with the patient at the outset of the evaluation and treatment, and specify the financial arrangements in terms that the patient can understand.
- Explain to the patient all costs involved with their treatment, including co-payments and expenses that are not covered by insurance. It would be useful to have a written policy in place which is signed by patients to indicate their understanding of the costs involved for their evaluation and treatment, and for the dentist and the patient to develop an individualized payment agreement in advance of treatment when the patient must pay for non-covered expenses.
Insurance Billing and Pitfalls
Insurance billing, though sometimes seemingly uncomplicated and straightforward, may easily lead to disputes and/or allegations of misconduct. To avoid this, billing statements, insurance claims, and treatment reports should be simple, clear, direct, and accurate representations of the services provided, the fees charged for each service, and the nature of the patient's evaluation and treatment.
- Discussing payment and insurance issues (including pre-certification) at the first meeting with the patient, or soon afterward, could help to ensure that the patient fully understands all financial arrangements and could also help to avoid any possible misunderstandings and subsequent disputes regarding issues such as co-payments or contract differences.
- It is good practice to have the patient's written authorization to release information necessary to process an insurance claim or to complete a treatment report for pre-certification; there may be circumstances in which authorization is required.
- Dentists should be aware of precisely what they are stating when signing any insurance form or report. What information you are asked to provide and what you are asked to attest to often varies depending upon the insurance form or report. For example, a signature as provider on the insurance form may, in some instances, constitute a certification that the signatory directly provided the services him or herself.
- Attention to details and making certain that you have provided all of the required information when completing insurance forms and reports can help to avoid delays in payment and subsequent misunderstandings and disputes between you and the patient.
- When a patient cancels or does not appear for an appointment, it is usually considered fraudulent to bill an insurance company for that appointment unless the insurer has provided for cancellations within the contract.
Professional Conduct in Patient Relations
As a dentist, you have a responsibility to maintain appropriate boundaries in your professional relationships. You should treat all patients with respect and with a professional demeanor.
A dentist should establish a working relationship with patients and when appropriate, with their legal guardians, involving them as active participants in treatment decisions.
Section 29.2(a)(2) of the Rules of the Board of Regents defines unprofessional conduct to include "willfully harassing, abusing or intimidating a patient either physically or verbally."
Sometimes problems may arise due to miscommunication and misperceptions between dentists and patients/guardians. You should try to recognize the indicators of such problems and try to prevent or quickly defuse these situations.
The dentist should keep careful records of what transpires in discussions with each patient and, if appropriate, his or her legal representative.
Office Hygiene - Infection Control
The Education Law requires that every four years every dentist and dental hygienist practicing in New York State complete approved coursework or training appropriate to his/her practice in infection control and barrier precautions. Regular training is necessary to prevent the transmission of disease in the course of professional practice. You must document compliance with this requirement at the time of your first registration and at each subsequent reregistration.
Dental Auxiliaries Permitted to Perform Bleaching Services
A dental hygienist may perform bleaching services under the personal supervision of a dentist However, for the reasons set forth below, a registered dental assistant may not.
Education Law §6608 defines the scope of practice for registered dental assisting and it states, in part, that registered dental assisting services "shall not include diagnosing and/or performing surgical procedures, irreversible procedures or procedures that would alter the hard or soft tissue of the oral and maxillofacial area or any other procedures determined by the department." These exclusions also appear in §§61.13(c)(3) and 61.13(c)(4) of the Commissioner's regulations.
Based on the foregoing, the Department has determined, in consultation with the State Board for Dentistry, that the bleaching process is an irreversible procedure that alters the enamel surface of teeth and, therefore, would not be permissible for registered dental assistants to perform. However, since Education Law §6606, which defines the scope of practice for dental hygiene, contains no such statement about irreversible procedures or altering the hard or soft tissue of the oral and maxillofacial area, dental hygienists may perform bleaching services under the personal supervision of a licensed dentist.
Citations of Pertinent Law, Rules or Regulations:
- Education Law §6608 Definition of practice of registered dental assisting: https://op.nysed.gov/professions/dentistry/laws-rules-regulations/article-133#6608a
- Commissioner's regulations §61.13 Practice of registered dental assisting: https://op.nysed.gov/professions/dentistry/laws-rules-regulations/part-61#6113
- Education Law §6606 Definition of practice of dental hygiene: https://op.nysed.gov/professions/dentistry/laws-rules-regulations/article-133#6606
- Commissioner's regulations §61.9 Practice of dental hygiene: https://op.nysed.gov/professions/dentistry/laws-rules-regulations/part-61#619
Questions or Additional Information
The laws, rules, and regulations pertaining to the practice of dentistry in New York State can be found at Laws, Rules & Regulations for Dentists. If more detailed information is required, you may contact the New York State Board for Dentistry by calling 518-474-3817 ext. 550 or e-mailing email@example.com.