Rules that Every Dentist MUST Know - Absolutely Critical for every Dental Practice

these are the rules in place as of 6/1/23, please check for updates

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CHAPTER 64B5-17

DENTAL PRACTICE AND PRINCIPLES

64B5-17.001        Required Availability of Dental Records Upon Relocation or Termination of Practice, or Death of Practitioner

64B5-17.0011      Change of Address

64B5-17.002        Written Dental Records; Minimum Content; Retention

64B5-17.003        Patient Referrals

64B5-17.004        Emergency Care

64B5-17.0045      Standards for the Prescribing of Controlled Substances for the Treatment of Acute Pain

64B5-17.005        Identification of Removable Prosthetic Devices

64B5-17.006        Prescription Forms

64B5-17.009        Patient Records; Copying Charges; Timely Release

64B5-17.010        Unlicensed Practice of Dentistry

64B5-17.0105      Ownership of Dental Instruments by a Dental Hygienist

64B5-17.011        Financial Responsibility

64B5-17.012        Use of Sargenti Material

64B5-17.013        Proprietorship by Nondentists

64B5-17.014        Removal of Amalgam Fillings

64B5-17.015        Office Safety Requirement

64B5-17.001 Required Availability of Dental Records Upon Relocation or Termination of Practice, or Death of Practitioner.

(1) Patient records are confidential and may not be released unless authorized by the patient in writing. This confidentiality prohibits review of the records by a dentist other than the dentist of record or by other health care providers unless they are actually involved in care or treatment of the patient. Maintenance of patient records by a deceased dentist's estate, authorized agent of the estate or by a successor-owner dentist of a practice does not authorize review of patient records. However, limited review for the purpose of obtaining a patient's name, address and last date of treatment in order to comply with this rule is permitted.

(2) Within 90 days of a dentist's death, the dentist's estate or agent shall place all patient records of the deceased dentist in the care of another Florida licensed dentist.

(a) The patient records of the deceased dentist shall be maintained and made available to patients for a period of 4 years.

(b) Within 90 days of a dentist's death the dentist's estate or agent shall cause a notice to be published in the newspaper of greatest general circulation in the county where the dentist practiced which advises patients of the dentist's death. The notice shall advise patients that they may obtain copies of their dental records and specify the name, address and telephone number of the person from whom the copies of records may be obtained. The notice shall appear at least once a week for four consecutive weeks.

(c) The subsequent Florida licensed dentist shall cause to be published a similar notice whenever the patient records of the deceased dentist are subsequently transferred to another licensed Florida dentist if such transfer is within 4 years of the dentist's death.

(d) During the four year retention period required by this rule each licensed Florida dentist who is in possession of the deceased dentist's patient records shall insure that the original patient records, or in cases where the patient has requested that the records be released or transferred, copies thereof remain in his possession.

(3) Dental records of a practitioner who is terminating or relocating his practice shall be retained by the dentist or his authorized agent, which may be a successor-owner dentist, and made available to patients for 4 years from the date the patient was last examined or treated.

(4) Within one month of a dentist's termination of practice or relocation of practice outside the local telephone directory service area of his or her current practice, a notice shall be published in the newspaper of greatest general circulation in the county where the dentist practiced which advises patients of the dentist's termination of practice or relocation. The notice shall advise patients that they may obtain copies of their dental records and specify the name, address and telephone number of the person from whom copies of records may be obtained. The notice shall appear at least once a week for 4 consecutive weeks.

(5) If a dentist relocates his practice but maintains a listing in the same local telephone directory used in his previous practice location, notice of relocation shall be clearly posted at his practice location for one month prior to relocation. The notice shall state the date of relocation and the address to which the office is being relocated.

(6) Records shall be made available at a location within the county where the dentist practices or practiced and shall be made available at reasonable times.

Rulemaking Authority 456.058, 466.004(4) FS. Law Implemented 456.058 FS. History–New 10-26-80, Formerly 21G-17.01, Amended 7-16-90, 10-28-91, 4-23-90, Formerly 21G-17.001, 61F5-17.001, 59Q-17.001.

64B5-17.0011 Change of Address.

