Changes to Dental Sedation Regulations Coming in 2024

This article does not constitute legal advice. You should consult your attorney for specific advice.

By David Palmer, Esq.

This article previews proposed changes for Arizona, Minnesota, and Washington. Look for updates on these regulations in upcoming issues of the Incisor, as well as significant changes to legislation and regulation across the U.S. If you’re a DOCS Member and have questions about these legislative changes, please contact [email protected]. (While our attorney is available to help answer questions, he cannot provide legal advice and you should consult your attorney for specific advice.)

Arizona

In response to an increased number of incidents over the past several years that have occurred to pediatric patients, the Board is considering changes that, if enacted, will require the following:

1. Arizona dentists would have to earn a pediatric endorsement to give anesthesia or sedation to anyone under the age of eight.
2. Pediatric endorsement holders would undergo an evaluation every two years.
3. Pediatric endorsement holders would have to administer sedation to at least 20 pediatric patients within those two years.

These changes have yet to take effect, but the Arizona Board indicated they would hold a special meeting within the next 60 days to discuss the proposed changes. DOCS will be closely monitoring this situation and will keep all Arizona members informed of any possible updates.

Minnesota

On August 7, 2023, the Minnesota Board of Dentistry released a set of proposed amendments to the rules relating to licensing and administration of sedation and anesthesia. Among those proposed amendments are the following:

1. In addition to the 50 hours of professional development required for each biennial cycle for dentists, a general, deep, or moderate sedation certificate holder must now earn at least 15 hours of professional development in anesthesia-related topics.
2. A dentist who administers general, deep, or moderate sedation must now monitor tissue oxygenation or ventilation using equipment that monitors end-tidal carbon dioxide (capnography).
3. A pediatric endorsement will be required for all moderate sedation certificate holders to administer moderate sedation to a pediatric patient aged eight or younger. This includes evidence of:
   1. Completing a pediatric program accredited by the Commission on Dental Accreditation or equivalent residency program and
   2. An attestation of completing at least 12 cases of pediatric moderate sedation on patients eight years old or younger within 12 months before applying for a pediatric endorsement, which will also be required for renewal of such an endorsement.

Washington

Minimal sedation: The existing rule identifies the minimum requirements for a licensed

dentist to administer a single dose or agent for minimal sedation with or without nitrous oxide. The proposed rule amendments include the following:

• Reduces initial education and training from 21 to 16 hours.
• Removes delineation of single agent versus combined or multiple agents.
• Clarifies specific acceptable training requirements.
• Adds patient evaluation requirement.
• Adds reference to the requirements for recordkeeping, necessary equipment, and required emergency medications or drugs as identified in WAC 246-817-724.
• Clarifies detailed recordkeeping requirements when nitrous oxide is administered.
• Adds requirement for BLS certification and
• Moves CE requirements to new section WAC 246-817-773.

Moderate sedation with enteral agents: The existing rule identifies the training and administration requirements a licensed dentist must comply with to administer moderate sedation. The proposed rule amendments include the following:

• Clarifies title as "Moderate sedation with enteral agents.”
• Increases education and training from 28 to 37 total hours.
• Adds specific acceptable training requirements.
• Adds hands-on skill training requirements.
• Adds patient evaluation requirement.
• Clarifies requirement for BLS certification.
• Moves CE requirements to new section WAC 246-817-773 and
• Increases CE requirement of seven hours from every five to every three years.

Moderate sedation with parenteral agents: The existing rule identifies the training requirements a licensed dentist must complete to administer moderate sedation with parenteral agents. The proposed rule amendments include the following:

• Increases initial education requirement from 15 patients to 20 patients of supervised experience.
• Adds hands-on skill training requirements.
• Changes term "minor" to "pediatric.”
• Adds a list of prohibited drugs.
• Adds patient evaluation requirement.
• Clarifies anesthesia monitor requirement.
• Increases pulse oximetry and respiratory recording to every five minutes from every 15 minutes.
• Adds requirement to have equipment calibrated to manufacturer instructions.
• Adds operating theater, table or chair, and lighting system requirements.
• Adds laryngeal mask airway equipment requirement.
• Adds electrocardiographic monitor equipment requirement with carve out for pediatric patients who are uncooperative, have emotional conditions such that monitoring is not possible, or do not tolerate the monitor pads or wiring.
• Clarifies monitoring requirements.
• Updates examples of emergency drugs.
• Adds bronchodilator agent, advanced cardiovascular life support (ACLS) emergency drugs, and antihypoglycemic agent to emergency drugs.
• Adds written contract requirement if providing sedation in another practitioner's operatory.
• Clarifies requirement for ACLS certification.
• Moves CE requirements to new WAC 246-817-773.
• Reduces CE requirement from 18 hours to 14 hours every three years.
• Adds authorization to provide a lower level of sedation.

Requirements for anesthesia monitor: The existing rule provides anesthesia monitor training requirements and identifies when a licensed dentist administering anesthesia must also have an additional (appropriately) trained individual monitoring the patient. The proposed rule amendments include:

• Adding a requirement that an anesthesia monitor is required when a dentist administers moderate sedation with parenteral agents.

On-site inspections: The proposed new section consolidates self and on-site inspections into one section with the following:

• 2023-16 WSR 160, *170 Page 14 of 48.
• Adds annual self-inspections of emergency preparedness for all dentists.
• Defines annual self-inspection for moderate sedation with parenteral agents and general anesthesia permits annually.
• Defines new on-site inspection requirements every five years for general anesthesia and moderate sedation with parenteral agent permit holders.
• Provides on-site inspection requirements every five years by organization or self-arranged using an approved form.
• Provides standards for those self-arranged inspections using approved forms.
• Provides a list of approved organizations and delays on-site inspection implementation including a requirement to maintain on-site inspection documentation for five years.

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Author: David Palmer, Esq. is an attorney licensed in the Commonwealth of Pennsylvania. Having spent time in private and corporate practice, he specializes in compliance, contract negotiation, insurance regulations, and healthcare. Outside of the office, David enjoys traveling and the outdoors.