CA Dental Board Report February 2023

Executive Director’s Report Meeting of the Dental Board of California February 9-10, 2023

The Dental Board of California met in Sacramento, CA, February 9-10, 2023. The following report summarizes actions and issues coming before the Board pertinent to pediatric oral health and practice delivery.

DENTAL BOARD MEMBER COMMITTEE ASSIGNMENTS

Under ongoing policy, the Board establishes each year a number of standing committees affecting such jurisdictional areas as licensing examinations, enforcement and disciplinary matters, and regulatory compliance. Each two-member committee meets as relatable issues arise and makes recommendations to the full Board. For 2023, two committees especially relevant to pediatric dental services were identified as follows:

• Access to Care Committee
• Anesthesia Committee

On each committee, one of the two pediatric dentists on the Dental Board were appointed, Dr. Yogita Thakur to Access to Care and Dr. Steven Chan to the Anesthesia Committee.

Comment: The appointments of Drs. Thakur and Chan to these two important committees brings specialty training, knowledge, experience and expertise to decisions and recommendations that have significant potential to affect pediatric patent care, access, safety, and service delivery.

SEDATION PERMITS ISSUED UNDER SB 501

As related in the report of the November meeting of the Board, under SB 501, signed into law in 2018, significant updates to anesthesia and sedation permitting became effective January 1, 2022. Changes include a new moderate sedation permit replacing the existing conscious sedation permit, a new pediatric minimal sedation permit replacing the existing oral conscious sedation permit for minor patients, and new pediatric endorsements for general anesthesia and moderate sedation permits when providing these services to pediatric patients. Delays in the rulemaking process impeded the ability of the Board to begin issuing these new permits and endorsements until mid-August of last year. Through December 31, and, therefore, for all of 2022, the Board has issued only 24 pediatric minimal sedation permits and 54 moderate sedation permits.

Comment: While permits issued and renewed prior to January 1, 2022, remain in effect until their biennial expiration date, it remains to be seen how many will be allowed to expire without replacement by the new permitting certification. Currently 1,190 oral conscious sedation permits for minors and 528 conscious sedation permits are due to expire between now and December 31, 2024. Of 940 existing general anesthesia permits, only 10 applications for a pediatric endorsements have been received by the Board.

IMPLEMENTATION OF SEDATION REGULATIONS UNDER SB 501

Following enactment of SB 501 on January 1, 2022, several areas of concern in the law have been identified that the Board is proposing be modified by legislative action as follows:

• Setting the maximum allowable fee for pediatric endorsement applications and renewals.
• Clarifying that physicians regulated by the Osteopathic Medical Board as well as the Medical Board of California are eligible to be granted general anesthesia and sedation permits issued by the Dental Board of California.
• Conforming the language on the Oral Conscious Sedation – Adult certificate with language for the other general anesthesia and sedation permits and eliminating the 10-case documentation pathway for the OCS-A certificate.
• Establishing continuing education requirements and an expiration date for Pediatric Minimal Sedation permitholders.
• Modifying and conforming the physical presence requirement for all sedation permitting to read “A dentist who administers or orders the administration of pediatric minimal sedation shall be physically present in the treatment facility while the patient is sedated.”
• Adding language to the application process for pediatric endorsements to the general anesthesia and moderate sedation permits that would make case records submitted to the Board expressly confidential and bar disclosure unless under a court order. This results from instances where a residency program under which an applicant was trained refused to provide copies of the sedation records to either the applicant or the Board.
• Including physical evaluation and medical history requirements under the Pediatric Minimal Sedation permit. Like the continuing education course requirements, physical evaluation and medical history language was inadvertently left out of SB 501.

Comment: These proposals will be included in the Board’s Sunset Review Report to the legislature with the recommendation that they be included in a subsequent “clean-up bill” legislation by the Assembly Business and Professions Committee or the Senate Business, Professions, and Economic Development Committee.

ADDITIONAL LEGISLATIVE PROPOSALS

By separate actions, the Board also approved several other legislative proposals potentially affecting pediatric dental care, delivery, and access.

• Clarifying and resolving ambiguities in the Licensure by Credential requirements and application process, including how hours of clinical practice in the preceding five to seven years are defined and calculated, capping the number of hours of residency training that may be applied to this prerequisite, and what documentation and conditions must be met to qualify two years of practice or teaching in a Federally-Qualified Health Center, community clinic, or dental school as qualification for California dental licensure.
• Modifying language regarding infection control education and training required of an unlicensed dental assistant. Current law requires the employer of an unlicensed dental assistant employed continuously for 120 days to subsequently verify Dental Practice Act, infection control, and basic life support course completion by the dental assistant within a year of the date of employment. However, an unlicensed seasonal or temporary employee, not working 120 days continuously, would escape such training and certification. This proposal would require such course completion within one year of the first date of employment, regardless of “gaps” in employment or whether the employee works continuously for 120 days at any point of employment.
• Specifying requirements for the display of the name and license of dentists at the place of practice. Board staff reports confusion among licensees regarding the requirement in the Dental Practice Act that a list of all individuals licensed to practice dentistry and associated with a practice must be displayed “in a conspicuous place” in an office where care is delivered. Proposed legislation would require display of license information in an area “likely to be seen by all patients who use the facility” and that the original or copy of the dental license, permit, or registration to be displayed as well.

Comment: While there is no certainty regarding the passage these legislative propositions, it is still likely they will reach in one form or another the Governor’s Desk and become future law.

Respectfully Submitted, Paul Reggiardo, DDS