Each licensee shall provide written notification to the department of the licensee's current mailing address and place of practice. The term “place of practice” means the primary physical location where the licensee practices the profession of dentistry or dental hygiene.

Rulemaking Authority 456.035, 466.004(4) FS. Law Implemented 456.035, 466.013 FS. History–New 3-27-90, Formerly 21G-17.0011, 61F5-17.0011, 59Q-17.0011, Amended 2-15-22.

64B5-17.002 Written Dental Records; Minimum Content; Retention.

A dentist shall maintain patient dental records in a legible manner and with sufficient detail to clearly demonstrate why the course of treatment was undertaken.

(1) Dental Record: The dental record shall contain sufficient information to identify the patient, support the diagnosis, justify the treatment and document the course and results of treatment accurately, by including, at a minimum, patient histories; X-rays (if taken); examination results; test results; records of drugs prescribed, dispensed, or administered; reports of consultation or referrals; and copies of records or reports or other documentation obtained from health care practitioners at the request of the dentist and relied upon by the dentist in determining the appropriate treatment of the patient.

(2) Record Alterations: Any additions, corrections, modifications, annotations, or alterations (hereinafter “change”) to the original dental record entry must be clearly noted as such and must include the date when the change was made, must be initialed by the person making the change, and must have an explanation for the change. An original entry to the record cannot be partially or wholly removed. Rather, to represent the deletion of a record entry, the entry must be struck through where it will remain legible. A change made on the same date of the original entry must also include the time of change.

(3) Record Transfer or Release: Whenever patient records are released or transferred, the dentist releasing or transferring the records shall maintain either the original records or copies thereof and a notation shall be made in the retained records indicating to whom the records were released or transferred and the authority for such release. Transfer of records in a multidentist practice office shall be done and documented in strict accordance with Section 466.018, F.S.

(4) Record Retention Period: A dentist shall maintain the written dental record of a patient for a period of at least four (4) years.

(a) The four (4) year retention period shall be calculated from the date the patient was last examined or treated by the dentist.

(b) Upon the death of the dentist, the retention provisions of Rule 64B5-17.001, F.A.C., are controlling.

(5) Appointment Book: Each dentist shall retain a copy of each entry in his or her patient appointment book or such other log, calendar, book, file or computer data, used in lieu of an appointment book, for a period of no less than four (4) years from the date of each entry thereon.

(6) Dentist of Record: All records that are required by this rule and any other patient record shall be properly annotated to identify the dentist of record. The dentist of record is the dentist who:

(a) Is identified and noted in the patient record as the dentist of record;

(b) Provides a specific treatment or service and is noted in the patient record as the dentist of record for that treatment or service;

(c) If there has been more than one provider of treatment, is the dentist who places the final restoration, does the surgical procedure, makes the diagnosis or finishes the service or procedure in question, or

(d) If the dentist of record is not identifiable, then the owner of the dental practice in which the patient was treated is the dentist of record.

(7) Owner of Dental Practice: All dental records required by this rule and any additional records maintained in the course of practicing dentistry shall be the property of the owner dentist of the dental practice in which the dental patient is seen or treated and the owner dentist shall be ultimately responsible for all record keeping requirements set forth by statute or rule.

(a) The owner dentist is responsible for the records of patients seen or treated by any employee, associate, or visiting dentist.

(b) Multiple owners are severally and equally responsible for the records of patients seen or treated with the dental practice of that dental group.

(c) A lessor or owner dentist is not responsible for the records of an independent dentist who is merely leasing or renting space or staff services for the operation of a separate dental practice within the owner dentist's physical facility.

(8) Electronic Dental Records: Patient records may be kept in an electronic format, provided that the dentist maintains a back-up copy of information stored in the back-up data processing system using disk, tape, or other secure electronic back-up system, onsite or off-site, as long as the back-up system is updated in a time frame that does not exceed seventy-two hours (72 hrs.), to assure that data is not lost due to system failure. Any electronic data system must be capable of producing a hard copy on lawful demand in accordance with and pursuant to federal or state laws and rules.

