Arkansas Administrative Code
Agency 038 - Board of Dental Examiners
Rule 038.00.09-001 - Article XIII: Rules of the Board governing Sedation and Anesthesia
Universal Citation: AR Admin Rules 038.00.09-001
Current through Register Vol. 49, No. 9, September, 2024
Article XIII ANALGESIA, SEDATION, AND GENERAL
ANESTHESIA RULES FOR A DENTIST IN AN
AMBULATORY FACILITY
A.
DEFINITIONS
1.
Analgesia - The diminution of
pain or production of increased tolerance to pain in the conscious
patient.
2.
Anesthesia
- Partial or complete loss of sensation with or without the loss of
consciousness.
3.
Anesthesia
Period - The period of time beginning with the placement of a needle,
mask, or solution into or onto the body until the patient has met the criteria
which are appropriate for dismissal.
4.
Levels of Supervision For Qualified
Staff -
a. Direct Supervision - The
dentist is in the dental office, authorizes the procedure, and remains in the
dental office while the procedures are being performed by the
auxiliary.
b. Personal Supervision
- The dentist is in the dental office, personally authorizes the procedure, and
before the dismissal of the patient, evaluates the patient.
c. Operative Supervision- The dentist is
personally operating on the patient and authorizes the auxiliary to aid the
treatment by concurrently performing a supportive procedure.
5.
Nitrous Oxide/Oxygen
Inhalation Analgesia - The administration, by inhalation, of a
combination of nitrous oxide and oxygen producing an altered level of
consciousness that retains the patient's ability to independently and
continuously maintain an airway and respond appropriately to physical
stimulation and/or verbal command. Nitrous oxide/ oxygen inhalation analgesia,
when used alone, is not considered a form of sedation but is considered to be
an analgesic only.
6.
Qualified Staff - An individual trained to monitor appropriate
physiological parameters and to help in any supportive or resuscitating
measures.
a. For dentists using Minimal or
Moderate Sedation, qualified staff must have a current Nitrous Oxide Permit
from the Board and be currently certified in health care provider
CPR.
b. For dentists using Deep or
General Sedation, qualified staff must have a current Nitrous Oxide Permit from
the Board and be currently certified in health care provider CPR AND have
completed a Board approved course as outlined in Section G. of this rule and be
registered with the Board as a Sedation Assistant.
7.
Minimal Sedation - a
minimally depressed level of consciousness produced by a pharmacological
method, that retains the patient's ability to independently and continuously
maintain an airway and respond normally to tactile stimulation and verbal
command. The patient should be oriented to person, place and time. Although
cognitive function and coordination may be modestly impaired, ventilatory and
cardiovascular functions are unaffected. In accordance with this particular
definition, the drugand/or techniques used should carry a margin of safety wide
enough never to render unintended loss of consciousness. Further, patients
whose only response is reflex withdrawal from repeated painful stimuli would
not be considered to be in a state of minimal sedation. When the intent is
minimal sedation for adults, the appropriate initial dosing of a single enteral
drug is no more than the maximum recommended dose of a drug that can be
prescribed for unmonitored home use. When the intent is Minimal Sedation, only
one drug can be given in addition to nitrous oxide.
Pediatric Considerations: In addition to the physiologic parameters for Minimal Sedation in children under 12 years of age, when the intent is Minimal Sedation, only one drug can be given in addition to nitrous oxide. A drug CANNOT be from the scheduled category of drugs II, III or IV. If a child under 12 years of age is given any drug for sedation from Schedule II, III or IV, that child is considered more than minimally sedated.
8.
Moderate Sedation-
a drug-induced depression of consciousness during which patients respond
purposefully to verbal commands, either alone or accompanied by light tactile
stimulation. No interventions are required to maintain a patent airway and
spontaneous ventilation is adequate. Cardiovascular function is usually
maintained. In accordance with this particular definition, the drugs and/or
techniques used should carry a margin of safety wide enough to render
unintended loss of consciousness unlikely. Repeated dosing of an agent before
the effects of previous dosing can be fully appreciated may result in a greater
alteration of the state of consciousness than is the intent of the dentist.
Further, a patient whose only response is reflex withdrawal from a painful
stimulus is not considered to be in a state of moderate sedation.
9.
