A dentist who wishes
to administer general anesthesia or sedation in the
dental office must obtain a permit from the Board of Dental
Examiners.
The dentist must complete an application and submit it with
a $100
application fee and verification of training in anesthesia
or sedation.
A 90-day temporary permit is issued once an application
is received and training is verified. An in-office evaluation
is required
within the 90-day time period. An evaluation fee will
be charged of $375 for
an anesthesia evaluation or $275 for a sedation evaluation.
New sedation rules
went into effect July 3, 2008.
REGARDING SEDATION, PLEASE NOTE !!
As of July 3, 2009,
no one may use sedation
who has
not obtained a permanent
or temporary sedation permit!
Apply now to receive a
temporary permit!
An advertising
flyer from the Dental Organization for
Conscious Sedation (DOCS) incorrectly stated that use of any (emphasis in the original) oral sedative used
in-office
requires a sedation permit. The NC Dental Board's policy
is
that "administration of a single dose of a minor psychosedative,
possibly in combination with nitrous oxide, to children or
adults prior to the commencement of treatment on the day of
the appointment..." is considered anxiolysis and DOES NOTrequire
a sedation permit (21NCAC 16Q.0101(3)).
A dentist whose use of a
minor psychosedative complies with this
definition of anxiolysis need not attend the DOCS course.
Q.
I would like to apply for a permit to administer moderate
conscious sedation limited to oral routes and nitrous oxide.
How can I get the three live patient experiences required by the
Board?
A.
Applicants for a moderate limited sedation permit must have 10
adult experiences, three of which must be live. Applicants
can get the live patient experiences as part of the 24 hours of
didactic training that is also required or by performing
moderate limited sedation in their own offices between February
1, 1990 and April 3, 2009. Applicants will need to provide the
Board with an affidavit setting out the names of the patients
and dates of the procedure as part of the permit application.
Q. Must
I have annual ACLS training to maintain my general anesthesia
permit?
A. No. You must keep your ACLS certificate
current, but need not take the training every year.
Q. Must
I have current ACLS to renew my moderate conscious sedation
permit?
A. No.
To renew your moderate conscious sedation permit, you must have
current BLS training and complete three hours of continuing
education in the areas specified in Rule 16Q .0501(d) or you may
renew by documenting current ACLS and BLS.
Q. I
took an 18 hour course in moderate conscious sedation in 2005.
May I count that training toward the 24 hours of training
required to obtain a permit to administer moderate conscious
sedation limited to oral routes and nitrous?
A. Yes.
Applicants for a moderate limited sedation permit may obtain the
required 24 hours of didactic training in more than one
course. All courses must have been taken on or after January
1, 2004, however.
Q. I
completed a pediatric residency program 10 years ago. Am I
qualified to apply for a pediatric conscious sedation permit?
A. Yes.
Successful completion of a pediatric residency or internship
satisfies the training requirements for the pediatric conscious
sedation permit, regardless of when the applicant completed the
training. The residency or internship program need not have
included training in parenteral intravenous sedation, except in
the emergency treatment setting.
Q. Where
can I find a list of courses that will satisfy the training
requirements for the various sedation permits?
A. Visit
the Board?s website at
www.ncdentalboard.org/whatnew.htm for a current list of
approved courses. There may be courses offered that are not
listed. If you would like to take a course that is not listed
on the website, you may ask the Board to approve
the course.
Q. Do
I need a permit to administer .25 mg of Diazepam if I cut the
pill in half and administer it at intervals?
A. Yes.
Anxiolysis, for which no permit is needed, is restricted to
cases in which the dentist administers a single dose of a minor
psychosedative, possibly in combination with nitrous oxide. By
cutting the pill in half, the dentist is administering two
doses, for which he or she would need a minimal conscious
sedation permit.
Q. What
is the maximum pharmacological agent I can administer with a
minimal conscious sedation permit?
A. The
agent may be administered in one or more doses, but must not
exceed the manufacturer?s maximum recommended dose.
Q. May
I prescribe a minor psychosedative for the patient to take the
night before a treatment for the purpose of reducing anxiety if
I do not have a sedation permit?
A. Yes.
You may direct the patient to take a single dose of a minor
psychosedative the night before treatment. You may also
administer a single dose of a minor psychosedative on the day of
the appointment, before treatment begins. Nitrous oxide may
also be administered.
Q. I
intend to apply for a moderate conscious sedation permit limited
to oral routes. I have performed more than 100 cases in the
past year, but some of the cases were in another state. Do
they count toward the experience requirement?
A. Yes.
21 NCAC 16Q .0301 provides that an applicant can qualify for a
moderate limited permit by performing 100 cases between July 3,
2007 and July 3, 2008. Cases completed in another state will
count toward the requirement. Be sure to remember to document
the cases by keeping track of the patient name and date of
administration of the sedation.
Q. If
I take an ACLS course, will that count toward the 60 hours of
training required to get permit to administer moderate conscious
sedation permit?
A. No.
Q. My
practice is to give multiple doses of Triazolam as needed,
especially in long appointments. Am I right that I only need a
minimal conscious sedation permit?
A. Yes.
The minimal conscious sedation permit allows you to give
multiple doses of a single pharmacological agent, so long as you
do not exceed the manufacturer?s maximum recommended dose. You
would also be permitted to administer nitrous oxide, if
indicated.
Q. Can
I administer oral Versed without a sedation permit?
A. No.
A dentist can administer a minor psychosedative for the purpose
of controlling anxiety without a permit. See 21 NCAC 16Q
.0101(3). Versed is not a minor psychosedative.
Q. I
have applied for my sedation permit and would like to suggest
the name of another dentist to conduct the required inspection
of my office. Can I do that?
A. The
inspectors are chosen by the Board, based upon location,
training and availability, but it is permissible to suggest a
name.
Q. How
long do I have to get a sedation permit under the new rules?
A.
The Board is providing a one year grace period for dentists to
get inspected and licensed under the new rules. After July 3,
2009, all dentists who administer sedation must have a valid
permit. Since the inspection process will likely take some
time to complete, the Board is urging permit applicants to get
their applications in by April 3, 2009.
Q.
Do I need to have a moderate conscious sedation permit to
administer a sedative as well as antihistamine to a patient?
A. Yes.
Rule 16Q .0101(15) defines minimal conscious sedation as the
administration of a single ?agent? not a single ?sedative.? If
a dentist intends to enhance the sedative effect of a
benzodiazepine by pairing it with an antihistamine, the dentist
has exceeded the scope of minimal conscious sedation.
Q.
I am applying for a minimal conscious sedation permit.
Do I have to demonstrate administration of sedation on a patient
during the evaluation?
A. No.
During the evaluation you will need to describe the drug dosage
and administration to the evaluator, but you don't need to have
a live patient present. Please refer to 21NCAC 16Q .0401
of the Board's Rules, which are on this website for more
information, or contact the Board's staff.
Q.
My dental assistant has completed the required 7 hour nitrous
oxide course. Is she permitted to start the patient on
oxygen before I begin administering the nitrous?
A. Yes,
so long as you directly supervise her. That means you must
direct her to start the oxygen and remain in the building at all
times. The assistant may not administer the nitrous.
•
Applications by mail may also be requested by
Email: info@ncdentalboard.org
Pick up at Executive Office:
507 Airport Blvd., Suite 105 • Morrisville, NC 27560
Office: 919-678-8223 or Fax: (919) 678-8472
Download
the Anesthesia Permit application now