Rulemaking Authority 466.004(4) FS. Law Implemented 456.057, 456.058, 466.028(1)(m), 466.018(4) FS. History–New 10-8-85, Formerly 21G-17.02, Amended 10-28-91, Formerly 21G-17.002, Amended 11-22-93, Formerly 61F5-17.002, 59Q-17.002, Amended 11-15-99, 4-22-03, 3-14-13, 5-14-15, 4-17-16.

64B5-17.003 Patient Referrals.

(1) Split-fee arrangements relating to the referral of patients by a client to another health care practice are prohibited.

(2) As used herein, the term “health care practice” shall mean a lawful and distinct business entity owned and operated under one name by an individual or group of duly licensed health care providers with facilities at one or more locations such as a solo dental practice, group practice, or professional service corporation, which offers health care services to the public within the limits of the professional licenses held by the owners, employees and agents of the business.

(3) Referral of a patient to another dentist in the same health care practice, so long as any remuneration shared by the dentists is not based upon the number of referrals within the practice and the referral of a patient to another dentist within the practice is in the best interest of the patient, is not a split-fee arrangement.

(4) Fee arrangements between dentists in the same health care practice which are based upon productivity or shared net profits are not split-fee arrangements.

(5) Notification forms signed by patients in accordance with subsection (5), above, shall be maintained in the patient's record.

Rulemaking Authority 466.004(4) FS. Law Implemented 456.052 FS. History–New 8-30-90, Formerly 21G-17.003, 61F5-17.003, 59Q-17.003, Amended 8-19-97, 2-15-22.

64B5-17.004 Emergency Care.

It is the responsibility of every dentist practicing in this State to provide, either personally, through another licensed dentist, or through a reciprocal agreement with another agency, reasonable twenty-four (24) hour emergency services for all patients under his continuing care.

Rulemaking Authority 466.004(4) FS. Law Implemented 466.028(1)(t), (x) FS. History–New 4-26-87, Formerly 21G-17.004, 61F5-17.004, 59Q-17.004.

64B5-17.0045 Standards for the Prescribing of Controlled Substances for the Treatment of Acute Pain.

The standards of practice in this rule do not supersede the level of care, skill and treatment recognized in general law related to healthcare licensure. All dentists who are authorized to prescribe controlled substances shall comply with the following:

(1) Definitions.

(a) Acute Pain. For the purpose of this rule, “acute pain” is defined as the normal, predicted, physiological, and time-limited response to an adverse chemical, thermal, or mechanical stimulus associated with surgery, trauma, or acute illness. The term does not include pain related to:

1. Cancer.
2. A terminal condition. For purposes of this subparagraph, the term “terminal condition” means a progressive disease or medical or surgical condition that causes significant functional impairment, is not considered to be reversible without the administration of life-sustaining procedures, and will result in death within 1 year after diagnosis if the condition runs its normal course.
3. Palliative care to provide relief of symptoms related to an incurable, progressive illness or injury.
4. A traumatic injury with an Injury Severity Score of 9 or greater.

(b) Prescription Drug Monitoring Program (PDMP) or “the system.” For the purpose of this rule, the system is defined as the Florida Department of Health's electronic system to collect and store controlled substance dispensing information as set forth in Section 893.055, F.S.

(c) Substance Abuse. For the purpose of this rule, “substance abuse” is defined as the use of any substances for non-therapeutic purposes or use of medication for purposes other than those for which it is prescribed.

(2) Standards. The nature and extent of the requirements set forth below will vary depending on the practice setting and circumstances presented to the dentist. The Board has adopted the following standards for the prescribing of controlled substances for acute pain:

(a))Evaluation of the Patient. A medical history and physical examination appropriate for the patient's clinical condition must be conducted and documented in the medical record. The medical record also shall document the presence of one or more recognized medical indications for the use of a controlled substance.

(b) Treatment Plan. The written treatment plan shall indicate if any further diagnostic evaluations or other treatments are planned including non-opioid medications and therapies if indicated. After treatment begins, the dentist shall adjust medication therapy, if necessary, to the individual medical needs of each patient.