Deep Sedation- a drug-induced
depression of consciousness during which patients cannot be easily aroused but
respond purposefully following repeated or painful stimulation. The ability to
independently maintain ventilatory function may be impaired. Patients may
require assistance in maintaining a patent airway, and spontaneous ventilation
may be inadequate. Cardiovascular function is usually maintained.
10.
General Anesthesia - a
drug-induced loss of consciousness during which patients are not arousable,
even by painful stimulation. The ability to independently maintain ventilatory
function is often impaired. Patients often require assistance in maintaining a
patent airway, and positive pressure ventilation may be required because of
depressed spontaneous ventilation or drug-induced depression of neuromuscular
function. Cardiovascular function may be impaired.
11.
Titration- administration of
incremental doses of a drug until a desired effect is reached. Knowledge of
each drug's time of onset, peak response and duration of action is essential to
avoid over sedation. Although the concept of titration of a drug to effect is
critical for patient safety, when the intent is moderate sedation one must know
whether the previous dose has taken full effect before administering an
additional drug increment.
12.
Routes of Administration Defined-
a. Enteral: any technique of administration
in which the agent is absorbed through the gastrointestinal tract or oral
mucosa (i.e. oral, rectal, sublingual).
b. Parenteral: a technique of administration
in which the drug bypasses the gastrointestinal tract (i.e. intramuscular,
intravenous, intranasal, submucosal, subcutaneous, intraosseous).
c. Transdermal: a technique of administration
in which the drug is administered by patch or iontophoresis through
skin.-
d. Transmucosal: a technique
of administration in which the drug is administered across mucosa such as
intranasal, sublingual or rectal.
e. Inhalation: a technique of administration
in which a gaseous or volatile agent is introduced into the lungs and whose
primary effect is due to absorption through the gas/blood interface.
13.
Patient Physical Status
Classification (as defined by the American Society of
Anesthesiologists)-
a. ASA I: A normal healthy
patient
b. ASA II: A patient with
mild systemic disease
c. ASA III: A
patient with severe systemic disease
d. ASA IV: A patient with severe systemic
disease that is a constant threat to life
e. ASA V: A moribund patient who is not
expected to survive without the operation
f. ASA VI: A declared brain-dead patient
whose organs are being removed for donor purposes
g. E: Emergency operation of any variety
(used to modify one of the above classifications, i.e. ASA III-E)
14.
Maximum Recommended Dose
(MRD) - maximum FDA- recommended dose of a drug as printed in
FDA-approved labeling for unmonitored home use.
15.
Incremental Dosing-
administration of multiple doses of a drug until a desired effect is reached,
but not to exceed the MRD.
16.
Supplemental Dosing- during minimal sedation, supplemental dosing
is a single additional dose of the initial drug that may be necessary for
prolonged procedures. The supplemental dose should not exceed one-half of the
initial total dose and should not be administered until the dentist has
determined the clinical half-life of the initial dosing has passed. The total
aggregate dose must not exceed 1.5 x the MRD on the day of treatment.
17.
Pediatric Sedation- Any
level above nitrous oxide analgesia on patients under the age of twelve (12)
years.
18.
Permit
reclassification- All Level 3 permits currently held by any dentists on
the date of adoption of this rule will be reclassified to Moderate Sedation
permits. All Level 4- General Anesthesia permits currently held by any dentists
on the date of adoption of this rule will be reclassified to Deep
Sedation-General Anesthesia permits.
B.
EDUCATIONAL REQUIREMENTS
1.
Nitrous Oxide/Oxygen
Analgesia
a. Anydentist licensed in
Arkansas may administer-nitrous oxide/oxygen inhalation analgesia.
b. A current certification in health-care
provider level of CPR is required.
2.
Minimal Sedation
a. Any dentist administering Minimal Sedation
must have training to the level of competency in minimal sedation consistent
with that prescribed in the ADA Guidelines for Teaching Pain Control
and Sedation to Dentists and Dental Students, Section
IV"Enteral and/or Combination
Inhalation-Enteral Minimal Sedation" OR an equivalent continuing
education course approved by the Arkansas State Board of Dental Examiners and
which may be completed in either a pre-doctoral dental curriculum or a
post-doctoral continuing education course.
b. Dentists administering Minimal Sedation to
children under the age of 12 must hold a current Pediatric Advanced Life
Support (PALS) certification OR a Deep Sedation or General Anesthesia
permit.
c. Dentists administering
Minimal Sedation to patients 12 years of age or older must hold current
certification in healthcare provider level of basic life support.
