Since the American Dental Association updated their sedation dentistry guidelines in 2007, states and provinces have responded by updating and passing new regulations. In honor of Sedation Safety Week 2011, and to raise awareness, I composed a list of the states and provinces that have changed their regulations since January 2010. John P. Bitting, Esq. Regulatory Counsel, DOCS Education

Alberta

The Alberta Dental Association and College advises dentists to complete a "training program, designed to produce competency in the use of the specific modality of conscious sedation, including indications, contraindications, patient evaluation, patient selection, pharmacology of relevant drugs, and management of potential adverse reactions" and obtain a Modality 3 permit before providing their patients with minimal or moderate sedation using an oral sedative with nitrous, supplemental dosing of an oral sedative, or more than one sedative agent.* *Even when the intent is only a single dose of a single sedative (without nitrous), the ADA&C still advises “successful completion of a training program designed to produce competency in the specific modality of sedation utilized.”

Colorado

Effective March 30, 2010: Colorado State Board of Dental Examiners Rule §XIV requires dentists to complete at least 16 hours of instructive classroom training in the administration of minimal sedation techniques and management of complications and emergencies before providing their patients with minimal sedation using oral sedatives.

Georgia

Effective March 10, 2010: Georgia Board of Dentistry Rule §150- 13-.01 requires dentists to complete at least 24 hours of instructive classroom training with 10 clinical patient experiences, and obtain a permit before providing their adult patients with moderate sedation using oral sedatives.* Advanced Cardiac Life Support (ACLS) certification is also required. *When the intent is single-agent minimal sedation on a patient of any age, formal training is not required, but the ADA guidelines recommend at least 16 hours of training.

Illinois

Effective May 5, 2010: Illinois Board of Dentistry Rule §1220.500 defines "Minimal Sedation" as a minimally depressed level of consciousness, produced by a pharmacological method, that retains the patient's ability to independently and continually maintain an airway and respond normally to tactile stimulation and verbal command. Although cognitive function and coordination may be modestly impaired, ventilatory and cardiovascular functions are unaffected." What this means to you: For the first time, Illinois dentists - without an IV permit - can provide their fearful patients with minimal sedation using individualized (e.g. incremental) dosing of oral sedatives so long as the patient's reasonably expected level of consciousness does not exceed the new definition of "Minimal Sedation." American Dental Association sedation guidelines provide that a dentist should complete at least 16 hours of instructive classroom training with clinically-oriented experiences before providing healthy patients with minimal sedation using oral sedatives.* *Illinois State Board of Dentistry Rule §1220.505 does not require formal training before dentists provide minimal sedation. Effective May 5, 2010: Illinois State Board of Dentistry Rule § 1220.245(c)(2)(A) requires dental assistants monitoring minimally sedated patients to be certified in at least twelve (12) combined hours of classroom and clinical instruction in “anatomy, physiology, pharmacology, monitoring, and emergency procedures with an emphasis on airway management.”* *Dental assistants with a nitrous monitoring certificate must still be certified in at least six (6) additional hours of advanced airway management and monitoring equipment. Dental hygienists with a nitrous certificate do not require additional training.

Iowa

The Iowa Dental Board requires a dentist to complete a 60-hour IV sedation course, administer 20 clinical patient cases, and obtain a permit before providing oral or IV moderate sedation to dental patients.* *When the intent is single-agent minimal sedation only, a permit is not required, but the ADA sedation guidelines recommend at least 16 hours of training.

Kansas

Effective December 1, 2010: Kansas Dental Board Rule §71- 5- 10(a)(3)(A) requires dentists to complete at least 18 hours of instructive classroom training, observe 20 clinical patient experiences, and obtain a Level I permit before providing their adult patients with conscious sedation using oral sedatives.* *Additional pediatric-specific training is required if oral sedation patients are under age 13. Grandfathering is also available for the new Level I permit. When the intent is anxiolysis only on a patient of any age, a permit will not be required.

Kentucky

Effective February 2, 2011: Kentucky Board of Dentistry Rule 201 KAR 8:550E § 6(4)(b) requires dentists to complete at least 24 hours of instructive classroom training, document 3 live patient cases, and obtain a permit before providing their adult patients with moderate sedation using oral sedatives.* *Dentists currently providing adult oral sedation may continue to do so without a permit until January 1, 2012 and can receive a permit by submitting 24 hours of didactic education plus 20 sedation records documenting their experience. Pediatric minimal sedation (<13yo) requires a 24-hour pediatric-specific course and a permit as well.