(c) Informed Consent and Agreement for Treatment. The dentist shall discuss the risks and benefits of the use of controlled substances including the risk of abuse and addiction as well as physical dependence with the patient, persons designated by the patient, or with the patient's surrogate or guardian if the patient is incompetent. The discussion shall also include expected pain intensity, duration, options, use of pain medications, non-medication therapies, and common side effects. Special attention must be given to those pain patients who are at risk of misuse or diversion of their medications.

(d) Periodic Review. Based on the circumstances presented, the dentist shall review the course of treatment and any new information about the etiology of the pain. Continuation or modification of therapy shall depend on the dentist's evaluation of the patient's progress. If treatment goals are not achieved, despite medication adjustments, the dentist shall reevaluate the patient and determine the appropriateness of continued treatment. The dentist shall monitor patient compliance of medication usage and related treatment plans.

(e) Consultation. The dentist shall refer the patient as necessary for additional evaluation and treatment in order to achieve treatment objectives. The management of pain in patients with a history of substance abuse or with a comorbid psychiatric disorder requires extra care, monitoring, and documentation, and may require consultation with or referral to an expert in the management of such patients.

(f) Medical Records. The dentist is required to keep accurate and complete records to include, but not be limited to:

1. The medical history and a physical examination, including history of drug abuse or dependence, if indicated,
2. Diagnostic, therapeutic, and laboratory results,
3. Evaluations and consultations,
4. Treatment objectives,
5. Discussion of risks and benefits,
6. Treatments,
7. Medications (including date, type, dosage, and quantity prescribed),
8. Instructions and agreements,
9. Drug testing results if indicated,
10. Justification for deviation from the 3-day prescription supply limit for a Schedule II opioid controlled substance for acute pain,
11. Outline of problems encountered when attempting to consult the PDMP, if the system was non-operational or the clinician, or his or her designee, is unable to access the PDMP due to a temporary technological or electrical failure; and
12. Periodic reviews. Records must remain current, maintained in an accessible manner, readily available for review, and must be in full compliance with Rule 64B5-17.002, F.A.C., Sections 456.057, 466.018, and 466.028(1)(m), F.S.

(g) Compliance with Laws and Rules. Dentists shall at all times, remain in compliance with this rule and all state and federal laws and regulations addressing the prescribing and administration of controlled substances.

Rulemaking Authority 456.44(4), 466.004 FS. Law Implemented 456.44(4) FS. History–New 8-12-02, Amended 12-4-18.

64B5-17.005 Identification of Removable Prosthetic Devices.

(1) The Board takes official notice of the large number of elderly dental patients residing in Florida and that many of them are confined to hospitals, nursing homes, and other health care institutions. The Board also recognizes the continuing difficulty in providing ongoing dental care to these individuals which is created as a result of the inadvertent misplacing or switching of their removable dental prosthetic devices, which can enhance the transmission of communicable diseases. Accordingly, in an effort to enhance the likelihood that these individuals will receive minimally competent dental treatment consistent with the requirements of Section 466.028(1)(x), F.S., the Board establishes an identification standard for removable prosthetic devices.

(2) Every licensed dentist in this State making or directing to be made a removable prosthetic device, bridge, appliance or other structure to be used and worn as a substitute for natural teeth and/or supporting structure shall offer to the patient for whom the prosthesis is intended the opportunity to have such prosthesis marked at the time of fabrication. The location and method used for marking the prosthesis shall be determined by the dentist and this marking shall be permanent, legible, and cosmetically acceptable and shall include the patient's name.

(3) If the dentist determines that identification is not practicable or clinically safe, the offer to mark the prosthesis need not be made.

(4) Any removable dental prosthesis fabricated prior to the effective date of this rule, shall be subject to the provisions of subsection (2), during a laboratory relining or rebasing of the prosthesis.

Rulemaking Authority 466.004(4) FS. Law Implemented 466.028(1)(x) FS. History–New 4-26-87, Amended 6-20-89, Formerly 21G-17.005, 61F5-17.005, 59Q-17.005.

64B5-17.006 Prescription Forms.