3.
Moderate Sedation
a. Any dentist administering Moderate
Sedation must have successfully completed a comprehensive training program in
moderate sedation that satisfies the requirements described in the Moderate
Sedation training section of the ADA Guidelines for Teaching Pain
Control and Sedation to Dentists and Dental Students OR an equivalent
continuing education course approved by the Arkansas State Board of Dental
Examiners.
b. Dentists
administering Moderate Sedation to patients under the age of 12 years must have
current certification in Pediatric Advanced Life Support (PALS) certification
OR a Deep Sedation or General Anesthesia permit.
c. Dentists administering Moderate Sedation
to patients 12 years of age or older must hold current certification in
Advanced Cardiac Life Support (ACLS) or an appropriate dental
sedation/anesthesia emergency management course.
d. Dentists administering Moderate Sedation
to adult patients who are deemed to be patients with special health care needs
(e.g. ASA III) must complete additional hours of additional training related to
sedation of complex patients per the ADA Guidelines for Teaching Pain
Control and Sedation to Dentists and Dental Students.
4.
Deep Sedation or General
Anesthesia
a. Any dentist
administering Deep Sedation or General Anesthesia must have successfully
completed an advanced education program in a facility accredited by the ADA
Commission on Dental Accreditation that affords comprehensive and appropriate
training necessary to administer and manage deep sedation or general anesthesia
as set forth in the ADA Guidelines for the Use of Sedation and General
Anesthesia by Dentists, Section
IV. C. OR
b. A residency in general anesthesia at an
institution certified by the American Society of Anesthesiology, the American
Medical Association, or the Joint Commission on Hospital Accreditation,
resulting in the dentist becoming clinically competent in the administration of
general anesthesia. The residency must include a minimum of 390 hours of
didactic study, 1040 hours of clinical anesthesiology, and 260 cases of
administration of General Anesthesia to an ambulatory outpatient.
c. Dentists administering Deep Sedation or
General Anesthesia must hold current certification in Advanced Cardiac Life
Support (ACLS) or an appropriate dental sedation/anesthesia emergency
management course.
C.
STANDARD OF CARE
These guidelines are designed to encourage a high level of quality care in the dental office setting. It should be recognized that emergency situations may require that these standards be modified based on the judgment of the clinician(s) responsible for the delivery of anesthesia care services. Changing technology and Arkansas rules, regulations or laws may also modify the standards listed herein.
1.
Before the administration of sedation or general anesthesia, a complete written
medical history must be obtained which shall include previous and current
medications, vital signs, allergies and sensitivities. The recording of
appropriate vital signs is required for all levels of sedation. The patient's
weight should be recorded when appropriate. Patients with significant medical
considerations (ASA III or IV) may require consultation with their primary care
physician or consulting medical specialist as well as written clearance for
treatment from that physician.
2.
During the anesthesia period the oxygenation, ventilation, and circulation of
the patient must be continuously evaluated and documented by qualified staff
assigned by the dentist.
3. Each
licensed dentist administering Deep Sedation or General Anesthesia must provide
for training in emergency procedures to his or her qualified staff personnel.
Emergency preparedness updates or drills for all staff must be held at least
annually.
4. A dentist who
administers any type of sedation or general anesthesia shall maintain emergency
equipment and medications appropriate for patient resuscitation. That dentist
shall be proficient in handling emergencies and complications to include the
maintenance of respiration, circulation, and the immediate establishment of a
patent airway, and cardiopulmonary resuscitation. The dentist shall maintain
appropriate emergency equipment and medications in the dental
facility.
5. All scheduled
medications shall be stored and inventoried in accordance with all applicable
state and federal regulations.
6.
The patient must be continuously observed during the anesthesia period either
by the dentist or qualified staff.
7. Personal supervision is required for
monitoring patients under nitrous oxide/oxygen analgesia for registered dental
assistants holding a current Nitrous Oxide Permit from the Board.
8. Direct supervision is required for
monitoring patients under nitrous oxide/oxygen analgesia for dental hygienists
holding a current Nitrous Oxide Permit from the Board.
