anesthesia & sedation permits

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.
An in-office evaluation is required before a permit may be issued.  An evaluation fee will be charged of $375 for an anesthesia evaluation or $275 for a sedation evaluation.

Please Note: Due to recent rule changes, the Board no longer issues temporary permits!

New sedation rules went into effect July 3, 2008.

As of July 3, 2009, no one may use sedation who has not obtained a permanent sedation permit!

Review the new rules.

Note: 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 to children or adults prior to the commencement of treatment on the day of the appointment..." is considered anxiolysis and DOES NOT require 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. 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 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. 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.

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.