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TO BE PUBLISHED IN THE OFFICIAL REPORTS
 

OFFICE OF THE ATTORNEY GENERAL
 

State of California
 

JOHN K. VAN DE KAMP
 

Attorney General
 

: 

OPINION : No. 85-605 

: 

of : MARCH 14, 1986 

: 

JOHN K. VAN DE KAMP : 

Attorney General : 

: 

RONALD M. WEISKOPF : 

Deputy Attorney General : 

: 

THE HONORABLE JOHN W. WITT, CITY PROSECUTOR, CITY OF 

SAN DIEGO, has requested an opinion on the following question: 

Is a dentist authorized to utilize the following in the course of the practice 

of dentistry: (1) urinalysis; (2) blood analysis; (3) hair analysis; (4) transcutaneous nerve 

stimulation; (5) electrogalvanic stimulation; (6) palpation to diagnose problems with the 

liver, thyroid and adrenal glands, (7) dietary recommendations; (8) prescribing Elavil to 

relax muscles, or (9) using oral drops to determine vitamin or mineral assimilation. 

CONCLUSION 

In the course of the practice of dentistry a dentist may utilize urinalyses, 

blood analyses and hair analyses, transcutaneous nerve stimulation and electro-galvanic 

stimulation, may offer dietary recommendations, may use oral drops to determine vitamin 

assimilation, and may prescribe the use of Elavil to relax muscles, if such undertakings 

are necessary to diagnose or treat a disease of the human teeth, alveolar process, gums, 

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jaws, or associated structures, and if they have been accepted as an effective means 

thereof by the dental community. A dentist is not authorized to palpate the liver, thyroid 

or adrenal glands. 

ANALYSIS 

Section 1627 of the Dental Practice Act (Bus. & Prof. Code, div. 2, ch. 4, § 

1600 et seq.) authorizes the practice of "dentistry" in California. Section 1625 defines 

that practice as follows: 

"Dentistry is the diagnosis or treatment, by surgery or other method, 

of diseases and lesions and the correction of malpositions of the human 

teeth, alveolar process, gums, jaws, or associated structures; and such 

diagnosis or treatment may include all necessary related procedures as well 

as the use of drugs, anesthetic agents, and physical evaluation. Without 

limiting the foregoing, a person practices dentistry within the meaning of 

this chapter who . . . 

". . . . . . . . . . . . . . . . . . . . . . 

"(b) Performs . . . an operation or diagnosis of any kind, or treats 

diseases or lesions of the human teeth, alveolar process, gums, jaws, or 

associated structures, or corrects malposed positions thereof. 

". . . . . . . . . . . . . . . . . . . . . ." 

We are asked if a dentist may utilize or perform any of the following in the course of that 

practice: urine, blood, and hair analyses; transcutaneous nerve and electrogalvanic 

stimulations; palpation to diagnose problems of the liver, the thyroid and the adrenal 

gland; offer dietary recommendations; prescribing Elavil; utilizing oral drops to 

determine vitamin and mineral assimilation. The question is asked in part because the 

undertakings, such as they be, clearly involve the practice of medicine and therefore may 

not be performed unless one is "authorized to [do so] pursuant to a certificate obtained in 

accordance with some . . . provision of law. . . ." (§ 2052; cf. § 2061.)1 We must 

1 Section 2052 of the Medical Practice Act (Bus. & Prof. Code, div. 2, ch. 5, § 2000 et seq.) 

provides: 

"Any person who practices or attempts to practice, or who advertises or 

holds himself or herself out as practicing, any system or mode of treating the sick 

or afflicted in this state, or who diagnoses, treats, operates for, or prescribes for 

any ailment, blemish, deformity, disease, disfigurement, disorder, injury, or other 

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therefore examine the Dental Practice Act to determine whether it authorizes a dentist to 

perform the procedures in question. (57 Ops.Cal.Atty.Gen. 341 (1974) (dentists 

performing acupuncture); cf. 66 Ops.Cal.Atty.Gen. 428, 430 (1983) (authority of RN to 

inject a contrast agent for a diagnostic study); 64 Ops.Cal.Atty.Gen. 240, 243-244 (1982) 

(authority of RN to prescribe, administer or furnish drugs).) 

