Current through Rules and Regulations filed through March 20, 2024
(1) When
the intent is minimal sedation (anxiolysis), which is defined as a minimally
depressed level of consciousness that retains the patient's ability to
independently and continuously maintain an airway with unaffected ventilatory
and cardiovascular function and respond normally to tactile and verbal
stimulation, a permit for conscious sedation is not required.
(a) When the intent is minimal sedation for
adults, the initial dosing is no more than the maximum recommended dose (MRD)
of a drug that can be prescribed for unmonitored home use. Nitrous oxide/oxygen
may be used in combination with a single enteral drug in minimal sedation. For
adults, supplemental dosing that may be necessary for prolonged procedures
should not exceed one-half of the initial drug dose and should not be
administered until the dentist has determined that the clinical half-life of
the initial dosing has passed. The total aggregate dose must not exceed 1.5x
the MRD on the day of treatment.
(b) The use of preoperative sedatives for
children (age 12 and under) except in extraordinary situations must be avoided
due to the risk of unobserved respiratory obstruction during transport by
untrained individuals. Children can become moderately sedated despite the
intended level of minimal sedation. Should this occur, the guidelines for
moderate sedation apply. For children, the American Dental Association supports
the use of the American Academy of Pediatrics/American Academy of Pediatric
Dentists Guidelines for Monitoring and Management of Pediatric Patients During
and After Sedation for Diagnostic and Therapeutic
Procedures.
(2) No
dentist shall administer conscious sedation at the moderate level in Georgia in
accordance with the definition of conscious sedation as defined by O.C.G.A.
43-11-1unless such dentist
possesses a permit based on a credentials review. The permits issued are
Moderate Enteral Conscious Sedation or Moderate Parenteral Conscious
Sedation.
(3) Moderate Conscious
Sedation is defined as 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.
(4) Moderate
Enteral Conscious Sedation is any technique of administration in which the
drugs are absorbed through the gastrointestinal tract or oral mucosa, i.e.
oral, rectal, and sublingual.
(a) To obtain a
Moderate Enteral Conscious Sedation Permit for adults, a dentist must provide
certification of the following:
1. Completion
of an ADA-accredited postdoctoral training program, which affords comprehensive
training necessary to administer and manage moderate enteral conscious
sedation; or
2. Completion of a
continuing education course approved by the board from a board approved
organization, which consists of a minimum of twenty-four (24) hours of didactic
instruction, of which eight (8) hours must be in-person, plus management of at
least ten (10) adult patient experiences which provides competency in moderate
enteral conscious sedation which may include simulated cases.
(b) To obtain a Moderate Enteral
Conscious Sedation Permit for pediatric patients (age 12 and under), a dentist
must provide certification of the following:
1. Completion of an ADA-accredited
postdoctoral training program, which affords comprehensive training and
experience in pediatric sedation commensurate with the requirements of Rule
150-13-.01(4)(b)(2),
and necessary to administer and manage moderate enteral conscious sedation of
pediatric patients; or
2.
Completion of a continuing education course approved by the board from a board
approved organization, which consists of a minimum of twenty-four (24) hours of
pediatric-specific didactic instruction, of which eight (8) hours must be
in-person, after adult training and ten (10) pediatric patient experiences,
which include supervised administration of sedation to at least five (5)
patients.
(5)
Moderate Parenteral Conscious Sedation is any technique utilizing multiple
sedation modalities, including intravenous, enteral, parenteral, and
inhalation.
(a) To obtain a Moderate
Parenteral Conscious Sedation Permit for adults, a dentist must provide
certification of the following:
1. Completion
of an ADA-accredited postdoctoral training program, which affords comprehensive
training to administer and manage moderate parenteral conscious sedation;
or
2. Completion of a continuing
education course approved by the board from a board approved organization which
consists of a minimum of sixty (60) hours of didactic instruction, of which
twenty (20) hours must be in-person, plus management of at least twenty (20)
adult patient experiences which provides competency in moderate parenteral
conscious sedation.
(b)
To obtain a Moderate Parenteral Conscious Sedation Permit for pediatric
patients (age 12 and under), a dentist must provide certification of the
following:
1. Completion of an ADA-accredited
postdoctoral training program, which affords comprehensive training and
experience in pediatric sedation commensurate with requirements of Rule
150-13-.01(5)(b)(2)
and necessary to administer and manage moderate parenteral conscious sedation
of pediatric patients; or
2.
