1. (a) Level III. A Level III hospital will provide basic emergency dental services with at least a licensed independent practitioner, registered nurse, licensed practical nurse, or intermediate or paramedic level emergency medical technician on site 24 hours a day. A hospital must be classified at Level III for emergency dental services if it complies with all of this subsection:

   1. (1) Clinical services and resources. Diagnostic, surgical, or medical specialty services are not required.
   2. (2) Personnel. A physician, licensed independent practitioner, registered nurse, licensed practical nurse, or Intermediate, Advanced Emergency Medical Technician (AEMT) or paramedic, as defined in OAC 310:641-1-7, will be on site 24 hours a day.
   3. (3) Supplies and equipment. Drugs necessary for the treatment of dental emergencies such as analgesics and antibiotics will be on site and immediately available:

   4. (4) Agreements and policies on transfers.

      1. (A) The hospital must have written policies defining the medical conditions and circumstances for emergency patients that may be retained for treatment in-house, and for those requiring stabilizing treatment and transfer to another hospital.
      2. (B) The hospital must have a written agreement with a dentist or oral and maxillofacial surgeon to provide immediate consultative services for dental patients 24 hours a day. These consultative services must include providing instructions for the initiation of appropriate therapy and/or patient referral to an alternate facility or immediate transfer to a facility capable of providing definitive dental care when appropriate.

2. (b) Level II. A Level II hospital will provide emergency dental services with an organized emergency department. A physician and nursing staff must be on site 24 hours a day. The hospital will have basic facilities for the management of minor dental emergencies. A hospital must be classified at Level II for emergency dental services if it complies with all of this subsection:

   1. (1) Clinical services and resources.

      1. (A) Emergency services. A physician competent in the care of the seriously ill or injured patient and credentialed by the hospital to provide emergency medical services and nursing personnel must be on site 24 hours a day.
      2. (B) Dental services. An appropriately credentialed dental practitioner must be on call 24 hours a day and promptly available in the emergency department.
      3. (C) Oral and maxillofacial surgery. An appropriately credentialed oral and maxillofacial surgeon will be on call 24 hours a day and promptly available in the emergency department.
      4. (D) Operatory. An operatory or operating room equipped to provide treatment for dental emergencies such as odontalgia, oral hemorrhage, dental abscesses, and subluxated, avulsed, and fractured teeth must be available 24 hours a day.
      5. (E) Diagnostic imaging. The hospital's diagnostic x-ray services, including intraoral radiography capability, must be available 24 hours a day. A radiology technologist will be on duty or on call and immediately available 24 hours a day.

      6. (F) Clinical laboratory service. The hospital's clinical laboratory services must be available 24 hours a day. All or part of these services may be provided by arrangements with certified reference laboratories that are available on an emergency basis 24 hours a day. These services include:

         1. (i) Standard analysis of blood, urine, and other body fluids to include routine chemistry and hematology testing;
         2. (ii) Coagulation studies; and
         3. (iii) Comprehensive microbiology services or at least appropriate supplies for the collection, preservation, and transport of clinical specimens for aerobic and anaerobic bacterial, mycobacterial, and fungus cultures.

   2. (2) Personnel.

      1. (A) Dental practitioner. An appropriately credentialed dental practitioner will be available for consultation on site or on call and promptly available in the emergency room 24 hours a day.
      2. (B) Dental assistant. A dental assistant or other appropriately trained staff will be on site or on call and promptly available to assist the dental practitioner in the operatory or operating room.

   3. (3) Supplies and equipment. In addition to the requirements at OAC 310:667-59-9(a)(3), the the hospital's operatory or operating room will have the following stationary or portable equipment for use in the management of minor dental emergencies on site, functional, and available:

      1. (A) Contour treatment chair or operating table appropriate for use in dental procedures;
      2. (B) Dental operative light;

      3. (C) Dental delivery unit with:

         1. (i) High and low-speed handpieces;
         2. (ii) Three way air/water syringe;
         3. (iii) High volume suction; and
         4. (iv) Saliva ejector.
      4. (D) Amalgamator;
      5. (E) Spot welder;
      6. (F) Rubber dams, punch, and clamps;

      7. (G) Sterile procedure sets for:

         1. (i) Tooth avulsions;
         2. (ii) Minor alveolar fractures;
         3. (iii) Endodontic kit; and
         4. (iv) Soft tissue tray for lacerations.
      8. (H) Appropriate dental tools such as mirrors, explorers, probes, curettes, excavators, burs and stones, rongeurs, elevators, files, reamers, mallet and chisels, mouth props, and amalgam tools as appropriate;
      9. (I) Rotary drill; and
      10. (J) Drugs and consumable supplies necessary for the treatment of dental emergencies such as analgesics, antibiotics, adhesives and cements.
   4. (4) Policies on transfers. The policies on transfers are as set forth in (a)(4)(A) of this Section (relating to agreements and policies on transfers).

