Part II. Standards of Practice
18VAC60-21-50. Scope of practice.
A. A dentist shall only treat based on a bona fide dentist-patient relationship for medicinal or therapeutic purposes within the course of the dentist's professional practice consistent with the definition of dentistry in § 54.1-2700 of the Code of Virginia, the provisions for controlled substances in the Drug Control Act (Chapter 34 (§ 54.1-3400 et seq.) of Title 54.1 of the Code of Virginia), and the general provisions for health practitioners in the Code of Virginia. A bona fide dentist-patient relationship is established when examination and diagnosis of a patient is initiated.
B. For the purpose of prescribing controlled substances, the bona fide dentist-patient relationship shall be established in accordance with § 54.1-3303 of the Code of Virginia.
C. When treating or prescribing for family, the practitioner shall maintain a patient record documenting compliance with statutory criteria for a bona fide practitioner-patient relationship.
Statutory Authority
§ 54.1-2400 of the Code of Virginia.
Historical Notes
Derived from Virginia Register Volume 32, Issue 5, eff. December 2, 2015; Errata, 32:6 VA.R. 1132 November 16, 2015; amended, Virginia Register Volume 41, Issue 2, eff. October 24, 2024.
18VAC60-21-55. Training requirements for administration of botulinum toxin injections for cosmetic purposes.
A. A dentist may possess and administer botulinum toxin injections for cosmetic purposes, provided that the dentist has completed 12 hours of training in the subjects listed in subsection C of this section. Training must include a minimum of four hours of clinical, in-person training on at least two live patients, which shall include patient follow-up post-procedure. Eight of the 12 hours of training may be didactic and may be obtained online or in person.
B. To satisfy the requirements of this section, training must be provided by a dental program or advanced dental education program accredited by CODA, the ADA or its constituent or branch associations, or the Academy of General Dentistry.
C. Training to possess and administer botulinum toxin injections for cosmetic purposes shall include the following subjects:
1. Assessing patients for use of botulinum toxin injections;
2. Screening of patient expectations and psychological motivations;
3. Diagnosis, planning, and treatment;
4. Informed consent, including off-label use of botulinum toxins;
5. Anatomy and neurophysiology of the head and neck;
6. Indications and contraindications for the use of botulinum toxin injections, including off-label and approved product uses;
7. Pharmacology of neurotoxins and botulinum toxins;
8. Safety and risks associated with use of botulinum toxins, including the recognition and management of adverse reactions and complications;
9. Preparation and administration of botulinum toxins; and
10. Evaluation of patient outcomes.
Statutory Authority
§ 54.1-2400 of the Code of Virginia.
Historical Notes
Derived from Virginia Register Volume 42, Issue 18, eff. May 20, 2026.
18VAC60-21-60. General responsibilities to patients.
A. A dentist is responsible for conducting a dentistry practice in a manner that safeguards the safety, health, and welfare of patients and the public by:
1. Maintaining a safe and sanitary practice.
2. Consulting with or referring patients to other practitioners with specialized knowledge, skills, and experience when needed to safeguard and advance the health of the patient.
3. Treating according to the patient's desires only to the extent that such treatment is within the bounds of accepted treatment and only after the patient has been given a treatment recommendation and an explanation of the acceptable alternatives.
4. Only delegating patient care and exposure of dental x-rays or taking of digital scans to qualified, properly trained and supervised personnel as authorized in Part IV (18VAC60-21-110 et seq.) of this chapter.
5. Giving patients at least 30 days written notice of a decision to terminate the dentist-patient relationship.
6. Knowing the signs of abuse and neglect and reporting suspected cases to the proper authorities consistent with state law.
7. Accurately representing to a patient and the public the materials or methods and techniques to be used in treatment.
B. A dentist is responsible for conducting financial responsibilities to patients and third-party payers in an ethical and honest manner by:
1. Providing customary fees and representing all fees being charged clearly and accurately.
2. Not exploiting the dentist-patient relationship for personal gain related to nondental transactions.
Statutory Authority
§ 54.1-2400 of the Code of Virginia.
