Current through Register Vol. 48, No. 3, March 22, 2024
A. Definitions.
1. "Analgesia" means the diminution or
elimination of pain with full consciousness maintained by the
patient.
2. "Deep sedation" means a
drug-induced depression of consciousness during which patients cannot be easily
aroused but respond purposefully following repeated or painful stimulation.
Reflex withdrawal from a painful stimulus is not considered a purposeful
response. The ability to independently maintain ventilator function may be
impaired. Patients may require assistance in maintaining patients' airways.
Spontaneous ventilation may be inadequate. Cardiovascular function is usually
maintained.
3. "Enteral" means a
route of administration that includes any technique in which the agent is
absorbed through the gastrointestinal tract or oral mucosa.
4. "General anesthesia" means a drug-induced
loss of consciousness during which patients are not aroused, even by painful
stimulation. The ability to independently maintain ventilator functions is
often impaired. Patients often require assistance in maintaining patients'
airways; positive pressure ventilation may be required because of depressed
spontaneous ventilation or drug-induced depression of neuromuscular function.
Cardiovascular function may be impaired.
5. "Inhalation" means a route of
administration in which a gaseous or volatile agent is introduced into the
lungs and whose primary effect is due to absorption through the interface of
gas and blood.
6. "Local
anesthesia" means the elimination of sensation, especially pain, in one part of
the body by the topical application or regional as applies to dental, oral, or
maxillofacial injection of a drug.
7. "Minimal sedation" means 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 to respond appropriately to physical stimulation or verbal
command.
8. "Moderate sedation"
means 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 patient airway, and
spontaneous ventilation is adequate. Cardiovascular function is usually
maintained.
9. "Nitrous oxide
analgesia or sedation" means 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 or verbal
command.
10. "Parenteral" means a
route of administration in which the drug bypasses the gastrointestinal
tract.
B. Education and
Training Requirements for Practicing Sedation.
1. To provide moderate enteral sedation,
applicable programs, pursuant to S.C. Code §
40-15-400(C)(1),
must be accredited by The American Dental Association and its Commission of
Dental Accreditation.
2. To provide
moderate parenteral sedation, applicable programs, pursuant to S.C. Code §
40-15-400(D)(1),
must be accredited by The American Dental Association and its Commission of
Dental Accreditation.
3. To provide
deep sedation/general anesthesia, applicable programs, pursuant to S.C. Code
§
40-15-400(E)(1),
must be accredited by The American Dental Association and its Commission of
Dental Accreditation.
4. Residency
programs, pursuant to S.C. Code §
40-15-400(F)
must be accredited by The American Dental Association and its Commission of
Dental Accreditation.
C.
For purposes of these regulations, the administration of sedation and/or
anesthesia by or under the direction of a licensed dentist in this state,
except in the event that the sedation and/or anesthesia is administered by a
licensed CRNA or anesthesiologist, shall be performed in accordance with the
laws and regulations of this State, applicable guidelines approved by the
Board, including but not limited to, current American Dental Association (ADA)
"Guidelines for the Use of Conscious Sedation, Deep Sedation and General
Anesthesia for Dentists" and current American Academy of Pediatric Dentistry
(AAPD) "Guidelines for the Elective Use of Pharmacologic Conscious Sedation and
Deep Sedation in Pediatric Dental Patients."
D. A licensed dentist in this state shall be
solely responsible for the administration and management of sedation and/or
anesthesia in the practice of dentistry, including but not limited to ordering,
supplying, and prescribing medications used in the sedation procedure, and must
determine which of the guidelines, as referenced above, he or she shall operate
under, and shall be responsible for complying with the same, as provided
above.
E. In procedures utilizing a
CRNA or an anesthesiologist, the administration of sedation and/or anesthesia
shall be in accordance with South Carolina law.
F. Dentists who have qualified to administer
sedation and/or anesthesia under these regulations are subject to review and
audit, and their facilities subject to on-site inspection by an official
designee of the Board to determine compliance with these regulations every two
years.
G. Reporting of Adverse
Occurrences - A licensed dentist must submit a written report within thirty
(30) days to the Board regarding any known mortality or serious, unusual
incident which occurs in a dental facility or during the twenty-four (24) hour
period after the patient leaves the facility, if the incident produces
significant temporary or permanent physical or mental injury of the patient as
a direct result of the administration of the general anesthesia or
sedation.
H. Nitrous Oxide/Oxygen.
For purposes of these regulations, a licensed dentist in this state shall be
solely responsible for the administration and management of nitrous
oxide/oxygen in the practice of dentistry, and adequacy of the facility,
including equipment with fail-safe features that prohibit the delivery of less
than thirty (30%) percent minimum oxygen flow. Dental offices are subject to
inspection and audit to determine compliance with these regulations.
I. Permit Fees for all dentists performing
sedation and general anesthesia; on-site inspections.
Any dentist practicing or seeking to practice moderate and/or
deep sedation/general anesthesia must obtain the appropriate permit.
1. Moderate sedation permit: $200
biennially.
2. Deep
sedation/general anesthesia permit: $200 biennially. A dentist with a deep
sedation/general anesthesia permit may also perform moderate sedation without
obtaining an additional permit.
3.
Permit fees are renewed biennially with a dental license renewal.
4. New applicants for sedation permits must
have an on-site inspection of each facility where permitted sedation will occur
before beginning sedation procedures that require a permit. Dentists with a
current license who have been practicing moderate or deep sedation/general
anesthesia prior to the effective date of these regulations may continue to so
practice during the pendency of their application and inspection
process.
5. Dentists applying for
permits under this section must list each and every location at which they will
practice sedation that requires a permit and must update the Board within
thirty (30) days of any change in location at which they will practice
permitted sedation. Each facility where permitted sedation occurs must be
equipped as required to provide the level of sedation being administered in
that facility, and will be inspected.
Statutory Authority: 1976 Code Sections
40-1-40
and
40-15-40