Completion of a continuing education course approved by the board from a board
approved organization, which consists of a minimum of sixty (60) hours of
pediatric-specific didactic instruction, of which twenty (20) hours must be in
person, after adult training and twenty (20) pediatric patient experiences to
include supervised administration of sedation to at least ten (10)
patients.
(6)
The dentist issued a permit in either Moderate Enteral Conscious Sedation or
Moderate Parenteral Conscious Sedation shall maintain a properly equipped
facility for the administration of such sedation, staffed with appropriately
trained and supervised personnel. The facility must have equipment capable of
delivering positive pressure oxygen ventilation, a pulse oximeter, suction
equipment that allows aspiration of the oral and pharyngeal cavities, an
operating table or chair that allows for the patient to be positioned to
maintain an airway, a firm platform for cardiopulmonary resuscitation, a
fail-safe inhalation system if nitrous oxide/oxygen is used, equipment
necessary to establish intravascular access, equipment to continuously monitor
blood pressure and heart rate, appropriate emergency drugs per ACLS or PALS
protocol, a manual or automatic external defibrillator, and a recovery area
with available oxygen and suction. The facility shall have continual monitoring
of end tidal CO2 (expired carbon dioxide) unless invalidated by the nature of
the patient, procedure, or equipment. "Continual" shall mean "repeated
regularly and frequently in steady rapid succession." All of the aforementioned
equipment, drugs, and supplies must be stationary and not subject to transfer
from one facility to another. The applicant must submit verification that the
facility meets the above requirements and shall be subject to an on-site
inspection. The dentist and all support personnel must be certified in
cardiopulmonary resuscitation at the basic life support healthcare provider
level given by a board approved sponsor with update not to exceed two years per
board rules
150-3-.08,
150-3-.09,
150-5-.04,
150-5-.05. Additionally, the dentist
must have current certification in advanced cardiovascular life support (ACLS)
for adult permits or pediatric advanced life support (PALS) for pediatric
permits or an appropriate dental sedation/anesthesia emergency management
course as approved by the board. Any dental hygienist or dental assistant,
expanded or general, performing phlebotomy or venipuncture procedures must be
in compliance with O.C.G.A. §
43-11-23.
(a) The dentist must take four (4) hours of
continuing education every two (2) years in pharmacology, anesthesia, emergency
medicine or sedation, as part of the 40 hour requirement for license renewal,
to maintain certification for the Enteral and/or Parenteral Conscious Sedation
Permits. Certification of this continuing education must be submitted at
renewal.
(b) The Georgia Board of
Dentistry shall be given a written, thirty (30) day advance notification of the
relocation of a facility, the addition of a facility or significant change to
the facility.
(c) When a Certified
Registered Nurse Anesthetist (CRNA) is permitted to function under the
direction and responsibility of a dentist for the administration of conscious
sedation, the operating dentist must have completed training and hold a valid
conscious sedation permit issued by the board that incorporates the level and
mode of sedation administered by the CRNA.
(d) The dentist must be certified in
cardiopulmonary resuscitation at the basic and advanced levels and all support
personnel who provide direct hands-on patient care must be certified in
cardiopulmonary resuscitation at the basic life support level given by a board
approved provider with an update not to exceed two years. While any conscious
sedation procedure is underway, a minimum of two support personnel certified in
basic cardiopulmonary resuscitation must be present.
(7) A licensed dentist shall not delegate to
a dental assistant or a dental hygienist the administration of any medication
or drugs given to a patient through phlebotomy and venipuncture
procedures.
(8) The requirements as
set forth in this rule apply to all new permit applicants upon its effective
date. Current, active sedation permit holders are grandfathered for educational
requirements and will have until December 31, 2011 to comply with facility
requirements including monitoring and emergency equipment, drugs, and supplies,
and periodic emergency training requirements for the dentist and all support
personnel.
(9) Permit fees: As
shown in the schedule of fees adopted by the Board of Dentistry.
(10) Renewal Fees: As shown in the schedule
of fees adopted by the Board of Dentistry.
(11) Late Renewal Fees: As shown in the
schedule of fees adopted by the Board of Dentistry.
O.C.G.A. §§
43-11-1,
43-11-7,
43-11-8,
43-11-21,
43-11-21.1.
