Texas Administrative Code
Title 22 - EXAMINING BOARDS
Part 5 - STATE BOARD OF DENTAL EXAMINERS
Chapter 110 - SEDATION AND ANESTHESIA
Section 110.4 - Minimal Sedation
Universal Citation: 22 TX Admin Code ยง 110.4
Current through Reg. 49, No. 12; March 22, 2024
(a) Education and Professional Requirements. A dentist applying for a Level 1 Minimal Sedation permit shall meet one of the following educational/professional criteria:
(1) satisfactory completion of training to
the level of competency in minimal sedation consistent with that prescribed in
the American Dental Association (ADA) Guidelines for Teaching Pain Control and
Sedation to Dentists and Dental Students, or a comprehensive training program
in minimal sedation that satisfies the requirements described in the ADA
Guidelines for Teaching Pain Control and Sedation to Dentists and Dental
Students. This includes a minimum of sixteen (16) hours of didactic training
and instruction in which competency in enteral and/or combined
inhalation-enteral minimal sedation technique is demonstrated; or
(2) satisfactory completion of an advanced
education program accredited by the ADA Commission on Dental Accreditation
(CODA) that affords comprehensive training necessary to administer and manage
minimal sedation, commensurate with the ADA's Guidelines for Teaching Pain
Control and Sedation to Dentists and Dental Students; or
(3) is a Texas licensed dentist, has a
current Board-issued enteral permit, and has been using minimal sedation in a
competent manner immediately prior to the implementation of this chapter on
June 1, 2011. Any Texas licensed dentist who was issued an enteral sedation
permit before June 1, 2011 and whose enteral sedation permit was active on June
1, 2011 shall automatically have the permit reclassified as a Level 1 Minimal
Sedation permit on June 1, 2011. A Texas licensed dentist whose permit is
reclassified from an enteral sedation permit to a Level 1 Minimal Sedation
permit on June 1, 2011 may continue to administer enteral sedation until
January 1, 2013. On or before January 1, 2013, the dentist shall either provide
proof that adequate education has been obtained by submitting an application
for a Level 2 permit on or before that date, or shall comply with the
requirements of a Level 1 permit after that date. A dentist shall always follow
the standard of care and clinical requirements for the level of sedation he or
she is performing.
(b) Standard of Care Requirements. A dentist performing minimal 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 minimal 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
minimal sedation procedure unless the dentist holds a permit issued by the
Board for the sedation procedure being performed.
(c) Clinical Requirements. A dentist must meet the following clinical requirements for utilization of minimal sedation:
(1) Patient Evaluation. Patients considered
for minimal 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 their 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 regarding the procedure associated with the delivery
of any sedative agents 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 adequate oxygen under positive
pressure.
(C) Baseline vital signs
must be obtained in accordance with §
108.7
and §
108.8 of
this title.
(D) A focused physical
evaluation must be performed as deemed appropriate.
(E) Pre-procedure dietary restrictions must
be considered based on the sedative technique prescribed.
(F) Pre-procedure verbal and written
instructions must be given to the patient, parent, escort, guardian, or
care-giver.
(3)
Personnel and Equipment Requirements.
(A) In
addition to the dentist, at least one additional person trained in Basic Life
Support (BLS) for Healthcare Providers must be present.
(B) A positive-pressure oxygen delivery
system suitable for the patient being treated must be immediately
available.
(C) When inhalation
equipment is used, it 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.
(D) An appropriate scavenging system must be
available if gases other than oxygen or air are used.
(4) Monitoring. The dentist administering the
sedation must remain in the operatory room to monitor the patient until the
patient meets the criteria for discharge to the recovery area. Once the patient
meets the criteria for discharge to the recovery area, the dentist may delegate
monitoring to a qualified dental auxiliary. Monitoring during the
administration of sedation must include:
(A)
Oxygenation.
(i) Color of mucosa, skin, or
blood must be evaluated continually.
(ii) Oxygen saturation monitoring by
pulse-oximetry should be used when a single drug minimal sedative is used. The
additional use of nitrous oxide has a greater potential to increase the
patient's level of sedation to moderate sedation, and a pulse oximeter must be
used.
(B) Ventilation.
The dentist (or appropriately qualified individual) must observe chest
excursions and must verify respirations continually.
(C) Circulation. Blood pressure and heart
rate should be evaluated preprocedurally, post-procedurally and
intra-procedurally as necessary.
(5) Documentation.
(A) Documentation must be made in accordance
with §
108.7
and §
108.8 of
this title and must include the names and dosages of all drugs administered and
the names of individuals present during administration of the drugs.
(B) A time-oriented sedation record may be
considered for documentation of all monitoring parameters.
(C) Pulse oximetry, heart rate, respiratory
rate, and blood pressure are the parameters which may be documented at
appropriate intervals of no more than 10 minutes.
(6) Recovery and Discharge.
(A) Oxygen and suction equipment must be
immediately available in the recovery area if a separate recovery area is
utilized.
(B) The qualified dentist
must monitor the patient during recovery until the patient is ready for
discharge by the dentist. The dentist may delegate this task to an
appropriately qualified dental auxiliary.
(C) The dentist must determine and document
that the patient's level of consciousness, oxygenation, ventilation, and
circulation are satisfactory prior to discharge. The dentist shall not leave
the facility until the patient meets the criteria for discharge and is
discharged from the facility.
(D)
Post-procedure verbal and written instructions must be given to the patient,
parent, escort, guardian, or care-giver. Post-procedure, patients should be
accompanied by an adult caregiver for an appropriate period of
recovery.
(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 minimal sedation, 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.
(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 minimal sedation permit shall not intentionally administer moderate sedation, deep sedation, or general anesthesia.
Disclaimer: These regulations may not be the most recent version. Texas 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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