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 must get the live patient experiences as part of the 24 hours of didactic training that is also required. 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/whatsnew.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. 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.
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?
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.
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.
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.