3. (c) Level I. A Level I hospital will provide comprehensive emergency dental services with an organized dental service and emergency department. A physician and nursing staff must be on site 24 hours a day. An oral and maxillofacial surgeon and anesthesiology services will be available either on duty or on call. The hospital must be able to provide definitive care for complex dental emergencies. A hospital must be classified at Level I for emergency dental services if it complies with all of this subsection:

   1. (1) Clinical services and resources.

      1. (A) Emergency services. A Level I hospital is subject to the same emergency services requirements as a Level II hospital as set forth in (b)(1)(A) of this Section.
      2. (B) Dental services. Dental services will be established by the medical staff. Privileges for physicians and dental practitioners participating in the dental service will be determined by the medical staff credentialing process. The dental service will be consulted on all patients with oral-facial pain, infection, swelling, and/or trauma.
      3. (C) Oral and maxillofacial surgery. A board certified or board prepared oral and maxillofacial surgeon will be on call 24 hours a day and promptly available in the emergency department.
      4. (D) Anesthesia. Anesthesia services must be on call 24 hours a day, promptly available, and administered in accordance with OAC 310:667-25-2.

      5. (E) Other specialties. The hospital will also have the following specialty services available as needed either on site or as part of a dental referral network:

         1. (i) Endodontics;
         2. (ii) Orthodontics;
         3. (iii) Pedodontics;
         4. (iv) Periodontics; and
         5. (v) Prosthodontics.
      6. (F) Operatory. An operatory equipped to provide treatment for dental emergencies such as odontalgia, oral hemorrhage, dental abscesses, and subluxated, avulsed, and fractured teeth must be available 24 hours a day.
      7. (G) Operating suite. An operating suite with thermal control equipment for patients and infusion of blood and fluids will be available 24 hours a day.
      8. (H) Post-anesthesia recovery unit. The hospital will have a post-anesthesia recovery room or surgical intensive care unit that is in compliance with OAC 310:667-15-7 and nursing personnel and anesthesia services remaining in the unit until the patient is discharged from post-anesthesia care.

      9. (I) Intensive care unit. The hospital's intensive care unit must include:

         1. (i) Compliance with OAC 310:667-15-7;
         2. (ii) A registered nurse on duty in the intensive care unit when it has a patient; and
         3. (iii) A registered nurse on call and immediately available when the unit does not have a patient.

      10. (J) Diagnostic imaging. The hospital's diagnostic x-ray services must be available 24 hours a day. A radiology technologist will be on duty or on call and immediately available 24 hours a day. The diagnostic imaging services provided by the hospital will include:

          1. (i) Panoramic radiography;
          2. (ii) Cephalometric radiography; and
          3. (iii) intraoral radiography.

      11. (K) Clinical laboratory service. The hospital's clinical laboratory services must be available 24 hours a day. All or part of these services may be provided by arrangements with certified reference laboratories that are available on an emergency basis 24 hours a day. These services include:

          1. (i) Comprehensive immunohematology services including blood typing and compatibility testing.
          2. (ii) A supply of blood and blood products on hand that is properly stored and adequate to meet expected patient needs.
          3. (iii) The hospital will have access to services provided by a community central blood bank;
          4. (iv) Standard analysis of blood, urine, and other body fluids to include routine chemistry and hematology testing;
          5. (v) Coagulation studies;
          6. (vi) Blood gas/pH analysis; and
          7. (vii) Comprehensive microbiology services or at least appropriate supplies for the collection, preservation, and transport of clinical specimens for aerobic and anaerobic bacterial, mycobacterial, and fungus cultures.

   2. (2) Personnel.

      1. (A) Dental practitioner. Practitioners board certified or board prepared in endodontics, orthodontics, periodontics, and prosthodontics will be available for consultation on site or immediately available by telephone or other electronic means 24 hours a day.
      2. (B) Dental assistant. A dental assistant or other appropriately trained staff will be available to assist the dental practitioner in the operatory 24 hours a day.

   3. (3) Supplies and equipment. In addition to the requirements at OAC 310:667-59-9(a)(3), the hospital's operatory will have the following stationary or portable equipment for use in the management of minor dental emergencies on site, functional, and available:

      1. (A) The supplies and equipment listed for Level II classification in (b)(3)(B) through (J) in this Section; and
      2. (B) Contour treatment chair;
   4. (4) Policies on transfers. The policies on transfers are as set forth in (a)(4)(A) of this Section (relating to agreements and policies on transfers).

Added at 17 Ok Reg 2992, eff 7-13-00

Amended at 20 Ok Reg 1664, eff 6-12-03

Amended at 39 Ok Reg 1392, eff 9-11-22