Historical Notes
Derived from Virginia Register Volume 32, Issue 5, eff. December 2, 2015; amended, Virginia Register Volume 41, Issue 2, eff. October 24, 2024; Volume 42, Issue 14, eff. March 25, 2026.
18VAC60-21-70. Unprofessional practice.
A. No dentist shall commit any act that violates provisions of the Code of Virginia that reasonably relate to the practice of dentistry, including:
1. Delegating any dental service or operation that requires the professional competence or judgment of a dentist to any person who is not a licensed dentist or dental hygienist or a registered dental assistant II.
2. Violating any applicable statute or regulation governing ionizing radiation in the Commonwealth of Virginia, including current regulations promulgated by the Virginia Department of Health.
3. Failing to maintain and dispense scheduled drugs as authorized by the Virginia Drug Control Act (Chapter 34 (§ 54.1-3400 et seq.) of Title 54.1 of the Code of Virginia) and the regulations of the Board of Pharmacy.
4. Failing to cooperate with an employee of the Department of Health Professions in the conduct of an investigation or inspection.
B. Sexual conduct with a patient, employee, or student.
1. Sexual contact with a patient, employee, or student shall constitute unprofessional conduct if:
a. The sexual contact is unwanted or nonconsensual; or
b. The sexual contact is a result of the exploitation of trust, knowledge, or influence derived from the professional relationship or if the contact has had or is likely to have an adverse effect on patient care.
2. The determination of when a person is a patient for purposes of this section will be made on a case-by-case basis, with consideration given to the nature, extent, and context of the professional relationship between the practitioner and the person. The fact that the person is not actively receiving treatment or professional services from a practitioner is not determinative of this issue. A person is presumed to remain a patient until the practitioner-patient relationship is terminated.
3. Sexual contact between a practitioner and a former patient after termination of the practitioner-patient relationship may still constitute unprofessional conduct if the sexual contact is a result of the exploitation of trust, knowledge, or influence derived from the professional relationship.
4. Sexual contact between a practitioner and a key third party shall constitute unprofessional conduct if the sexual contact is the result of the exploitation of trust, knowledge, or influence derived from the professional relationship or if the contact has had or is likely to cause an adverse effect on patient care. For purposes of this section, "key third party" shall mean spouse, partner, parent, child, guardian, or legal representative of a patient.
Statutory Authority
§ 54.1-2400 of the Code of Virginia.
Historical Notes
Derived from Virginia Register Volume 32, Issue 5, eff. December 2, 2015; amended, Virginia Register Volume 41, Issue 2, eff. October 24, 2024.
18VAC60-21-80. Advertising.
A. Practice limitation. A general dentist who limits the general dentist's practice to a dental specialty or describes the general dentist's practice by types of treatment shall state in conjunction with the general dentist's name that he is a general dentist providing certain services (e.g., orthodontic services).
B. Fee disclosures. Any statement specifying a fee for a dental service that does not include the cost of all related procedures, services, and products that, to a substantial likelihood, will be necessary for the completion of the advertised services as it would be understood by an ordinarily prudent person shall be deemed to be deceptive or misleading. Where reasonable disclosure of all relevant variables and considerations is made, a statement of a range of fees for specifically described dental services shall not be deemed to be deceptive or misleading.
C. Discounts and free offers. Discount and free offers for a dental service are permissible for advertising only when the nondiscounted or full fee, if any, and the final discounted fee are also disclosed in the advertisement. In addition, the time period for obtaining the discount or free offer must be stated in the advertisement. The dentist shall maintain documented evidence to substantiate the discounted fee or free offer.
D. Retention of advertising. A prerecorded or archived copy of all advertisements shall be retained for a two-year period following the final appearance of the advertisement. The advertising dentist is responsible for making prerecorded or archived copies of the advertisement available to the board within five days following a request by the board.