Section 1625 in conjunction with section 1627 of the Dental Practice Act 

authorizes a licensed dentist to--

1. diagnose or treat, 

2. by surgery or other method, 

3. diseases and lesions (and correct malpositions), 

4. of the human teeth, alveolar process (i.e., the socket within the jawbone 

in which the root(s) of a tooth are set), gums, jaws, or associated structures, 

and 5. such diagnosis or treatment, may include all necessary related 

procedures, as well as the use of drugs, anesthetics and physical evaluation. (§ 1625.) 

The scope of dental practice so defined is not open ended. The broad definitional 

authority found in the first, second, third and fifth components -- that to diagnose and 

treat by surgery or other method (and to perform an operation of any kind (subd. (b)), 

utilizing all necessary related procedures including physical evaluation, is limited by the 

fourth component to correcting diseases and lesions of the human teeth, alveolar process, 

jaws and associated structures. Thus any diagnostic or treatment endeavor a dentist 

would undertake must be related and directed thereto. (Cf. 57 Ops.Cal.Atty.Gen. 341, 

343 ("that facial area"). In other words, section 1625 literally focuses on particular 

localities and any authority it provides is circumscribed accordingly. (Cf. 66 

physical or mental condition of any person, without having at the time of so doing 

a valid, unrevoked, or unsuspended certificate as provided in this chapter, or 

without being authorized to perform such act pursuant to a certificate obtained in 

accordance with some other provision of law, is guilty of a misdemeanor." 

The inquired procedures constitute the practice of medicine because they involve the diagnosis 

or treatment of physical conditions. 

Section 2061 of the Medical Practice Act echoes the last part of section 2052, thus: 

"Nothing in this chapter shall be construed as limiting the practice of other persons 

license, certified, or registered under any other provision of law relating to the healing arts when 

such person is engaged in his or her authorized and licensed practice." 

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Ops.Cal.Atty.Gen. 302, 308-309 (1983) (defined authority of psychologists is limited to 

mental, as opposed to physical conditions).) 

Such observation however may be only stating the obvious and further 

explanation is required. That is because the phrase "diseases and lesions . . . of the 

human teeth, alveolar process, gums, jaws, or associated structures" is elusive. A 

"disease" we know is an impairment of the normal state that interrupts or modifies the 

performance of the body's functions, systems or organs (Webster's Third New Internat. 

Dict. (1971 ed.) at 648), while a "lesion" is "an abnormal change in structure of an organ 

or part due to injury or disease." (Id., at 1296.) (Accord, Stedman's Medical Dict. (5th 

Lawyer's Ed. 1982) at 403 & 776.) But that does not help much to define the authorized 

scope of dental practice. 

Section 1625 provides that a dentist may diagnose and treat diseases and 

lesions of certain structures mentioned therein, a formulated definition of the scope of the 

practice that has existed since the progenitor of the current Dental Practice Act was 

enacted in 1915. (Stats. 1915, ch. 426, § 11, p. 705 ("diseases or lesions of the human 

teeth or jaw").) The problem is that there are certain dysfunctions of those structures that 

are specifically diseases of them in that they specifically occur or manifest themselves 

there both with respect to the cause of the problem (i.e., its etiology), and the abnormal 

physical condition presented (i.e., its pathology and symptomology). (E.g., dental caries 

and malocclusions, the two most common dental abnormalities (Guyton, Textbook of 

Medical Physiology (5th ed. 1976) at 1070), pyorrhea (cf. Whetstone v. Bd. of Dental 

Examiners (1927) 87 Cal.App. 156, 158, 162-164), myofascial pain-dysfunction, 

abcesses, and sometimes temporomandibular osteoarthritis). A dentist may certainly 

diagnose and treat such diseases or lesions. Those problems are particularly localized and 

section 1625 clearly authorizes a dentist to address them. However, other abnormalities 

of the structures mentioned in section 1625 are but degenerative changes in those 

structures that have been brought about by a systemic dysfunction elsewhere in the body. 

(E.g., scurvy (see, e.g., Davidson, The Principles and Practice of Medicine (7th ed. 1964) 

at 474-480; Guyton, supra, at 983; Medical Reference Library, Symptoms & Illnesses 

(Time, 1983) at 256-257; Wyngaarden & Smith ed. Cecil Textbook of Medicine (16th ed. 

1982) at 1370-1372), AIDS, pregnancy, etc. See generally Burket's Oral Medicine (7th 

(Lynch) ed. 1977), ch. 33, pp. 651-661.) What is the dentist's authorized role in such 

cases? In other words, may a dentist proceed to diagnose and treat the root cause of a 

problem with a section 1625-structure when such is elsewhere in the body? 

