COLORADO STATE BOARD OF DENTAL EXAMINERS
Rulemaking Hearing, October 24, 2007
Proposed Changes with Statement of Basis, Purpose, and Authority
Basis and Purpose:  To define appropriate advertising practices for dentists and dental hygienists in order to protect the consumer from misrepresentation.
Statement of Authority:	Pursuant to CRS 12-35-107 (1) (b), Make, publish, declare, and periodically review such reasonable rules as may be necessary to carry out and make effective the powers and duties of the board as vested in it by this article. Rules of the board may include but shall not be limited to: 
(I)	The examination of applicants for licensing as dentists and dental hygienists; 
(II)	The practices of dentistry and dental hygiene; 
(III)	The tasks and procedures that may be assigned to dental assistants and dental hygienists; and 
(IV)	The specification of essential instructions to be included in a laboratory work order.

Rule XXVI.  Advertising
(Effective August 1, 2000) (Temporarily Expired December 2, 2002) (Effective July 1, 2003; Amended October 27, 2004) (Amended October 26, 2006 and Effective December 31, 2006) (Amended April 25, 2007 and Effective July 1, 2007) (Amended October 24, 2007 and Effective December 31, 2007)
This rule applies to advertising in all types of media that is directed to the public. No dentist or dental hygienist shall advertise in any form of communication in a manner that is misleading, deceptive or false.
A.	Misleading, deceptive, or false advertising includes, but is not limited to the following, and if proven is a violation of Section 12-35-129 (1), C.R.S.: 
(1)	A known material misrepresentation of fact; 
(2) 	Omits a fact necessary to make the statement considered as a whole not materially misleading; 
(3)	Is intended to be or is likely to create an unjustified expectation about the results the dentist or dental hygienist can achieve; 
(4)	Contains a material, objective representation, whether express or implied, that the advertised services are superior in quality to those of other dental or dental hygiene services if that representation is not subject to reasonable substantiation. For the purposes of this subsection, reasonable substantiation is defined as tests, analysis, research, studies, or other evidence based on the expertise of professionals in the relevant area that have been conducted and evaluated in an objective manner by persons qualified to do so, using procedures generally accepted in the profession to yield accurate and reliable results. Individual experiences are not a substitute for scientific research. Evidence about the individual experience of consumers may assist in the substantiation, but a determination as to whether reasonable substantiation exists is a question of fact on a case-by-case basis; 
(5)	Claims that state or imply a specialty practice by a general dentist in violation of section (B) hereof; 
(6)	The false or misleading use of a claim regarding Board certification, registration, listing, education, or an unearned degree; 
(7)	Advertisement that uses patient testimonials unless the following conditions are met: 
(A)	The patient's name, address, and telephone number as of the time the advertisement was made must be maintained by the dentist or dental hygienist and that identifying information shall be made available to the Board within ten (10) days of a request for the information by the Board. 
(B)	Dentists or dental hygienists who advertise dental or dental hygiene services, which are the subject of the patient testimonial, must have actually provided these services to the patient making the testimonial. 
(C)	If compensation, remuneration, a fee, or benefit of any kind has been provided to the person in exchange for consideration of the testimonial, such testimonial must include a statement that the patient has been compensated for such testimonial. 
(D)	A specific release and consent for the testimonial from the patient shall be obtained from the patient which shall be made available to the Board within ten (10) days of request of that information. 
(E)	Any testimonial shall indicate that results may vary in individual cases. 
(F)	Patient testimonials attesting to the technical quality or technical competence of a service or treatment offered by a licensee must have reasonable substantiation.
(8)	Advertising that makes an unsubstantiated medical claim or is outside the scope of dentistry, unless the dentist or dental hygienist holds a license or registration in another profession and the advertising and/or claim is within the scope authorized by the license or registration in another profession;
(9)	Advertising that makes unsubstantiated promises or claims, including but not limited to claims that the patient will be cured; 
(10)	The use of “bait and switch” in advertisements. “Bait and switch” advertising is defined as set forth in the Colorado Consumer Protection Act, Section 6-1-105, C.R.S.; 
(11)	The Board recognizes that clinical judgment must be exercised by a dentist or dental hygienist. Therefore, a good faith diagnosis that the patient is not an appropriate candidate for the advertised dental or dental hygiene service or product is not a violation of this rule; 
(12)	If an advertisement includes an endorsement by a third party in which there is compensation, remuneration, fee paid, or benefit of any kind, the endorsement by the third party must indicate that it is a paid endorsement; 
(13)	Inferring or giving the appearance that an advertisement is a news item without using the phrase "paid advertisement"; 
(14)	Promotion of a professional service which the licensee knows or should know is beyond the licensee’s ability to perform; 
(15)	The use of any personal testimonial by the licensed provider attesting to a quality or competence of a service or treatment offered by a licensee that is not reasonably verifiable; 
(16)	At the time any type of advertisement is placed the dentist or dental hygienist must in good faith possess information that would substantiate the truthfulness of any assertion, omission or claim set forth in the advertisement; 
(17)	A licensed dentist or dental hygienist shall be responsible and shall approve any advertisement made on behalf of the dental or dental hygiene practice. The dentist or dental hygienist shall maintain a listing stating the name and license number of the dentists or dental hygienists who approved and are responsible for the advertisement and shall maintain such list for a period of three (3) years; 
(18)	Advertising that claims to provide services at a specific rate and fails to disclose that the patient’s insurance may provide payment for all or part of the services.
B.	SPECIALTY PRACTICE AND ADVERTISING. 
1.	A licensed dentist has the legal authority to practice in any and all areas of dentistry and also the authority to confine the areas in which he or she chooses to practice. 
2.	Dental specialties are recognized as only those defined by the American Dental Association and dental specialists are those dentists who have successfully completed a Commission on Dental Accreditation specialty program. 
3.	Practitioners who have successfully completed a Commission on Dental Accreditation accredited specialty program may advertise the practice of that specialty. Practitioners who have not completed an accredited specialty program, and have limited their practice to a specific Commission on Dental Accreditation defined specialty, must clearly state in all advertising and/or public promotions, that he or she is a general dentist who has limited his or her practice to that field of dentistry. 
4.	It is misleading, deceptive or false for general practitioners to list their names, advertise, or promote themselves in any area or location that implies a specialty. A general practitioner who advertises in any medium under a specialty heading or section may be considered as having engaged in misleading, deceptive or false advertising and may be in violation of section 12-35-129 (1), C.R.S. 