Maryland

Effective January 4, 2010: Maryland State Board of Dental Examiners Rule §10.44.12.08(D)(1) requires dentists to complete at least 24 hours of instructive classroom training with 20 clinical patient experiences, and obtain a Class 1 permit before providing their patients with moderate sedation using oral sedatives.* Advanced Cardiac Life Support (ACLS) certification or board-approved airway management training will also be required. *When the intent is anxiolysis only, a permit will not be required.

Massachusetts

Effective August 20, 2010:Massachusetts Board of Registration in Dentistry Rule §6.13 requires a dentist to complete at least 16 hours of instructive classroom training with clinically-oriented patient experiences, and obtain a "B-2" permit before administering minimal sedation using oral sedatives in-office (with or without nitrous).* Advanced Cardiac Life Support (ACLS) or PALS certification will also be required. *Moderate sedation requires a 60-hour "B-1" permit. Effective August 20, 2010: Massachusetts Board of Registration in Dentistry Rule §6.15(2)(b) requires dental offices where local anesthesia is administered to have an automated external defibrillator (AED) among other required emergency equipment and drugs.

Minnesota

Effective September 27, 2010: Minnesota Board of Dentistry Rule §3100.0100 subp. 13a defines "Minimal Sedation" as a minimally depressed level of consciousness produced by a pharmacological or nonpharmacological method that retains the patient's ability to independently and continuously maintain an airway and respond normally to tactile stimulation and verbal command. Minimal sedation is characterized by moderate impairment to the patient's cognitive function and coordination, but leaves unaffected the patient's ventilatory and cardiovascular functions." What this means to you: For the first time, Minnesota dentists - without an IV permit - can provide their fearful patients with minimal sedation using individualized (e.g. incremental) dosing of oral sedatives so long as the patient's reasonably expected level of consciousness does not exceed the new definition of "Minimal Sedation." American Dental Association sedation guidelines provide that a dentist should complete at least 16 hours of instructive classroom training with clinically-oriented experiences before providing healthy patients with minimal sedation using oral sedatives .* *Minnesota Board of Dentistry Rule §3100.0100 does not require formal training before providing minimal sedation to dental patients.

Oregon

Effective July 1, 2010: Oregon Board of Dentistry Rule §818-026-0050 requires dentists to complete at least 16 hours of instructive classroom training and obtain a permit before providing their patients with minimal sedation using oral sedatives (e.g. Valium® with nitrous).* *Single-dose anxiolysis without nitrous does not require a permit.

South Dakota

Effective January 1, 2011: South Dakota State Board of Dentistry Rule §20:43:09:04(1) will require a dentist to complete a 60-hour I.V. sedation course, administer 20 clinical patient experiences, and obtain a permit before providing oral or I.V. moderate sedation to dental patients.* *When the intent is one-drug minimal sedation only (with or without N20), a permit will not be required.

Tennessee

Tennessee Board of Dentistry Rule §0450-2-.07(6) requires a dentist to complete at least 24 hours of instructive classroom training with 20 clinical patient experiences, and obtain a permit before providing their adult patients with conscious sedation using oral sedatives.* Advanced Cardiac Life Support (ACLS) certification is required. *When the intent is anxiolysis only, a permit is not required.

Utah

Effective February 7, 2011: Utah Administrative Code § R156-69-202 requires dentists to complete at least 16 hours of instructive classroom training with clinically-oriented experiences and obtain a Class 2 permit before providing their patients with minimal sedation using oral sedatives (with or without nitrous)* *Before February 7, 2011, the Class 2 permit was required before administering nitrous, but no formal training was required before providing minimal sedation using oral sedatives. Moderate sedation requires a 60-hour Class 3 permit.

The information contained in this, or any case study post in Incisor, should never be considered a proper replacement for necessary training and/or education regarding adult oral conscious sedation. Regulations regarding sedation vary by state. This is an educational and informational piece. DOCS Education accepts no liability whatsoever for any damages resulting from any direct or indirect recipient's use of or failure to use any of the information contained herein. DOCS Education would be happy to answer any questions or concerns mailed to us at 3250 Airport Way S, Suite 701 | Seattle, WA 98134. Please print a copy of this posting and include it with your question or request.
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