The answer is not easily articulated and a hard and fast rule cannot be set 

because there are innumerable possibilities of systemic dysfunction which can have some 

effect on a structure mentioned in section 1625. Generally speaking though, we believe 

that where a systemic problem is such that it is particularly apt to localize itself in one of 

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those oral-structures, it is within the defined province of dentistry to diagnose and treat it. 

(Cf. 16 Cal. Admin. Code, § 1033.) On the other hand, where the organic disturbance is 

such that its effect on the 1625-structure is merely incidental to something greater 

occurring elsewhere in the body, we do not believe a dentist is authorized to undertake its 

diagnosis or treatment. Rather, "if such organic disturbance be suspected . . . the proper 

course of action would be for the [dentist] to refer the patient to a physician . . . who can 

order and tailor such diagnostic tests as are necessary to discern it and who has the 

wherewithal to interpret the results, to diagnose the problem and to plan a course of 

treatment accordingly." (66 Ops.Cal.Atty.Gen., supra, at 309, fn. 10 (licensed 

psychologists suspecting that an organic imbalance may be the cause of a mental, 

emotional or psychological distress).) In other words, the dentist's role -- which is not at 

all minimal in overall patient care -- would be to recognize the possibility of a greater 

systemic problem from the oral pathology and to make an appropriate medical referral. 

In connection therewith, any treatment a dentist would provide would be specifically 

directed and localized to the manifestation of the problem in the structure mentioned in 

section 1625 rather than being directed to the underlying etiology itself. To posit 

otherwise pits the dentist between the Scylla of treating but the oral part of an overall 

problem while ignoring the rest and the Charybdis of addressing the rest, even indirectly, 

and thus "operating" on structures other than those upon which he or she is authorized to 

work. (§ 1625, § 1625, subd. (b); cf. Jacobs v. Board of Dental Examiners (1922) 189 

Cal. 709, 714 ("operate").) 

With this in mind we can answer the specifics of the question asked. 

However, our answer must still be general because we are not healing arts professionals 

with sufficient expertise as to the efficacy of the procedures involved (indeed some are 

very novel) and because we are not specifically told with sufficient exactitude the 

condition(s) a dentist would address by their application. 

We can begin with examples of the two extremes posed by items #6 

(palpation of the liver, thyroid and adrenal gland) and #8 (prescribing Elavil to relax 

muscles). Palpation is the physical examination with the hands of an area, organ or 

structure to discern an abnormality with it. The method involves the use of fingertips for 

touch, the metacarpophalangeal area of the palms for vibration, and the dorsal aspect of 

the hand for temperature. (Rose & Kaye, Internal Medicine For Dentistry (St. Louis: 

The C. V. Mosby Co., 1983) at p. 7.) Using palpation to diagnose a problem with the 

liver, adrenal gland or thyroid would not be within the authorized practice of dentistry as 

we have viewed it because it is not likely that a dysfunction of those organs would affect 

a dental structure specifically but rather would produce a systemic disturbance with 

serious effects elsewhere if not throughout the body. Given that, any diagnosis to be 

made as to the status of those organs -- even should an abnormality with them be the 

cause of a defect in a section 1625 structure -- would be a medical determination for a 

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physician to make and not one to be made by a dentist. Should such an abnormality be 

suspected, it would behoove a dentist to refer the patient to a physician so it could be 

determined. (Cf. 66 Ops.Cal.Atty.Gen., supra, at 309, fn. 10.) A dentist might "treat" the 

symptoms that have particularly manifested themselves in the teeth, alveolar process, 

jaws, gums, or associated structures, but such treatment would have to be specifically 

directed to them. A dentist would not be authorized to address or treat the problem of the 

underlying etiology itself. 

With respect to the prescribing of Elavil (item #8), dentists are specifically 

authorized by section 1625 to use drugs in the course of their treatment of "diseases of 

the mouth." (Cf. Bus. & Prof. Code, §§ 4036, 4213, 4227, 4228; Health & Saf. Code, 

§§ 11026, 11150, 11210.) To the extent that Elavil (amitriptyline HCl), a trycyclic 

antidepressant with sedative effects (see Physician's Desk Reference (1984 ed.) pp. 1278-

1280), or any other drug would be useful in that endeavor whether to produce local or 

general insensibility to pain, to relax a patient, or to combat a localized infection (e.g., 

gingivitis), its use by a dentist is specifically authorized. (Cf. 57 Ops.Cal. Atty.Gen. 341, 

343, supra, citing Painless Parker v. Board of Dental Examiners (1932) 216 Cal. 285, 

295.) 