(1) Approved prescription forms must contain all information necessary for completion of the assigned work and must include at a minimum:

(a) Title – “Laboratory Procedure Prescription”;

(b) Name, address and license number of the registered dental laboratory;

(c) Name, address and license number of the Florida licensed dentist who owns the prescription form and is authorizing the procedure;

(d) Patient's name or number;

(e) Date sent to lab;

(f) Signature of the licensed dentist, which may be an electronic signature;

(g) Sufficient descriptive information to clearly identify each separate and individual piece of work to be performed by the dental laboratory; and,

(h) Specification of materials to be contained in each work product.

(2) Copies of prescription forms must be maintained, either on paper or stored electronically in an encrypted data base, in the prescribing dentist's office for a period of four (4) years following the date the prescription was issued. The original prescription shall be retained in a file by the dental laboratory for a period of four (4) years.

(3) A registered dental laboratory may perform work for another registered dental laboratory if that work is performed pursuant to a written authorization form containing all information necessary for completion of the assigned work and must include at a minimum:

(a) Title – “Laboratory Procedure Authorization”;

(b) Name, address and license number of the originating registered dental laboratory;

(c) Name, address and license number of the registered dental laboratory performing the work;

(d) Evidence that the originating laboratory has obtained a valid prescription which shall include the name, address and license number of the licensed dentist who wrote the original prescription authorizing the procedure;

(e) Sufficient descriptive information to clearly identify each separate and individual piece of work to be performed by the dental laboratory; and,

(f) Specification of materials to be contained in each work product.

Rulemaking Authority 466.021 FS. Law Implemented 466.021 FS. History–New 12-21-99, Amended 3-23-06, 10-9-06, 5-28-09.

64B5-17.009 Patient Records; Copying Charges; Timely Release.

(1) A dentist who makes an examination of, or administers treatment to any person, shall upon the request of such person or his legal representative furnish copies of all reports or records made of such examination or treatment, including x-rays. The furnishing of copies shall not be conditioned upon payment of an unpaid or disputed fee for services rendered.

(2) A dentist may charge a fee for copying reports or records not to exceed the cost per page charged by the Clerk of the County Court where the dentist practices. The fee for copies of x-rays shall not exceed actual cost of duplication. Payment of copying fees may be required upon delivery of the copies.

(3) A dentist shall comply with a patient's written request for copies of records and reports in a timely manner, with due regard for the patient's health needs. In the absence of circumstances beyond the control of the licensee, timely shall mean less than 30 days.

Rulemaking Authority 466.004(4) FS. Law Implemented 456.057 FS. History–New 4-26-87, Amended 6-20-89, Formerly 21G-17.009, 61F5-17.009, 59Q-17.009, Amended 1-23-01.

64B5-17.010 Unlicensed Practice of Dentistry.

For the purposes of interpreting Sections 466.003(3), 466.026(1)(a) and 466.028(1)(g), F.S., the Board shall not consider it to be the unlicensed practice of dentistry for an unlicensed person to furnish, supply, construct or reproduce an appliance to be worn in the human mouth or to verify the patient's shade-selection outside the dentist's direct supervision for fixed partial prosthesis if:

(1) The appliance is a removable mouth protection device that is inserted and removed by the user without adjustment by a licensed dentist (e.g. athletic mouth guards);

(2) A prescription or dentist's order is not required in order to obtain the appliance;

(3) The appliance does not adjust or otherwise affect the natural features of the face or mouth or affect any appliance placed in the mouth by a licensed dentist;

(4) The appliance or device does not have the potential to cause significant or irreparable damage to the dentition and/or oral tissue;

(5) The request for the shade verification is accompanied by a prescription form or work order written by a licensed dentist to meet the requirements of Section 466.021, F.S.;

(6) The dentist has previously completed the initial shade selection;

(7) The shade verification site is approved by the dentist and meets all requirements of Sections 466.028(1)(u), 466.031(1) and 466.032(1), F.S.;

(8) During shade verification, no appliances or prosthetic devices are to be placed, removed or sealed in the oral cavity at the site except by a licensed dentist on a patient of record in accordance with the requirements of Sections 466.024(5) and 466.028(1)(m), F.S.;

(9) During shade verification, contact to the patient is limited to visual contact only;

(10) During shade verification, soft or hard tissue shall not be manipulated;

(11) During shade verification, the patient shall be instructed on how to retract his or her own lip, and the shade tab shall only be held in proximity, but without physical contact to the patient's dentition; and,

(12) During shade verification, photography shall be limited to the patient's visible dentition during smile and the patient's dentition with the patient retracting their lips.