9. Supervision of dental auxiliaries
monitoring sedated patients-
a. Personal
supervision is required for Minimal and Moderate Sedation
b. Operative supervision is required for Deep
Sedation and General Anesthesia.
c.
Personal supervision is required for Qualified Staff who continuously monitor
post-surgical patients before final evaluation and discharge by the
dentist.
10. For
Pediatric Sedation, all drugs from Schedule II, III or IV for sedations must be
administered in the dental office.
D.
PERMITS, QUALIFIED STAFF, EQUIPMENT,
DOCUMENTATION, EMERGENCY CARE & PATIENT MONITORING
1.
Nitrous Oxide Inhalation
Analgesia
a. Permit: A permit is not
required for the dentist.
b.
Qualified Staff: All patients shall be monitored continuously by personnel who
hold a current permit with the Board to induce and monitor nitrous oxide/oxygen
inhalation analgesia and a current certification in health-care provider level
CPR.
c. Equipment: Fail safe
nitrous oxide equipment with nitrous oxide scavenging.
d. Documentation: The use of nitrous oxide
and oxygen analgesia must be properly recorded on each individual patient's
record.
e. Emergency care: The
dental office shall maintain emergency equipment and medications to perform
basic life support.
f. Patient
Monitoring: The dentist or qualified staff must remain in the operatory while a
patient is receiving nitrous oxide inhalation analgesia.
2.
Minimal Sedation
a. Permit: A permit from the Board is not
required for Minimal Sedation.
b.
Qualified Staff: All patients shall be monitored continuously by qualified
staff who hold a current permit with the Board to induce and monitor nitrous
oxide/oxygen inhalation analgesia and a current certification in health-care
provider level CPR.
c. Equipment:
1) The nitrous oxide and patient monitoring
equipment listed below must be used for every patient being sedated. If
multiple patients are being sedated simultaneously, each piece of equipment
listed must be available for every patient being sedated.
(a) Fail safe nitrous oxide
equipment
(b) Scavenging system for
nitrous oxide
(c) Pulse oximeter
for pediatric minimal sedation
(d)
Blood pressure cuff and stethoscope
2) The emergency equipment listed below must
be available in any office where minimal sedation is administered:
(a) Oral air-ways
(b) Appropriate emergency drugs
(c) Automated External
Defibrillators
(d) Positive
pressure oxygen delivery system with appropriately sized mask
d. Documentation: The
use of minimal sedation must be properly recorded on each individual patient's
record. Documentation should include but not be limited to:
1) Informed consent
2) Health history
3) For pediatric minimal sedation, heart rate
and respiratory rate must be recorded preoperatively, intraoperatively and
postoperatively as necessary. Blood pressure must be recorded preoperatively,
intraoperatively and postoperatively as necessary unless the patient is unable
to tolerate such monitoring (i.e. a small child with a blood pressure cuff).
Oxygen saturation must also be recorded preoperatively, intraoperatively and
postoperatively.
4) Names of all
drugs administered including dosages and the weight of patients under the age
of 12.
5) Local anesthetic
record
6) Record of all
procedures
7) Post operative
instructions
8) Record that level
of consciousness was satisfactory prior to discharge
e. Emergency care: The dental office shall
maintain emergency equipment and medications to perform basic life support.
Dentists intending to produce Minimal Sedation must be able to diagnose and
manage the physiologic consequences (rescue) for patients whose level of
sedation enters that of a higher level than Minimal. The dentist must have the
training to identify and manage such an occurrence until either assistance
arrives (emergency medical services) or the patient returns to the intended
level of Minimal or lower level of sedation without airway or cardiovascular
complications
f. Patient
Monitoring: The dentist or qualified staff must remain in the operatory during
active dental treatment to monitor the patient continuously until the patient
meets the criteria for discharge to the recovery area. The dentist or qualified
staff must monitor the patient during recovery until the patient is ready for
discharge by the dentist. The dentists must determine and document that levels
of consciousness, oxygenation, ventilation and circulation are satisfactory
prior to discharge.
3.
