Board Publicly Commends AAO, TAO for their Advocacy on the New Rules

For several months, AAO and the Texas Association of Orthodontists have been working together to advocate for teledentistry regulations that protect orthodontic patient health and safety. On May 13, 2022, the Texas State Board of Dental Examiners took final action to enact strong new teledentistry regulations for the State of Texas.

These regulations now provide the Board with a basis for enforcement against teledentistry providers (including mail-order orthodontic companies) who do not meet the minimum standards of care for orthodontic treatment. And, at the conclusion of the rulemaking process, the Board went on record during the hearing thanking the AAO and the Texas Association of Orthodontists for their heavy involvement in the process, the insightful input received from both organizations, and for supporting the Board throughout the process.

Among other requirements on teledentistry enacted in the new rules, the new Texas rules require that anyone providing treatment through teledentistry “perform and review a limited physical examination when a reasonable and prudent dentist would do so under the same or similar circumstances. At a minimum, a limited physical examination should be performed and reviewed annually”—that is, an in-person examination must be performed at least annually for teledentistry patients, or more frequently/sooner if the standard of care requires.

As part of the regulatory rulemaking process, the Texas Governor’s office confirmed that this new language gives the Texas board authority to enforce, where appropriate, a standard of care requiring an in-person examination prior to beginning teledentistry (remote orthodontic) treatment. In a May 8 letter to the dental board, the Regulatory Compliance division of the Governor’s office stated,

Importantly, the proposed rule still refers to what a reasonable and prudent dentist would do and does not foreclose that, under certain circumstances, the standard of care may require a dentist to perform an in-person examination of or have other in-person contact with a patient before providing teledentistry dental services.(emphasis added).

You can view a copy of the Governor’s office letter here. The Governor’s office further confirmed that enforcing a standard of care requiring an in-person examination prior to teledentistry treatment would also be consistent with Texas state public policy.

The AAO and TAO have worked with the TSBDE for nearly two years in the effort. The effort represents a “best case” of advocacy efforts combining AAO staff support, Component Legal Support Fund resources, and the strong engagement of TAO state leadership and members.

Utilizing CLSF funding approved by the AAO Board of Trustees, AAO Legal and Advocacy staff (Trey Lawrence, Nathan Mick and Gianna Nawrocki) have attended and spoken at numerous Texas dental board hearings, rule committee hearings, and have met with personnel from the Texas Governor’s office. TAO members repeatedly attended dental board hearings, provided oral and written testimony, and contacted legislators. AAO Component Legal Support Fund (CLSF) funds covered AAO staff travel costs as well as the services of the AAO/TAO’s lobbyist, Carrie Simmons.

Additionally, federal relationships built through the AAO Political Action Committee (AAOPAC) opened doors for the AAO to share concerns relating to mail-order orthodontic treatment and changes to the standard of care in Texas with key Members of Congress. AAO urged Congressman Brian Babin (R-TX) and Congressman Lloyd Doggett (D-TX) to speak with decision makers in Texas and help advocate for patient health and safety.

The new rule combined with guidance from the Governor’s office now provides the authority for the Board to take enforcement action against providers of orthodontic treatment who do not meet the standard of care regarding in-person examinations. However, the advocacy effort is not finished. It is crucial now that Texas patients who appear to have been harmed by substandard orthodontic care file a complaint with the TSBDE, as the board can only take enforcement action when patient complaints are received. Information on how Texas patients can file an online complaint with the Texas dental board can be found here: https://tsbde.texas.gov/complaints/how-to-submit-a-complaint/.

Additionally, AAO staff will be working with TAO leadership to provide Texas members with more information about the significance of the new rules as well as their role in assisting patients who have been harmed, including at the upcoming TAO annual meeting in conjunction with the SAO/SWSO/MSO constituent meetings.