E. Routine dental services. Advertising of fees pursuant to this section is limited to procedures that are set forth in the American Dental Association's "Dental Procedures Codes," published in Current Dental Terminology in effect at the time the advertisement is issued.
Statutory Authority
§ 54.1-2400 of the Code of Virginia.
Historical Notes
Derived from Virginia Register Volume 32, Issue 5, eff. December 2, 2015; amended, Virginia Register Volume 41, Issue 2, eff. October 24, 2024.
18VAC60-21-90. Patient information and records.
A. A dentist shall maintain complete, legible, and accurate patient records for not less than six years from the last date of service for purposes of review by the board with the following exceptions:
1. Records of a minor child shall be maintained until the child reaches 18 years of age or becomes emancipated, with a minimum time for record retention of six years from the last patient encounter regardless of the age of the child;
2. Records that have previously been transferred to another practitioner or health care provider or provided to the patient or the patient's personal representative pursuant to § 54.1-2405 of the Code of Virginia; and
3. Records that are required by contractual obligation or federal law may need to be maintained for a longer period of time.
B. Every patient record shall include documentary evidence of the following:
1. Patient's name on each page in the patient record;
2. A health history taken at the initial appointment that is updated (i) when analgesia, sedation, or anesthesia is to be administered; (ii) when medically indicated; and (iii) at least annually;
3. Diagnosis and options discussed, including the risks and benefits of treatment or nontreatment and the estimated cost of treatment options;
4. Consent for treatment obtained and treatment rendered;
5. List of drugs prescribed, administered, or dispensed and the route of administration, quantity, dose, and strength;
6. Radiographs, digital images, and photographs clearly labeled with patient name, date taken, and teeth identified;
7. Notation of each treatment rendered, the date of treatment and of the dentist, dental hygienist, and dental assistant II providing service;
8. Duplicate laboratory work orders that meet the requirements of § 54.1-2719 of the Code of Virginia, including the address and signature of the dentist;
9. Itemized patient financial records as required by § 54.1-2404 of the Code of Virginia;
10. A notation or documentation of an order required for treatment of a patient by a dental hygienist practicing under general supervision as required in 18VAC60-21-140 B; and
11. The information required for the administration of moderate sedation, deep sedation, and general anesthesia required in 18VAC60-21-260 D.
C. Records shall not be withheld because the patient has an outstanding financial obligation.
D. A reasonable cost-based fee may be charged for copying patient records to include the cost of supplies and labor for copying documents, duplication of radiographs and images, and postage if mailing is requested as authorized by § 32.1-127.1:03 of the Code of Virginia. The charges specified in § 8.01-413 of the Code of Virginia are permitted when records are subpoenaed as evidence for purposes of civil litigation.
E. Records shall not be abandoned or otherwise left in the care of someone who is not licensed by the board except that, upon the death of a licensee, a trustee or executor of the estate may safeguard the records until they are transferred to a licensed dentist, sent to the patients of record, or destroyed.
F. Patient confidentiality must be preserved when records are destroyed.
Statutory Authority
§§ 54.1-2400 and 54.1-2709.5 of the Code of Virginia.
Historical Notes
Derived from Virginia Register Volume 32, Issue 5, eff. December 2, 2015; amended, Virginia Register Volume 35, Issue 5, eff. November 28, 2018; Volume 41, Issue 2, eff. October 24, 2024.
18VAC60-21-100. Reportable events during or following treatment or the administration of sedation or anesthesia.
The treating dentist shall submit a written report to the board within 15 calendar days following an unexpected patient event that occurred intra-operatively or during the first 24 hours immediately following the patient's departure from his facility, resulting in either a physical injury or a respiratory, cardiovascular, or neurological complication that was related to the dental treatment or service provided and that necessitated admission of the patient to a hospital or in a patient death. Any emergency treatment of a patient by a hospital that is related to sedation anesthesia shall also be reported.
Statutory Authority
§ 54.1-2400 of the Code of Virginia.
Historical Notes
Derived from Virginia Register Volume 32, Issue 5, eff. December 2, 2015.