Moderate Sedation
a. Permit: A
permit from the Board is required. A Facility Permit is also required. In
facilities where more than one dentist provides services to moderately sedated
patients, the dentist who is personally providing the dental service to the
moderately sedated patient must personally hold a valid moderate sedation
permit, unless the sedation is being provided by a contracted anesthesia
provider under Section D.6 of this rule.
b. Qualified Staff: All patients shall be
monitored continuously by qualified staff who hold a current permit with the
Board to induce and monitor nitrous oxide/oxygen inhalation analgesia and a
current certification in health-care provider level CPR.
c. Equipment:
1) An operating theater large enough to
adequately accommodate the patient on a table or in an operating chair and
allow an operating team consisting of at least three individuals to freely move
about the patient.
2) An operating
table or chair which permits the patient to be positioned so the operating team
can maintain the airway, quickly alter patient position in an emergency, and
provide a firm platform for the management of cardiopulmonary
resuscitation.
3) A lighting system
which is adequate to permit evaluation of the patient's skin and mucosal color
and a back up lighting system which is battery powered and of sufficient
intensity to permit completion of any operation underway at the time of general
power failure.
4) Suction equipment
which permits aspiration of the oral and pharyngeal cavities and accepts a
tonsilar suction. A backup suction device must also be available
5) An oxygen delivery system with adequate
full face masks and appropriate connectors that are capable of delivering
oxygen to a patient under positive pressure, together with an adequate backup
system.
6) A recovery area that has
available oxygen, adequate lighting, suction, and electrical outlets. The
recovery area can be the operating theater. The patient must be able to be
observed by qualified staff at all times during the recovery period.
7) Ancillary equipment must include the
following:
(a) The nitrous oxide and patient
monitoring equipment listed below must be used for every patient being sedated.
If multiple patients are being sedated simultaneously, each piece of equipment
listed must be available for every patient being sedated.
(i) Fail safe nitrous oxide
equipment
(ii) Scavenging system
for nitrous oxide
(iii) Pulse
oximeter
(iv) Blood pressure cuff
and stethoscope
(b) The
emergency equipment listed below must be available in any office where moderate
sedation is administered:
(i) Oral
air-ways
(ii) Appropriate emergency
drugs
(iii) Automated External
Defibrillators
(iv) Positive
pressure oxygen delivery system with appropriately sized mask.
d.
Documentation: The use of moderate sedation must be properly recorded on each
individual patient's record. Documentation should include but not be limited
to:
1) Informed consent
2) Health history
3) Heart rate, oxygen saturation and
respiratory rate must be recorded preoperatively, intraoperatively and
postoperatively as necessary. Blood pressure must be recorded preoperatively,
intraoperatively and postoperatively as necessary unless the patient is unable
to tolerate such monitoring (i.e. a small child with a blood pressure
cuff).
4) Names of all drugs
administered including dosages and the weight of any patient under 12 years of
age.
5) Local anesthetic
record
6) Record of all
procedures
7) Post operative
instructions
8) Record that level
of consciousness was satisfactory prior to discharge
9) Time-oriented anesthetic record
e. Emergency care: The dental
office shall maintain emergency equipment and medications to perform basic life
support. Dentists intending to produce Moderate Sedation must be able to
diagnose and manage the physiologic consequences (rescue) for patients whose
level of sedation enters that of a higher level than Moderate. The dentist must
have the training to identify and manage such an occurrence until either
assistance arrives (emergency medical services) or the patient returns to the
intended level of Moderate or lower level of sedation without airway or
cardiovascular complications. The dentist must be trained in and capable of
providing, at the minimum, bag-valve-mask ventilation so as to be able to
oxygenate any patient who develops airway obstruction or apnea. The equipment
listed in Section D. 3. c. of this Article is the minimal requirement for
offices where Moderate Sedation is provided.
f. Patient Monitoring: The dentist must
remain in the operatory to monitor the patient continuously until the patient
meets the criteria for recovery. When active treatment concludes and the
patient recovers to a minimally sedated level, qualified staff may remain with
the patient and continue to monitor them until they are discharged from the
facility. The dentists must not leave the facility until the patient meets the
criteria for discharge and is discharged from the facility. The dentist must
determine and document that levels of consciousness, oxygenation, ventilation
and circulation are satisfactory prior to discharge.
4.
