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February 8, 2023



TDHA began negotiating with TDA in the summer of 2022 to determine whether or not there were potential issues within the larger local anesthesia discussion on which both associations could agree.  In December 2022, we came to a final agreement (see letter of Dec. 13, 2022) that if TDA changes its policy at their House of Delegates meeting in May 2023, both associations will support changing Texas law to allow a dental hygienist to administer local infiltration anesthetic to a non-sedated or nitrous oxide/oxygen inhalation sedated patient who is 18 years of age or older in the context of delivering hygiene services under the direct supervision (as currently defined in 22 Texas Administrative Code § 110.1(7)) and delegation of a Texas-licensed dentist. Part of the agreement is that the hygienist must complete formal education with didactic and clinical training related to the administration of local anesthetic agents, and that TDHA will not pursue to expand scope to mid-level practitioners for a period of ten years.  All of this is contingent on passage and signing into law of the bill.


Current Status

Chairwoman Stephanie Klick requested two bill drafts from Legislative Council: one, a version of the bill drafted by TDA and negotiated with both parties that has come back with some language that both TDHA and TDA had agreed (and continue to agree) to take out regarding the number of hours required for training (attached); and two, a “shell bill,” which is legislative parlance for a placeholder bill that is only intended to be a place to substitute entirely language from a different bill in a manner that will keep the germaneness intact and ensure it is not subject to a point of order (a procedural error that can kill a bill). The shell bill is not back from Lege Council yet.


Due to the timing and backup at Lege Council and bill filing deadline of March 10, the method by which we will have to correct this error is in a committee substitute version of the bill, but that means that this bill will have to be filed with language that we do not support.  This is not an uncommon practice at the Legislature—many if not most bills get filed knowing that tweaks will have to be made along the way to passage.  It is incredibly rare to get a bill back from Legislative Council and filed that is “perfect.”  Additionally, there is some language around CODA that we are still trying to work out with TDA, which will have to be changed as well. 


We will not be asking for the entire association’s support for a bill until and unless the language is corrected in the substituted version—this usually occurs when the bill gets set for a committee hearing.  However, we must get a bill filed in the next twelve days to have a chance to make these changes.  The shell bill will also have to be filed within the same timeframe. 


Talking Points

·       TDHA and TDA are close to an agreement on a bill, but the version drafted by Legislative Council will require a committee substitute before we can “officially” support it. 

·       Legislative deadlines require that we get something filed before March 10. 

·       Any bill(s) that get filed between now and March 10 are steps forward in a process with TDA and not the final language that will be passed into law. 



Denise Rose | Partner & Governmental Affairs Consultant 
100 Congress Avenue Suite 1100 | Austin, TX | 78701 
V: (512) 236-2075 | C: (512) 417-0638 | 

Update on Local Anesthesia Bill

Local Anesthesia: What are the Facts?


It is the numbing of gums and teeth in a specific area of the mouth where scaling and root planing are necessary to treat periodontal (gum) disease. These scaling and root planing procedures may cause discomfort or pain if the tissues are not anesthetized.


CLAIM: Dental hygienists do not have the education to administer local anesthesia.

FACT: Dental hygienists have a minimum of three years of college education. This is comparable to the education of nurses who are RN’s. Dental hygienists’ education includes embryology, gross anatomy, head, neck and dental anatomy, dental radiology, medical emergencies, periodontal disease process and treatment, oral pathology, immunology, dental and medical pharmacology, and pain control. The curriculum also emphasizes community dental health, legal and ethical issues in dental hygiene practice, current technologies, and clinical practice standards.


CLAIM: Current law limits those who are authorized to anesthetize dental patients to dentists, physician anesthesiologists, and certified nurse anesthetists. Dentists may currently utilize these anesthesiologists and nurse anesthetists if needed for administering a local anesthetic.

FACT: To imply that dentists hire anesthesiologists and nurse practitioners to administer local anesthesia for scaling and root planing procedures in dental offices is misleading and erroneous. It is also misleading to imply that the depth of study and preparation of an anesthesiologist or a nurse anesthetist is necessary for administering local anesthesia for dental patients.