Rulemaking Authority 466.004(4) FS. Law Implemented 466.026(1)(a), 466.028(1)(g) FS. History–New 9-5-91, Formerly 21G-17.010, 61F5-17.010, Amended 5-9-95, Formerly 59Q-17.010, Amended 10-8-03.

64B5-17.0105 Ownership of Dental Instruments by a Dental Hygienist.

For purposes of interpreting Sections 466.0285, 466.024, 466.023 and 466.0235, F.S., a Dental Hygienist is not precluded from owning dental instruments used by her or him in the provision of dental hygiene services, working under the authorization of dentist or providing dental hygiene services to carry out provisions outlined in the statute when a supervising dentist is not required.

Rulemaking Authority 466.004 FS. Law Implemented 466.0285 FS. History–New 12-23-02, Amended 6-3-19.

64B5-17.011 Financial Responsibility.

As a prerequisite for licensure or license renewal every dentist is required to maintain medical malpractice insurance or provide proof of financial responsibility as set forth herein:

(1) Obtaining and maintaining professional liability coverage in an amount not less than $100,000 per claim, with a minimum annual aggregate of not less than $300,000, from an authorized insurer as defined under Section 624.09, F.S., from a surplus lines insurer as defined under Section 626.914(2), F.S., from a risk retention group as defined under Section 627.942, F.S., from the Joint Underwriting Association established under Section 627.351(4), F.S., or through a plan of self-insurance as provided in Section 627.357, F.S.

(2) Obtaining and maintaining an unexpired, irrevocable letter of credit, established pursuant to Chapter 675, F.S., in an amount not less than $100,000 per claim, with a minimum aggregate availability of credit of not less than $300,000. The letter of credit shall be payable to the dentist as beneficiary upon presentment of a final judgment indicating liability and awarding damages to be paid by the dentist or upon presentment of a settlement agreement signed by all parties to such agreement when such final judgment or settlement is a result of a claim arising out of the rendering of, or the failure to render, dental care and services. Such letter of credit shall be nonassignable and nontransferable. Such letter of credit shall be issued by any bank or savings association organized and existing under the laws of the State of Florida or any bank or savings association organized under the laws of the United States that has its principal place of business in this state or has a branch office which is authorized under the laws of this state or of the United States to receive deposits in this state.

(3) Upon application to the Board, the following licensees shall be exempted from meeting the requirements of this rule:

(a) Any dentist who practices exclusively as an officer, employee or agent of the federal government or of the State of Florida or its agencies or subdivision. For purposes of this rule, an agent of the State of Florida, its agencies or its subdivisions is a person who is eligible for coverage under any self insurance or insurance program authorized by the provisions of Section 768.28(14), F.S., or who is a volunteer under Section 110.501(1), F.S.

(b) Any dentist whose license has become inactive under Chapter 466, F.S., and who is not practicing in this state. Any dentist applying for reactivation of a license must show either that such licensee maintained tail insurance which provided liability coverage for incidents that occurred on or after October 1, 1993, or the initial date of licensure in this state, whichever is later, and incidents that occurred before the date on which the license became inactive; or such licensee must submit an affidavit stating that such licensee has no unsatisfied medical malpractice judgments or settlements at the time of application for reactivation.

(c) Any dentist licensed or certified under Chapter 466, F.S., who practices only in conjunction with his/her teaching duties at an accredited school or in its main teaching hospitals. Such dentist may engage in the practice of dentistry to the extent that such practice is incidental to and a necessary part of duties in connection with the teaching position in the school.

(d) Any dentist holding an active license under Chapter 466, F.S., who is not practicing in this state. If such person initiates or resumes practice in this state, he/she must notify the Board of such activity.

(e) Any dentist who can demonstrate to the Board that he/she has no malpractice exposure in the State of Florida.

