State Board of Dentistry Report – January 17, 2020

The board reviewed the minutes from the November 2019 meeting. There were many corrections, including one that changed the vote total. The amended minutes passed unanimously with two abstentions.

Prosecutorial Report

  • The first case involved a consent agreement for infection control protocols arriving from a patient complaint. Among the violations was corrosion on certain instruments and no spore testing procedures. Upon notification from the Department of Health, the office began a compliance program including using an outside vendor for spore testing. A civil penalty of $2,500 plus $3,300 in costs were assessed, as well as two years of office supervision and submission of spore testing results. When asked by the board, prosecutors replied that there was no patient notification because the communicable disease risk was not significant.
  • The second case involved a dentist who entered the three-year voluntary recovery program for alcoholism, bipolar disorder, and ADHD.
  • The third case involved a dentist who received a five-year suspension in Mississippi for prescribing outside their scope of treatment. The practitioner received a similar suspension, although prosecutors indicated that there was a small chance that they would ever practice in Pennsylvania.
  • The fourth case involved a dentist who received a public warning and $3,000 fine in Texas for mistakenly extracting the wrong tooth and subsequently billing MA for the procedure. The Pennsylvania penalty was negotiated to $1,500.
  • The fifth and sixth case involved a dentist administering conscious sedation during an implant procedure. The stacking of medication required a Rescricted Permit I, but the practitioner did not have the proper permit. The sinus was perforated during the procedure and experts noted that the perio charting was insufficient. A subsequent case involved wisdom tooth extraction where the patient lost tactile feeling in the tongue as a result of a partially severed nerve. The procedure took five to six hours to complete, and experts indicated that it did not meet the standard of care. Prosecutors noted that the general practitioner should have referred the case but opted to perform the procedure out of duty to a longtime patient. The practitioner received a significant penalty and costs, with 20 hours of additional education required.
  • The seventh case involved recusals. A multiple-site practice involving two sisters was cited for infection control violations as a result of an anonymous call. The immediate and temporary suspension was resolved in June 2019 due to licensee cooperation, and both were permitted to return to practice. One did, and the other opted to retire and not renew their license. A civil penalty and costs were assessed.
  • The eighth case involved a hygienist who was convicted of a sexual offense involving a minor. The crime was not involved in his practice as a hygienist. The immediate and temporary suspension of his license resulted in its permanent surrender.
  • The ninth case involved a practitioner who had their license indefinitely suspended and subsequently reinstated as a result of alcoholism. After reinstatement, the practitioner relapsed, resulting in a violation of their probation. Their license was resuspended.

Special Guests

Dr. Mana Mozaffarian addressed the board. Dr. Mozaffarian was recently hired as Chief Dental Officer in Pennsylvania, splitting her responsibilities between the Departments of Health and Human Services. Dr. Mozaffarian has an applied math degree before attending dental school at Penn, which leads to her interest in quantifying the effectiveness in public health programming. She was employed at Aetna as dental director before accepting her current position.

Some of the research projects that she has overseen were periodontal treatment among MA populations and its tie-in to overall health, tobacco cessation counseling, and HPV vaccinations. She noted that she was against Public Health Dental Hygiene Practitioner (PHDHP) practice until reading much of the research into it. She now feels that with the right scope of practice and limitations, it can provide a public health option for MA recipients. She would like more research and metrics into which programs work well.

A board member asked if Dr. Mozaffarian was interested in addressing inadequate reimbursement as an obstacle to MA participation. She responded that she was, but acknowledged it is a long process with many stakeholders and will not be completed any time soon.

Dr. Jim Robbins, an oral surgeon practicing in Media, addressed the board. Dr. Robbins is the head of the anesthesia evaluation program, operated under the auspices of the Pennsylvania Society of Oral and Maxillofacial Surgeons. He described the improvements to the program under his tenure. He noted that many licensees do not understand their responsibilities under permit regulations. He recommended the SBOD consider sending a letter to licensees to consider whether they need an anesthesia permit, and to permit holders reminding them of their six-year inspection requirement. Board members advised Dr. Robbins to be careful about directly issuing certificates to permit holders, as they are delegated by the state to inspect. Dr. Robbins assured the board that the certificate was clearly not state issued, and only signified that PSOMS had inspected that particular office.

Report of the Chair

As this meeting had the potential to become contentious, and with some audience members not able to sit in the gallery, the Dr. Erhard recommended that all comments come through the chair. The board was encouraged to see all outstanding regulatory packages listed on the agenda and requested that it be done going forward.

Dr. Erhard reported on a meeting of the American Association of Dental Boards, which he attended with Ms. Murray and Dr. Unis Sullivan. Among the reports from other states that are of importance to Pennsylvania:

  • Nearly every state is attempting to address teledentistry in upcoming regulations.
  • Minnesota is applying license by credential for dental therapists, requiring a four-year hygiene education and direct supervision by a dentist.
  • Indiana is adapting its rules to only allow one unsupervised hygiene visit without subsequently seeing a dentist.
  • New Jersey is reviewing its rules regarding corporate dentistry, which is currently disallowed.

Dr. Seid recommended considering the current state of telemedicine, and ensure that teledentistry regulations consider only utilizing Pennsylvania dentists, address record keeping requirements, and delineate the different potential technologies.

Report of Board Counsel

Ms. Lutz addressed current legislation affecting the board. HB 2110 would require all healthcare licensees complete training in implicit bias and cultural competence as a condition of their renewal. The legislation has not moved from committee.

HB 572 was recently enacted into law. It requires a prescriber to assess the patient for a substance use disorder before prescribing an opioid. The Department of Health will promulgate regulations, and the SBOD will enforce. Mr. Johnson noted that many of the medical and osteopathic boards that he oversees have expressed concern over this legislation, as it does not address medical emergencies and could be utilized negatively against the provider community.

Regulatory Report

The board discussed the regulations adding three additional practice sites for unsupervised practice by Public Health Dental Hygiene Practitioners (PHDHP): Private residences of the homebound, child care settings, and physicians’ offices. As decided in previous meetings, private residences were removed and will be addressed in a different rulemaking. Board counsel drafted a potential amendment to physicians’ offices to limit practice to medically underserved areas. The board recommended changing the restriction to Dental Health Professional Shortage Areas (DHPSAs) and citing the exact Department of Health code where DHPSAs are defined. Board counsel suggested the board may want to consider adding a grandfather clause, in the event that a PHDHP practicing in a physician’s office be rezoned out of a DHPSA due to practitioner relocations and populations changes.

A requirement for collaborative practice agreements was discussed. Board counsel noted that to require collaborative practice agreements in this regulatory package would expand the scope beyond the three additional practice sites and would require the board to restart the regulatory process. Many board members supported the concept.

Dr. Erhard noted the seminal nature of this vote. He defined care in dentistry as relieving of pain and restoration of function. By this definition, this regulatory expansion does not solve access to care and could create a false sense of security among the public.

Board counsel urged the board to act to either move forward with the amended regulations or stop the regulatory process altogether. After significant discussion, the board voted unanimously to require PHDHP practice in physicians’ offices to be limited to those in DHPSAs.