CLAIM: Allowing licensed dental hygienists to administer local anesthesia lowers the standard of care in Texas.

FACT: There is no evidence that this statement is true. There is evidence that in 46 other states, the District of Columbia and the U.S. Military it is considered the standard of care for hygienists to anesthetize their patients when the treatment calls for it.  


CLAIM: Most dental hygienists graduate from a 2-year program at a community or junior college. 

FACT: This is partially true. The Registered Dental Hygienist (RDH) designation is equivalent to the Registered Nurse (RN) designation in nursing. And, as in nursing, many hygienists have associate, bachelor and master’s degrees. What is important, however, is that dental hygienists who administer local anesthesia are required to have the same proficiency in performing this procedure as a dentist. They must take the same course and demonstrate equal proficiency during supervised clinical experiences.

CLAIM: Only dentists have the proper education and training to administer local anesthesia. There are no shortcuts to be properly trained and educated to inject patients with local anesthetic.

FACT: It is true that there are no shortcuts to being properly trained and educated to inject patients with local anesthetic. There is no evidence that only dentists have the proper education and training to do it.  Forty-six other states, Washington, D.C., and the U.S. Military have shown that hygienists can safely administer local anesthesia and have been doing so in some states since 1971.[i]  This 50-year record of safety, where no hygienist has ever been cited for board disciplinary action, is evidence that hygienists are properly trained and administer local anesthesia safely in those states that allow it.    


CLAIM: Allowing hygienists to administer local anesthesia would be financially beneficial to hygienists.

FACT: This statement is totally false. Dental hygienists who are educated and certified to administer local anesthesia are paid no more than hygienists without the certification.


CLAIM: Continuing advancements in topical anesthetics limit the need to administer local anesthesia.

FACT:  There is no evidence-based support for this statement. It is well accepted that injectable anesthesia is the first choice for pain control for deep scaling and root planing procedures.[ii] [iii]  Studies show that only injectable local anesthetics can provide adequate comfort for deep soft tissues and root surfaces.[iv] Using topical anesthetic in deep pockets is a disservice to patients. Patients pay for and expect definitive, painless treatment of periodontal disease. Topical anesthesia is not profound enough for patient comfort and the duration is less than 20 minutes, which is not enough time for adequate periodontal therapy.[v]


[i] Boynes SG, Bassett K. Utilization standards for local anesthesia delivery by no dentists. Pain Management. Nov 8, 2016

[ii] Van Steenberghe D, Garmyn P, Geers L, Hendrickx E, Marechal M, Huizar K, et al..Patients' experience of pain and discomfort during instrumentation in the diagnosis and non-surgical treatment of periodontitis. J Periodontol 2004;75:1465-1470.


[iii] Canakci CF, Canakci V. Pain experienced by patients undergoing different periodontal therapies. J Am Dent Assoc 2007;138:1563-1573.


[iv] Antoniazzi RP, Cargnelutii B, et al. Topical intrapocket anesthesia during scaling and root planing: a randomized clinical trial. Braz Dent J. 2015;26(1):26-32.


[v] Friskopp J, Huledal G.Plasma levels of lidocaine and prilocaine after application of Oraqix, a new intrapocket anesthetic, in patients with advanced periodontitis. J Clin Periodontol 2001;28:425-429.

Texas and Delaware are the only states not permitting dental hygienists to administer local anesthesia. GA and MS have passed and are in the rules and regulation stage.

Staying Connected to Your Legislators Virtually During the Next Legislative Session


1.  Get to know your elected officials, especially those that represent you.​

2.  Plan your virtual meeting.​

3.  Send supportive TDHA resource materials before the virtual meeting.​

4.  Share your agenda ahead of time.​

5.  Be politically correct.​

6.  Be prompt, punctual and prepared.​

7.  Things to consider when ending the meeting.​

8.  Things to do after the virtual meeting.​    

9.  Help candidates get elected by volunteering.  IT TAKES TIME TO BUILD A RELATIONSHIP!​

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