7.1 Standard of Care, Teledentistry & Abandonment

7.1 Standard of Care, Consent, and Abandonment

Reasonable and prudent practice

Rule 108.7 requires the level of care a reasonable and prudent dentist would provide under the same or similar circumstances, together with specific professional duties. A poor outcome alone is not proof of negligence, and a technically successful procedure can still violate duties if diagnosis, consent, records, or follow-up were deficient.

The dentist performs an appropriate examination, develops and documents diagnosis and treatment planning, reviews the medical history at the intervals the rule requires, maintains adequate records, uses suitable referrals, and provides emergency preparedness. Current rules require an initial medical history and limited physical examination. At a minimum, both are reviewed and updated annually, and they are revisited whenever a reasonable and prudent dentist would do so under the same or similar circumstances.

Consent and patient choice

Informed consent is communication, not merely a signature. Explain the nature and purpose of proposed care, material risks and benefits, reasonable alternatives including no treatment, expected costs or limitations as appropriate, and who will perform significant portions. Answer questions in understandable language and document the discussion. When complications are a reasonable possibility, obtain the signed consent required by the rule.

Consent does not authorize substandard care or an act outside scope. A patient may refuse recommended treatment, but the record should show capacity, information provided, consequences discussed, and the follow-up or referral offered.

Orthodontic 2026 changes

Current Rule 108.7 adds a duty for an in-person intraoral examination and head-and-neck examination in the covered orthodontic-care context. Remote records or device impressions do not replace that required examination. Rule 108.2 also prohibits conditioning treatment on use of a particular orthodontic device in exchange for examination or review, and Rule 108.8 adds orthodontic counseling acknowledgment and longer record retention. Current assessment questions may test these new provisions.

Ending the relationship

A dentist may withdraw for nonpayment, repeated missed appointments, breakdown of trust, need for unavailable expertise, or other lawful reason, but must avoid abandonment during active treatment. Current Rule 108.5 requires at least 30 days written notice, delivered by hand or certified mail with return receipt requested. The notice should:

• describe the patient’s current status and continuing treatment needs;
• explain reasonably foreseeable consequences of stopping;
• recommend obtaining another dentist;
• offer information or records needed for continuity; and
• state that the dentist remains available for emergency care for a reasonable period, not to exceed 30 days, while the patient arranges care.

The exact transition depends on urgency. A dentist cannot simply dismiss a patient in the middle of an uncontrolled postoperative emergency and rely on a form letter. The patient also cannot compel indefinite nonemergency treatment after adequate termination.

Records and referrals

Provide records under Rule 108.8 and do not withhold them because the treatment bill is unpaid. The dentist may charge lawful copying costs and may use the rule’s process, but access needed for continuity should not be obstructed. When referring, communicate relevant diagnosis, imaging, drugs, complications, and urgency with authorization or other lawful basis.

Emergency preparedness

Rule 108.7 requires emergency oxygen, equipment, and staff preparation appropriate to practice. BLS must be current. A posted 911 number without functional oxygen or trained staff does not meet the professional duty.

Applied examples

A dentist sends a vague text—“we will not see you again”—to a patient with active infection and offers no emergency coverage or referral. That risks abandonment. A certified letter explaining status, urgency, consequences, transfer, and up-to-30-day emergency availability is the correct framework. A patient signs a consent form but was never told of a material nerve-injury risk; the signature alone does not establish informed consent.

Referral and consultation

A reasonable dentist recognizes limits of training, equipment, and setting. Referral is timely when delay would worsen prognosis, and the record states the reason, urgency, information sent, and patient response. A referral does not automatically end the original dentist’s emergency or follow-up duty; define who is responsible until the consultant accepts care.

When a patient refuses referral, document the recommendation, material risk of refusal, alternatives, and instructions for deterioration. If the refusal makes safe care impossible, use the lawful termination process rather than abruptly abandoning the patient.

Continuity during disputes

A billing dispute, negative review, or complaint does not erase emergency obligations. Keep communication professional, avoid retaliation, provide required records, and separate collection activity from clinical transition. If the patient is abusive or threatening, protect staff and use security or law enforcement as appropriate, but still arrange legally adequate notice and urgent-care information unless immediate circumstances make another lawful response necessary.

Teledentistry applies the same clinical standard

Occupations Code Chapter 111 and Rule 108.16 govern care delivered to a patient at a different physical location through telecommunications or information technology. A dentist, hygienist, or assistant delivering teledentistry to a patient located in Texas must hold the active Texas credential appropriate to the work. The dental professional must meet the same standard of care as for the same service in person, establish a practitioner-patient relationship, and maintain complete and accurate records. Remote delivery does not enlarge anyone’s scope or supervision authority. A dentist may simultaneously delegate to and supervise through teledentistry no more than five health professionals who are not dentists.

The dentist must use fraud-prevention protocols, protect communications and records under state and federal privacy law, and tell patients how to complain to TSBDE. In addition to ordinary consent, the written teledentistry consent identifies the delegating dentist and participating auxiliaries as required, discloses delegation, and documents the risks and limits of electronic communication, confidentiality, connection disruption, and the activities permitted remotely. The licensee confirms identity and health history to the extent possible and decides whether the condition is appropriate for a remote encounter.

Prescriptions issued through teledentistry must satisfy the same legitimacy and professional-judgment standards as in-person prescribing. Rule 108.16 adds shorter ceilings for controlled substances prescribed through teledentistry: generally no more than a two-day supply for an opiate or a five-day supply for another controlled substance, with the rule’s weekend and national-holiday extension. Those ceilings do not make a drug clinically appropriate and do not displace PMP, federal, or other Texas requirements.