Current through Reg. 49, No. 12; March 22, 2024
(a) Education and Professional Requirements.
A dentist applying for a nitrous oxide/oxygen inhalation sedation permit shall
meet one of the following educational/professional criteria:
(1) satisfactory completion of a
comprehensive training program consistent with that described for nitrous
oxide/oxygen inhalation sedation administration in the American Dental
Association (ADA) Guidelines for Teaching Pain Control and Sedation to Dentists
and Dental Students. This includes a minimum of fourteen (14) hours of
training, including a clinical component, during which competency in inhalation
sedation technique is achieved. Acceptable courses include those obtained from
academic programs of instruction recognized by the ADA Commission on Dental
Accreditation (CODA); or courses approved and recognized by the ADA Continuing
Education Recognition Program (CERP); or courses approved and recognized by the
Academy of General Dentistry (AGD) Program Approval for Continuing Education
(PACE);
(2) satisfactory completion
of an ADA/CODA approved or recognized pre-doctoral dental or postdoctoral
dental training program which affords comprehensive training necessary to
administer and manage nitrous oxide/oxygen inhalation sedation; or
(3) is a Texas licensed dentist, has a
current Board-issued nitrous oxide/oxygen inhalation sedation permit, and has
been using nitrous oxide/oxygen inhalation sedation in a competent manner
immediately prior to the implementation of this chapter on June 1, 2011. Any
dentist whose Board-issued nitrous oxide/oxygen inhalation sedation permit is
active on June 1, 2011 shall automatically continue to hold this
permit.
(b) Standard of
Care Requirements. A dentist performing nitrous oxide/oxygen inhalation
sedation shall maintain the minimum standard of care for anesthesia, and in
addition shall:
(1) adhere to the clinical
requirements as detailed in this section;
(2) maintain under continuous direct
supervision auxiliary personnel who shall be capable of reasonably assisting in
procedures, problems, and emergencies incident to the use of nitrous
oxide/oxygen inhalation sedation;
(3) maintain current certification in Basic
Life Support (BLS) for Healthcare Providers for the assistant staff by having
them pass a course that includes a written examination and a hands-on
demonstration of skills; and
(4)
not supervise a Certified Registered Nurse Anesthetist (CRNA) performing a
nitrous oxide/oxygen inhalation sedation procedure unless the dentist holds a
permit issued by the Board for the sedation procedure being performed. This
provision and similar provisions in subsequent sections address dentists and
are not intended to address the scope of practice of persons licensed by any
other agency.
(c)
Clinical Requirements. A dentist must meet the following clinical requirements
to utilize nitrous oxide/oxygen inhalation sedation:
(1) Patient Evaluation. Patients considered
for nitrous oxide/oxygen inhalation sedation must be suitably evaluated prior
to the start of any sedative procedure. In healthy or medically stable
individuals (ASA I, II), this may consist of a review of their current medical
history and medication use. However, patients with significant medical
considerations (ASA III, IV) may require consultation with the patient's
primary care physician or consulting medical specialist.
(2) Pre-Procedure Preparation and Informed
Consent.
(A) The patient, parent, guardian, or
care-giver must be advised of the risks associated with the delivery of nitrous
oxide/oxygen inhalation sedation and must provide written, informed consent for
the proposed sedation.
(B) The
dentist shall determine that an adequate oxygen supply is available and
evaluate equipment for proper operation and delivery of inhalation agents prior
to use on each patient.
(C)
Baseline vitals must be obtained in accordance with §
108.7
and §
108.8 of
this title.
(3)
Personnel and Equipment Requirements.
(A) In
addition to the dentist, at least one member of the assistant staff should be
present during the administration of nitrous oxide/oxygen inhalation sedation
in nonemergency situations.
(B) The
inhalation equipment must have a fail-safe system that is appropriately checked
and calibrated. The equipment must also have either:
(i) a functioning device that prohibits the
delivery of less than 30% oxygen; or
(ii) an appropriately calibrated and
functioning in-line oxygen analyzer with audible alarm.
(C) If nitrous oxide and oxygen delivery
equipment capable of delivering less than 30% oxygen is used, an in-line oxygen
analyzer must be utilized.
(D) The
equipment must have an appropriate nitrous oxide/oxygen scavenging
system.
(E) The ability of the
provider and/or the facility to deliver positive pressure oxygen must be
maintained.
(4)
Monitoring.
(A) The dentist must induce the
nitrous oxide/oxygen inhalation sedation and must remain in the room with the
patient during the maintenance of the sedation until pharmacologic and
physiologic vital sign stability is established.
(B) After pharmacologic and physiologic vital
sign stability has been established, the dentist may delegate the monitoring of
the nitrous oxide/oxygen inhalation sedation to a dental auxiliary who has been
certified to monitor the administration of nitrous oxide/oxygen inhalation
sedation by the State Board of Dental Examiners.
(5) Documentation.
(A) Pre-operative baseline vitals must be
documented.
(B) Individuals present
during administration must be documented.
(C) Maximum concentration administered must
be documented.
(D) The start and
finish times of the inhalation agent must be documented.
(6) Recovery and Discharge.
(A) Recovery from nitrous oxide/oxygen
inhalation sedation, when used alone, should be relatively quick, requiring
only that the patient remain in an operatory chair as needed.
(B) Patients who have unusual reactions to
nitrous oxide/oxygen inhalation sedation should be assisted and monitored
either in an operatory chair or recovery room until stable for
discharge.
(C) The dentist must
determine that the patient is appropriately responsive prior to discharge. The
dentist shall not leave the facility until the patient meets the criteria for
discharge and is discharged from the facility.
(7) Emergency Management. Because sedation is
a continuum, it is not always possible to predict how an individual patient
will respond. If a patient enters a deeper level of sedation than the dentist
is qualified to provide, the dentist must stop the dental procedure until the
patient returns to the intended level of sedation. The dentist is responsible
for the sedative management, adequacy of the facility and staff, diagnosis and
treatment of emergencies related to the administration of the nitrous oxide,
and providing the equipment and protocols for patient rescue. A dentist must be
able to rescue patients who enter a deeper state of sedation than intended. The
dentist, personnel and facility must be prepared to treat emergencies that may
arise from the administration of nitrous oxide/oxygen inhalation
sedation.
(8) Management of
Children. For children twelve (12) years of age and under, the dentist should
observe 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.
(d) A dentist who holds a nitrous
oxide/oxygen inhalation sedation permit shall not intentionally administer
minimal sedation, moderate sedation, deep sedation, or general
anesthesia.