Deep Sedation
a. Permit: A permit issued to the dentist
from the Board to administer Deep Sedation is required as well as a Facility
Permit.
b. Qualified Staff: The
technique for Deep Sedation requires the following three individuals:
1) A dentist holding a current permit for
Deep Sedation from the Board
2) An
individual to assist with observation and monitoring of the patient and who may
administer drugs if appropriately licensed; and
3) Qualified staff to assist the operator as
necessary. All individuals assisting at this level must:
(a) hold a current permit from the Board to
monitor and administer nitrous oxide
(b) hold a current permit from the Board as a
Sedation Assistant,
(c) hold a
current certification in health-care provider level of CPR
c. Equipment:
Requirements are the same as the first six requirements for Moderate Sedation listed in Section D. 3. c. of this Article. In addition to those previously listed requirements, the following ancillary equipment is required:
1) The nitrous oxide and
patient monitoring equipment listed below must be used for every patient being
sedated. If multiple patients are being sedated simultaneously, each piece of
equipment listed must be available for every patient being sedated.
a. Fail safe nitrous oxide
equipment
b. Scavenging system for
nitrous oxide
c. Pulse
oximeter
d. Blood pressure cuff and
stethoscope
e.
Electrocardioscope
f. Automatic
blood pressure monitoring device
2) The emergency equipment listed below must
be available in any office where deep sedation or general anesthesia is
administered:
a. Oral air-way
b. Appropriate emergency drugs
c. Automated External
Defibrillators
d. Positive pressure
oxygen delivery system
e. Tonsillar
and pharyngeal type suction tip
f.
Laryngoscope complete with adequate selection of blades, batteries and
bulb
g. Endotracheal tubes and
appropriate connectors
h. Adequate
equipment for the establishment of an intravenous infusion
i. McGill forceps
j. Appropriate emergency drugs for
ACLS
k. Thermometer
d. Records: Anesthesia
records must be maintained as a permanent portion of the patient file and shall
include at a minimum:
1) Informed
consent
2) Health history
3) Vital signs, recorded preoperative,
intraoperative and postoperative
4)
Names of all drugs administered including dosages
5) Local anesthetic record
6) Record of all procedures
7) Post operative instructions
8) Record that level of consciousness was
satisfactory prior to discharge
9)
Time-oriented anesthetic record
10) Pulse oximetry
readings
e. Emergency
care: The dental office shall maintain emergency equipment and medications to
perform advanced cardiac life support (ACLS). Dentists intending to produce
Deep Sedation must be able to diagnose and manage the physiologic consequences
(rescue) for patients whose level of sedation enters that of General
Anesthesia. The dentist must have the training, skills, drugs and equipment to
identify and manage such an occurrence until either assistance arrives
(emergency medical services) or the patient returns to the intended level of
Deep or lower level of sedation without airway or cardiovascular
complications.
f. Patient
Monitoring: The dentist must remain in the operatory to monitor the patient
continuously until the patient meets the criteria for recovery. When active
treatment concludes and the patient recovers to a minimally sedated level,
qualified staff may remain with the patient and continue to monitor them until
they are discharged from the facility. The dentists must not leave the facility
until the patient meets the criteria for discharge and is discharged from the
facility. The dentists must determine and document that levels of
consciousness, oxygenation, ventilation, circulation and temperature are
satisfactory prior to discharge.
5.
General Anesthesia
All requirements for permits, qualified staff, equipment, records, emergency care, and patient monitoring are exactly the same as for Deep Sedation.
6.
Contracting Anesthesia
a. A dentist
whose dental office meets the facility requirements and has obtained a Facility
Permit from the Board may contract with a licensed physician (MD) with a
specialty in anesthesiology, certified registered nurse anesthetist (CRNA), or
a dentist holding an anesthesia permit for in office Deep Sedation or General
Anesthesia. The Arkansas State Board of Dental Examiners holds the contracting
dentist ultimately responsible for the quality of the anesthesia given and the
patient care delivered.
b. A
dentist may admit or have a patient admitted to an outpatient surgery center
approved by the Arkansas Department of Health, JCAH (out-patient facilities),
AAAHC, or other nationally recognized accreditation agency or a hospital and
utilize any appropriate level of sedation or general anesthesia as provided by
a licensed physician (MD) with a specialty in anesthesiology or a certified
registered nurse anesthetist (CRNA) without the dentist holding a Board permit
for that level of anesthesia, sedation or a Facility Permit.