(4) Every dentist complying with these requirements pursuant to either subsection (1) or (2), above, shall ensure that such insurance or proof covers liability for actions of any dental hygienist supervised by the dentist. Dental hygienists working unsupervised pursuant to Section 466.0235, F.S., shall be required to maintain medical malpractice insurance or provide proof of financial responsibility if he or she is not a volunteer under Section 110.501(1), F.S.

Rulemaking Authority 466.004(4) FS. Law Implemented 456.048 FS. History–New 11-22-93, Amended 3-31-94, Formerly 61F5-17.011, 59Q-17.011, Amended 12-20-98, 3-19-02, 6-13-07.

64B5-17.012 Use of Sargenti Material.

The Board of Dentistry has determined pursuant to Sections 466.001 and 466.028(1)(x) and (ff), F.S., that the use of “Sargenti Cement” (e.g., N2, RC2B, or RC2W or essentially similar compounds) as an endodontic filling material or cement does not meet the minimum standards of performance for competent dental practice in Florida. The Board specifically finds that “Sargenti Cement” containing paraformaldehyde, when used as an endodontic filling material or cement, can cause severe and irreversible damage to patients. “Sargenti Cement” that is improperly used or which escapes beyond the root canal is much more likely to cause significant damage than incorrectly performed endodontic procedures using alternative filling materials or cements. Most licensed dentists in Florida do not use “Sargenti Cement” in endodontic therapy. Therefore, the use of “Sargenti Cement” as an endodontic filling material does not meet the existing minimum standard of performance for competent dental practice in Florida.

Rulemaking Authority 466.004(4) FS. Law Implemented 466.028(1)(x), (ff) FS. History–New 5-29-96, Formerly 59Q-17.012.

64B5-17.013 Proprietorship by Nondentists.

(1) No corporation, lay body, organization, or individual other than a licensed dentist or a professional corporation or limited liability company composed of dentists shall engage in the practice of dentistry through the means of engaging the services, upon a salary, commission, or other means of inducement, of any person licensed to practice dentistry in this state. The provisions of this rule are not applicable to dentists working under any of the settings described in Section 466.025, F.S.

(2) No dentist shall enter into any agreement with a nondentist which directs, controls, or interferes with the dentist's clinical judgment, or which controls the use of any dental equipment or material while such is being used for the provision of dental services. Nor shall any dentist enter into an agreement which permits any entity which itself is not a licensed dentist to practice dentistry, or to offer dentistry services to the public through the licensed dentist. The clinical judgment of the licensed dentist must be exercised solely for the benefit of his/her patients, and shall be free from any compromising control, influences, obligations, or loyalties. To direct, control, or interfere with a dentist's clinical judgment shall not be construed to include those matters specifically excluded by Section 466.0285(1)(c), F.S.

(3) For the purposes of this rule:

(a) The term “clinical” means having a significant relationship, whether real or potential, direct or indirect, to the actual rendering or outcome of dental care, the practice of dentistry or the quality of dental care being rendered to one or more patients.

(b) The term “control” shall mean to exercise authority or dominating influence over; having the authority or ability to regulate, direct, or dominate.

(4) A licensed dentist may enter into an agreement with a nondentist to receive “Practice Management Services.” The term “Practice Management Services” is defined to include consultation or other activities or services offered by someone other than a Florida licensed dentist regarding one or more of the following types of products or services:

(a) The suitability of dental office space, furnishings and equipment;

(b) Staff necessary to operate a dental practice;

(c) Regulatory compliance expertise and services;

(d) Methods to increase productivity of a dental practice;

(e) Inventory and supplies required to operate a dental practice;

(f) Information systems designed to produce financial and operational data on the dental practice;

(g) Marketing plans or advertising to increase productivity of a dental practice;

(h) Site selection, relocation, design or physical layout of a dental practice, or

(i) Financial services such as accounting and bookkeeping, monitoring and payment of accounts receivable, payment of leases and subleases, payroll or benefits administration, billing and collection for patient services, payment of federal or state income tax, personal property or intangible taxes, administration of interest expense or indebtedness incurred to finance the operation of the dental practice, or malpractice insurance expenses.

