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Virginia Regulatory Town Hall
Department of Health Professions
Board of Dentistry
Regulations Governing the Practice of Dentistry [18 VAC 60 ‑ 21]
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7/18/19  11:14 am
Commenter: Samuel W. Galstan, DDS, MPH, MAGD, President, Virginia Dental Association


As President of the Virginia Dental Association, I strongly agree with the rulemaking petition that “digital impression file” is equivalent to a physical or analog “final impression”, that teledentistry should be clearly defined in the Regulations governing the practice of Dentistry in Virginia, and that all interactions in the dental setting be guided by the importance of the doctor / patient relationship. The VDA represents nearly 3,700 member dentists who deeply care about the health, safety and welfare of patients in the Commonwealth of Virginia, and making this rule making change would help ensure this.
The mission of the Department of Health Professions, which is the umbrella agency for the 13 health regulatory boards including the Board of Dentistry, is to ensure safe and competent patient care by licensing health professionals, enforcing standards of practice, and providing information to health care practitioners and the public.
Presently, there is a Guidance document, 60-23 that deals with teledentistry, however, as we all know, Guidance documents are just that, they are for guidance only, and they are not codified and carry no regulatory or disciplinary weight. This request for rulemaking is simply requesting that this guidance document on teledentistry is simply converted to code, to account for technological advances and the current state of dental practice in Virginia, as well as to acknowledge the importance of the doctor / patient relationship. An impression is an impression, no matter by what means it is taken, and the doctor / patient relationship is paramount to ensure health, safety and welfare of patient care, and this must be clarified, protected and acknowledged by Virginia law. This rule making change on Teledentistry should be clearly defined in the Regulations Governing the Practice of Dentistry.
Any delivery of teledentistry services to patients must comply with scope of practice laws and regulations in Virginia and the delivery of teledentistry services must be consistent with the in-person delivery of those services to ensure patient safety.
In all dental setting, teledentistry included, the dentist/patient relationship needs to be formed and the dentist needs to examine a patient prior to certified staff taking digital scans that are used to fabricate an appliance or device that is placed in a patient’s mouth, and that supervision by a dentist of all allied personnel in the dental office is critical. All dental treatment, whether traditional or through teledentistry, must conform to current Virginia laws and regulations, as it is ultimately the dentist’s responsibility to protect the patient.
This petition requests to update the definition of a final impression due to technologic advancements and to remain consistent with the statue already in place. It seeks to define a "digital impression file," equivalent to an analog "final impression" if used to fabricate an appliance to be inserted into a patient's mouth. It should not matter if the file is produced by scanning a patient's mouth through the use of an intra-oral scanner or scanning a patient's dental cast model by an optical scanner. Both create a "digital file" containing the patient's personal identifying information which can then be used to fabricate an appliance to be inserted into a patient's mouth just as occurs in the analog equivalent of a "final impression." All of this needs to be clarified and coded into Virginia law.

References include:

The adopted Guidance document: 60-23, that indicates Teledentistry "should not be construed to alter the scope of practice of any health care provider or authorize the delivery of health care services in a setting, or in a manner, not authorized by law. In fact, these guidelines support a consistent standard of care and scope of practice notwithstanding the delivery tool or business method used to enable practitioner-to- patient communications. For clarity, a practitioner using teledentistry services in the provision of dental services to a patient (whether existing or new) must take appropriate steps to establish the practitioner-patient relationship as defined in Virginia Code § 54.1-3303 and conduct all appropriate evaluations and history of the patient consistent with traditional standards of care for the particular patient presentation."

Statutory Authority: § 54.1-2400 and Chapter 27 of Title 54.1 of the Code of Virginia. § 54.1-2711. Practice of dentistry.
iv) extracts teeth, corrects malpositions of the teeth or jaws, takes impressions for the fabrication of appliances or dental prosthesis, supplies or repairs artificial teeth as substitutes for natural teeth, or places in the mouth and adjusts such substitutes.”

Thank you for your consideration,
Samuel W. Galstan, D.D.S., M.P.H., M.A.G.D.
President, Virginia Dental Association