The same would be said for urinalysis (#1) and blood analysis (#2), and 

perhaps for hair analysis (#3) and the use of oral drops to determine vitamin and mineral 

assimilation (cf. "applied Kinesiology") (#9). Urinalysis and blood analysis are useful 

and well established diagnostic tools to ascertain how well or poorly various bodily 

systems are performing. They also are used to disclose the presence of infection. We are 

told that the other two procedures also serve a diagnostic purpose: hair analysis and the 

placing of oral drops of a particular nutrient on an area of skin followed by observing 

musculature contraction, would be used to determine vitamin and mineral deficiencies 

and the general nutritional status of a dental patient. The value of these as diagnostic 

tools, however, has not been generally accepted. Nevertheless, to the extent that either of 

them or the first two diagnostic tests could efficaciously be used to help diagnose an 

abnormality specifically localized in a structure mentioned in section 1625, its being used 

would be an authorized component of a dentist's diagnostic armamentarium. However, 

the use of any such test to diagnose a systemic disturbance that has but incidentally 

manifested itself in such a structure would exceed a dentist's authority. 

The same dichotomy would apply to a dentist giving nutritional advice 

(#7). While section 2068 of the Medical Practice Act specifically provides that its 

strictures should not be construed to prohibit any person from "providing nutritional 

advice or giving advice concerning proper nutrition," the section also declares that no 

authority is conferred thereby "to practice medicine . . . or to undertake the prevention, 

treatment, or cure of disease . . . or to state that any product might cure any disease . . . or 

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condition in violation of any provision of law." Nevertheless, the Legislature has clearly 

recognized that health practitioners can provide nutritional advice in the course of their 

practice. (§ 2068.)2 Surely the giving of the same is an integral part of good dentistry for 

it is all well established that the eating of certain foods can be harmful to one's dental 

health and the lack in one's diet of certain foods with their vitamin and mineral content 

can be just as deleterious. (See, e.g., Guyton, Textbook of Medical Physiology, supra, at 

970-986; J. Katz, "Nutritional Disorders," Internal Medicine for Dentistry, supra, at pp. 

1102-1113.) A dentist would be authorized by section 1625 to offer nutritional advice 

incident to treating problems with the structures mentioned therein that have been caused 

by improper nutrition but again, if serious nutritional disturbances which affect other 

parts of the body are suspected, referral to a physician should be made. 

We understand transcutaneous nerve stimulation (#4) and electrogalvanic 

stimulation (#5) to be variations on acupuncture -- a method of controlling pain that is 

now respected and generally accepted within the medical community. (See, e.g., Bus. & 

Prof. Code § 2075; cf. 57 Ops.Cal.Atty.Gen. 340, 341, supra.) In 57 Ops.Cal.Atty.Gen. 

340 we were asked whether a dentist could use acupuncture in the course of his practice. 

We concluded that one could: Although acupuncture was then a novel treatment or mode 

of pain control and although it was not taught as part of any study at an accredited 

California dental school, we saw no legal objection to its being used in licensed dental 

practice. (Id., at 343.) The Legislature, we said, "intended to give the dentist broad 

discretion in his selection of an appropriate method of treatment for an affliction of that 

facial area described in section 1625" (ibid.) and "the administration of some mode of 

anesthetic for the production of local or general insensibility to pain had long been a part 

of the practice of dentistry." (Ibid.) Thus we concluded that acupuncture -- for the direct 

treatment of an affliction or to control pain in assistance to such -- came within the 

definition of dentistry as a licensed dentist is authorized to practice pursuant to section 

1625 of the Dental Practice Act and accordingly that dentists could use it "as long as it 

2 Section 2068 requires persons in the commercial practice of providing nutritional advice to 

post the following statement in an easily visible and prominent place in his or her place of 

practice: 

"NOTICE 

"State law allows any person to provide nutritional advice or give advice 

concerning proper nutrition--which is the giving of advice as to the role of food and food 

ingredients, including dietary supplements. This state law does NOT confer authority to 

practice medicine or to undertake the diagnosis, prevention, treatment, or cure of any 

disease, pain, deformity, injury, or physical or mental condition and specifically does not 

authorize any person other than one who is a licensed health practitioner to state that any 

product might cure any disease, disorder, or condition." 