COLORADO STATE BOARD OF DENTAL EXAMINERS
Rulemaking Hearing, October 24, 2007
Proposed Changes with Statement of Basis, Purpose, and Authority
Basis and Purpose:	To recognize that pediatric cases may require special case management, and that pediatric and special needs patients may need specialized care in order to prevent injury and to protect the health and safety of the patients, the dentist, and the dental staff.
Statement of Authority:	Pursuant to CRS 12-35-107 (1) (b), Make, publish, declare, and periodically review such reasonable rules as may be necessary to carry out and make effective the powers and duties of the board as vested in it by this article. Rules of the board may include but shall not be limited to: 
(I)	The examination of applicants for licensing as dentists and dental hygienists; 
(II)	The practices of dentistry and dental hygiene; 
(III)	The tasks and procedures that may be assigned to dental assistants and dental hygienists; and 
(IV)	The specification of essential instructions to be included in a laboratory work order.

Rule XXIX.  PEDIATRIC CASE MANAGEMENT;
MEDICAL IMMOBILIZATION/PROTECTIVE STABILIZATION
(Amended October 24, 2007 and Effective December 31, 2007)
A.	The purpose of this rule is to recognize that pediatric cases may require special case management, and that pediatric and special needs patients may need specialized care in order to prevent injury and to protect the health and safety of the patients, the dentist, and the dental staff.  In addition to patient management of the pediatric and special needs patient, it may be necessary to medically immobilize the pediatric and special needs patients to prevent injury and to protect the health and safety of the patients, the dentist, and the dental staff.  To achieve effective pediatric patient management, it is important to build a trusting relationship between the dentist, the dental staff, the patient, and the parent of guardian. This necessitates that the dentist establishes communication with them and promotes a positive attitude towards oral and dental health in order to alleviate fear and anxiety and to deliver quality dental care.
B.	Pediatric Case Management
1.	Parents or legal guardians cannot be denied access to the patient during treatment in the dental office unless the health and safety of the patient, parent or guardian, or dental staff would be at risk.  The parent or guardian shall be informed of the reason they are denied access to the patient and both the incident of the denial and the reason for the denial shall be documented in the patient’s dental record.
2.	This provision shall not apply to dental care delivered in an accredited hospital or acute care facility.
C.	Medical Immobilization/Protective Stabilization
1.	Within this rule, the terms medical immobilization and protective stabilization are used interchangeably.  These terms refer to partial or complete immobilization of the patient necessary to protect the patient, practitioner, and other dental staff from injury while providing care.  Immobilization can be performed by the dentist, staff, or parent or legal guardian with or without the aid of an immobilization device.
2.	Training requirement.  Prior to utilizing medical immobilization, the dentist shall have received training beyond basic dental education through a residency program or graduate program that contains content and experiences in advanced behavior management or a continuing education course of no less than 6 hours in advanced behavior management that involves both didactic and demonstration components.  This training requirement will be effective October 1, 2006. 
3.	Pre-Immobilization Requirements
a.	Prior to utilizing medical immobilization, the dentist shall consider each of the following: 
1.	Other alternative less restrictive behavioral management methods;
2.	The dental needs of the patient;
3.	The effect on the quality of dental care;
4.	The patient’s emotional development; and
5.	The patient’s physical condition; and
6.	The safety of the patient, dentist, and staff.
b.	Prior to using medical immobilization, the dentist shall obtain written informed consent for the specific technique of immobilization from the parent or legal guardian and document such consent in the dental record, unless the parent or legal guardian is immobilizing the patient.  Consent involving solely the presentation or description of a listing of various behavior management techniques is not considered to constitute informed consent for medical immobilization.  The parent or guardian must be informed of the advantages and disadvantaged of the technique(s) of immobilization being utilized and/or considered.