(5) For purposes of implementing the provisions of Sections 466.0285, 466.003 and 466.028(1)(g) and (z), F.S., no dentist shall enter into a practice management agreement with anyone other than a dentist or group of dentists which provides or offers to provide, whether by contract or employment, with or without fee, any practice management service which attempts to govern in any way, whether directly or indirectly, the clinical sufficiency, suitability, reliability or efficacy of a particular product, service, process or activity as it relates to the delivery of dental care. Practice management agreements between dentists and anyone other than a dentist or group of dentists shall not:

(a) Preclude or otherwise restrict, by penalty or operation, the dentist of record's ability to exercise independent professional judgment over all qualitative and quantitative aspects of the delivery of dental care;

(b) Allow anyone other than a dentist of record or the dentist of record's practice to supervise and control the selection, compensation, terms, conditions, obligations or privileges of employment or retention of clinical personnel of the practice;

(c) Limit or define the scope of services offered by the dentist of record or the dentist of record's practice;

(d) Limit the methods of payment accepted by the dentist of record or the dentist of record's practice;

(e) Require the use of patient scheduling systems, marketing plans, promotion or advertising for the dentist of record or the dentist of record's practice which, in the judgment of the dentist of record or the dentist of record's practice will have the effect of discouraging new patients from coming into the practice or discouraging patients of record from seeing the dentist or postponing future appointments or which gives scheduling preference to one individual, class or group of existing or new patients over another individual, class or group of existing or new patients;

(f) Directly or indirectly condition the payment or the amount of the management fee on the referral of patients, and in addition, the management fee shall reasonably relate to the fair market value of the services provided;

(g) Penalize the dentist of record or the dentist of record's practice for reporting perceived violations of this section to, or seeking clarification from, appropriate state or federal agencies, departments or boards.

(6) For purposes of implementing the provisions of Section 466.028(1)(h), F.S., no dentist shall enter into any agreement, or series of agreements, with anyone other than a dentist or group of dentists, which violates the parameters established in subsection (4) or (5), above, and entering into such a contract constitutes a de facto employment of the dentist by a nondentist. Except as permitted by Chapter 542, F.S., licensed dentists are prohibited from agreeing not to compete in the provision of dental services with any entity which is not itself a licensed dentist, or which is not licensed or otherwise permitted by law to provide the services which are the subject of the agreement not to compete.

(7) The provisions of this rule are not intended to impair the validity of any contract in existence as of the effective date of this rule. Any existing contract renewed or extended after the effective date of this rule shall be subject to the provisions of this rule.

Rulemaking Authority 466.004 FS. Law Implemented 466.003, 466.028(1)(g), (z), 466.0285 FS. History–New 10-16-96, Formerly 59Q-17.013, Amended 3-27-02.

64B5-17.014 Removal of Amalgam Fillings.

(1) The Board of Dentistry has determined that claims regarding amalgam fillings as a causal factor in systemic illnesses are not supported by the Food and Drug Administration, the U.S. Public Health Service, or the National Institutes of Health. The Board therefore deems that the removal of amalgam fillings for the purported purpose of curing or preventing systemic illness constitutes alternative or complementary health care. In compliance with Section 456.41, F.S., any dentist performing such alternative or complementary health care treatment shall inform the patient of the following:

(a) The nature of the treatment and the benefits and risks associated with the treatment; and,

(b) The dentist's education, experience and credentials regarding the complementary or alternative treatment option.

(2) Each dentist shall indicate on the patient's record the method(s) by which the requirements of Section 456.41, F.S., were met.

Rulemaking Authority 466.004 FS. Law Implemented 456.41, 466.028(1)(l), (w), (x), (y) FS. History–New 10-21-02.

64B5-17.015 Office Safety Requirement.

As part of the minimum standard of care, every dental office location shall be required to have an automatic external defibrillator by February 28, 2006. Any dentist practicing after February 28, 2006, without an automatic external defibrillator on site shall be considered to be practicing below the minimum standard of care.

Rulemaking Authority 466.004(4), 466.017(3)(c) FS. Law Implemented 466.017(4), 466.028(1)(x) FS. History–New 5-31-04.