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relates to their special area of authorized practice." (Id., at 341.)3 We follow suit today 

and conclude herein that a dentist may employ subcutaneous nerve stimulation and 

electrogalvanic stimulation as part of the treatment of a disease or lesion of the teeth, 

gums, jaw or alveolar process, or corrections of malpositions thereof. 

We have answered the question of whether a dentist might undertake 

various endeavors in the course of his or her practice in general terms upon our 

perception of the practice of dentistry that is defined in section 1625. Two other aspects 

of the Dental Practice Act must be considered. 

Section 1670 provides that a dentist may have his license revoked or 

suspended by the Board of Dental Examiners for "unprofessional conduct, or 

incompetence, or gross negligence, or repeated acts of negligence in his or her profession 

. . . ." In such context, the term "gross negligence" has been defined to be either the want 

of even scant care or an extreme departure from the ordinary standard of professional 

practice. (Yellin v. Board of Medical Quality Assurance (1985) 174 Cal.App.3d 1040, 

1058-1059; Gore v. Board of Medical Quality Assurance (1980) 110 Cal.App.3d 184, 

198 ("an extreme departure from the standard of medical care"); accord, Franz v. Board 

of Medical Quality Assurance (1982) 31 Cal.3d 124, 138; Mulligan v. Hearing Aid 

Dispensers Examining Com. (1983) 142 Cal.App.3d 1002, 1006 ("generally accepted 

practices and procedures within the professional community").) 

Again, we have no expertise to determine the efficacy of the procedures 

involved. Nor is it for us to determine whether their use, in particular situations or at all, 

would extremely depart from standard professional practice. Rather that is a 

determination for the Board of Dental Examiners to make upon expert testimony as to 

such. (Gore v. Board of Medical Quality Assurance, supra, 110 Cal.App.3d at 196; Thole 

v. Structural Pest Control Bd. (1974) 42 Cal.App.3d 732, 738; cf. Contreras v. St. Luke's 

Hospital (1978) 78 Cal.App.3d 919, 927.) But should it be shown that an extreme 

departure from the accepted practices and procedures within the dental community has 

taken place, the offending dentist could be appropriately disciplined. (See also § 1705.5: 

on an application by ten dentists, the superior court may issue an injunction restraining a 

dentist from violating the Dental Practice Act.) 

3 The fact that acupuncture was not taught as part of any study at an accredited 

California Dental School was an irrelevancy in determining whether it fell within the 

scope of authorized practice because the scope of that authorized practice is not 

predicated on the discipline's curriculum but rather upon the statutory definitions. (Id., at 

341, 343.) 

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Another possibility along these lines exists. Section 1680, subdivision (p) 

of the Dental Practice Act defines "unprofessional conduct" upon which the board may 

discipline a licentiate to include: 

"[t]he clearly excessive prescribing or administering of drugs or 

treatment, or the clearly excessive use of diagnostic procedures, or the 

clearly excessive use of diagnostic or treatment facilities, as determined by 

the customary practice and standards of the dental profession" 

It also provides that a violation of that subdivision constitutes a misdemeanor. 

Once again, we are not versed in the intricacies of the procedures which are 

inquired of herein and we are not given sufficient specifics as to their intended use and 

connection with the practice of dentistry. At least four of the procedures are novel and 

their being used at all has been seriously questioned. Should it be shown in the 

appropriate forum that any of those procedures, or indeed any of the other five, is of no 

value in the proper practice of dentistry, the Board of Dental Examiners would be 

authorized to institute disciplinary action against a dentist who consistently utilized it 

(§§ 1670, 1680(p); cf. § 1670, repeated acts of negligence) and a public prosecutor would 

also be justified in instituting criminal proceedings against him or her. (§ 1680, subd. 

(p).) 

We therefore conclude that in the course of the practice of dentistry a 

dentist may seek a urinalysis, blood analysis, and hair analysis, may use oral drops to 

determine vitamin assimilation, may prescribe Elavil to relax muscles, may offer dietary 

recommendations, and may use transcutaneous nerve stimulation or electrogalvanic 

stimulation to control pain, where such endeavors could effectively be used to diagnose 

or treat a disease of the teeth, gums, jaw, alveolar process or associated structures. A 

dentist may not palpate the liver, the thyroid or the adrenal gland to discern problems 

therewith. 

***** 

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