4.	Medical Immobilization or Protective Stabilization
a.	Immobilization can be performed by the dentist, staff, or parent or legal guardian with or without the aid of an immobilization device.
b.	Immobilization must cause no serious or permanent injury and the least possible discomfort.
c.	Indication.  Partial or complete immobilization may be used for required diagnosis and/or treatment if the patient cannot cooperate due to lack of maturity, mental or physical handicap, failure to cooperate after other behavior management techniques have failed and/or when the safety of the patient, dentist or dental staff would be at risk without using protective stabilization.  This method can only be used to reduce or eliminate untoward movement, protect the patient and staff from injury, and to assist in the delivery of quality dental treatment.
d.	Contraindications.  Medical immobilization may not be used for the convenience of the dentist, as punishment, to provide care for a cooperative patient, or for a patient who cannot be immobilized safely due to medical conditions.
e.	Documentation.  The patient’s records should include:
1.	Specific written informed consent for the medical immobilization, including the reason why immobilization is required;
2.	Type of immobilization used, including immobilization by a parent or guardian;
3.	Indication or reason for specific immobilization;
4.	Duration of application;
5.	Documentation of adequacy of patient airway, peripheral circulation and proper positioning of immobilization device or technique in increments of 15 minutes while immobilization is utilized.
6.	In addition, there must be documentation of the outcome of the immobilization, including the occurrence of any marks, bruises, injuries, or complications to the patient.
f.	Duration of Application.
1.	The patient record must document the time each immobilization began and ended.
2.	The status and progress of the treatment and the plan for future or remaining treatment with treatment options shall be reported at least hourly, or more frequently if appropriate, to the parent or legal guardian.  After each such hourly report, renewed consent for continuation of the immobilization must be specifically obtained.  Such consent may be verbal but shall be documented in the record.
g.	If the treatment plan changes during the procedure from that presented to the parent or legal guardian in the initial informed consent discussion, the parent or legal guardian shall be notified and consulted immediately.
h.	Dental hygienists and dental assistants shall not use medical immobilization by themselves, but may assist the dentist as necessary. 

COLORADO STATE BOARD OF DENTAL EXAMINERS
Rulemaking Hearing, October 24, 2007
Proposed Changes with Statement of Basis, Purpose, and Authority
Basis and Purpose:  To ensure total disclosure of all patient records, books, papers, documentary evidence or other materials subpoenaed or requested by the Board pursuant to its statutory authority to conduct investigations and inspections.
Statement of Authority:	Pursuant to CRS 12-35-107 (1) (b), Make, publish, declare, and periodically review such reasonable rules as may be necessary to carry out and make effective the powers and duties of the board as vested in it by this article. Rules of the board may include but shall not be limited to: 
(I)	The examination of applicants for licensing as dentists and dental hygienists; 
(II)	The practices of dentistry and dental hygiene; 
(III)	The tasks and procedures that may be assigned to dental assistants and dental hygienists; and 
(IV)	The specification of essential instructions to be included in a laboratory work order.

RULE XXX.  COMPLIANCE WITH BOARD SUBPOENA
(Effective December 31, 2007)
A.	When the Board requests a patient’s complete patient record, pursuant to subpoena, the patient chart or record shall include all medical histories for the patient, all patient notes, all labeled and dated radiographs, all billing and/or all insurance records that are compiled for a specific patient.  
B.	It is the responsibility of the licensed dentist or dental hygienist to assure that all records submitted are legible and, if necessary, to have records transcribed to assure legibility.
C.	Failure by a licensed dentist or dental hygienist to submit the complete patient record to the Board, or any relevant papers, books, records, documentary evidence, and/or other materials, as requested pursuant to subpoena is a violation of § 12-35-129(1)(i), C.R.S.