E.
OBTAINING
PERMITS FOR NITROUS OXIDE ANALGESIA, MINIMAL, MODERATE AND DEEP SEDATION,
GENERAL ANESTHESIA AND FACILITIES
1.
Sedation & Anesthesia Permits:
a. Nitrous oxide/oxygen inhalation analgesia:
Does not require a permit or registration with the Board.
b. Minimal Sedation: No permit is required
for Minimal Sedation.
c. Moderate
Sedation, Deep Sedation and General Anesthesia:
1) Requires a permit for the dentist
administering sedation /anesthesia.
2) Requires a Facility Permit.
2.
Obtaining a
Permit:
a. Moderate Sedation, Deep
Sedation and General Anesthesia Permits:
1) In
order to receive a Moderate Sedation Permit, Deep Sedation Permit or a General
Anesthesia Permit, the dentist must apply on an application form to the
Arkansas State Board of Dental Examiners, submit the required application fee,
and submit documentation showing that the educational requirements have been
met.
2) Applicants who have
applications approved by the Board are issued a permit. A self-evaluation and
compliance form (available from the Board) must be completed and submitted
before any Moderate Sedation, Deep Sedation or General Anesthesia usage can
begin.
3) After the Deep Sedation -
General Anesthesia permit has been issued, the Board requires an on-site
inspection of the facility, equipment and credentials of the personnel to
determine if, in fact, the personnel, equipment and facility requirements have
been met. The evaluation shall be conducted as outlined in this
document.
4) At the discretion of
the Board, a re-evaluation of an office, dentist, and staff may be scheduled at
any time. The Board shall consider such factors as it deems pertinent
including, but not limited to, patient complaints and reports of adverse
occurrences.
5) Moderate Sedation,
Deep Sedation and General Anesthesia permits must be renewed at the same time
each year a dentist renews his license to practice dentistry. Failure to renew
a permit will cause the forfeiture of the permit and once forfeited,
re-application and re-evaluation will be required. Forfeiture of a permit will
immediately terminate the authority of a dentist to administer Moderate
Sedation, Deep Sedation or General Anesthesia.
3.
Facility Permits:
a. Every dental office, clinic or facility
where Moderate Sedation is to be administered to patients must have a Moderate
Sedation Facility Permit issued by the Board. The dentist/owner of the practice
or the dentist who is the primary provider of dental care in the office must
complete a self-inspection Facility Permit application. Said application will
be kept on file by the Board. The Board may, on a random basis, inspect any
facility holding a Moderate Sedation Facility Permit. No Moderate Sedation
shall be performed until the facility self-inspection form is received by the
Board and a facility permit issued. Facility permits are required for all
office where Level 3 permits are converted to Moderate Sedation permits on the
date of adoption of this rule. Dentists being reclassified from Level 3 to
Moderate Sedation will have 90 days from the date of adoption of this rule to
submit their self-inspection forms and have a facility permit issued. Any
dentist providing Moderate Sedation without a facility permit after the 90 day
grace period will be subject to having charges filed with the Board for
providing Moderate Sedation without a facility permit.
b. Every dental office, clinic, or facility
where Deep Sedation or General Anesthesia is to be administered to patients
must be inspected and meet the standards for a facility listed in this Article
and have a Facility Permit issued by the Board. No Deep Sedation or General
Anesthesia shall be performed until the facility has been inspected and a
facility permit issued.
c. To
obtain a Deep Sedation-General Anesthesia Facility Permit, the dentist owning
said Facility must apply on an application form to the Arkansas State Board of
Dental Examiners, and submit the required application fee to have the Facility
inspected.
d. All Facility Permits
must be renewed at the same time each year that a dentist renews his license to
practice dentistry. Failure to renew the permit will cause the forfeiture of
the permit and once forfeited, re-application and re-inspection will be
required. Forfeiture of a Facility Permit will immediately terminate the
authority of a dentist to have Moderate Sedation, Deep Sedation or General
Anesthesia administered in the Facility.
F.
ON-SITE FACILITY INSPECTION AND
EVALUATION/RE-EVALUATION FOR MODERATE SEDATION, DEEP SEDATION, GENERAL
ANESTHESIA FACILITIES
An evaluation or re-evaluation shall consist of a review of the following:
1. Office facilities,
equipment, dental records and staff to include documentation of review of
emergency preparedness with staff at least annually, written protocol for
office emergencies and current appropriate licenses & permits for
dentist(s) and staff.
2.
Demonstration of the anesthesia technique for the level of sedation/anesthesia
permit for which the dentist has applied. Dental procedures utilizing Deep
Sedation or General Anesthesia must be observed.
3. Emergency Protocols - Knowledge of and a
method of treatment for the following emergencies:
a. Laryngospasm
b. Bronchospasm
c. Angina pectoris
d. Myocardial infarction
e. Hypotension
f. Hypertension
g. Cardiac Arrest
h. Allergic reaction
i. Seizures
j. Emesis and aspiration of foreign material
under anesthesia
k.
Syncope
l. Airway
obstruction
m. Abnormal
psychological responses
4. Composition of On-site Inspection and
Evaluation/Re-evaluation Teams:
a. Teams shall
consist of two or more dentists chosen and approved by the Board.
b. The evaluators must hold a current permit
of the same level or higher as the permit of the dentist being inspected and
must have practiced with that level of sedation permit for a minimum of one
year. Whenever possible, if the dentist being inspected is a dental specialist
the evaluators will also be licensed in that same specialty.
c. The Board must appoint a dentist member of
the Board to serve as an observer at any evaluation.
d. Grading of the Inspection and Evaluation:
1) The inspection and evaluation shall be
graded on a pass/fail system. An evaluation form provided by the Board shall be
used. The grade shall be determined by the Board, based upon results provided
by the evaluators.
2) If there is
not a recommendation for pass or fail by the evaluators, another evaluation
will be made with either two different evaluators or with a third evaluator
whose function would be to cast the deciding vote on the evaluation.
3) The sedation or anesthesia permit of a
dentist who fails the evaluation will be suspended by the Board. A dentist who
has received such a negative evaluation may appeal that decision to the
Arkansas State Board of Dental Examiners and request a re-evaluation. This
appeal must be made in writing to the Board stating the grounds for the appeal
within 90 days from the evaluation. During the suspension and appeal process,
the practitioner is prohibited from utilizing any sedation and/or General
Anesthesia. Upon receipt of the appeal request, the Board will decide the
matter and may grant or deny a permit, or request re-evaluation of the
appellant by a different evaluation team. An additional evaluation fee will be
required for this re-evaluation. Said re-evaluation inspection must be
completed within 60 days of receiving the appeal if the Board views that
re-inspection is appropriate.
G.
QUALIFIED STAFF: Sedation Monitoring
Requirements
There are certain situations when a dentist must entrust the monitoring of a sedated patient to a staff member. The Board recognizes this need and has developed an expanded function permit for certain dental assistants, hygienists or other staff members who meet the following minimal criteria and have applied for and received a permit from the board.
Staff monitoring patients undergoing any level of sedation must hold a current Nitrous Oxide Permit from the Board and a current certification in health care provider level of CPR.
Staff monitoring patients undergoing Deep Sedation or General Anesthesia must hold a current permit from the Board as a Sedation Assistant.
To qualify as a Sedation Assistant, an person must:
1. Be a Certified Dental Assistant,
Registered Dental Assistant, Registered Nurse or Licensed Practical
Nurse
2. Hold a current
certification in health care provider level CPR
3. Hold a current permit from the Board to
monitor and induce nitrous oxide analgesia
4. Successfully complete the American
Association of Oral and Maxillofacial Surgeons Anesthesia Assistant's Training
Program or a Board approved equivalent course within the two year period
immediately previous to submitting an application to be a Sedation Assistant.
Exemptions: Licensed physicians with a specialty in anesthesiology and Certified Registered Nurse Anesthetists are exempt from the educational and permit requirements listed in this section. Other licensed health care providers, who can show proof of successful completion of a course which meets or exceeds those listed in this regulation, may obtain an exemption from the Board on a case by case basis.
Amended ? / ? / 2009
Disclaimer: These regulations may not be the most recent version. Arkansas may have more current or accurate information. We make no warranties or guarantees about the accuracy, completeness, or adequacy of the information contained on this site or the information linked to on the state site. Please check official sources.
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