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Anesthesia Overview

The North Dakota Board of Dental Examiners are committed to the safe and effective use of general anesthesia, deep sedation, moderate sedation and minimal sedation. The Board's Anesthesia Committee bases their standards on the ADA Guidelines for The Use of Sedation and General Anesthesia by Dentists, ADA Guidelines for Teaching Pain Control and Sedation and the American Association of Oral and Maxillofacial Surgeons Office Anesthesia Evaluation Manual 8^th Edition. Requirements for permits are not identical to ADA Guidelines for moderate sedation therefore please carefully review the permit application and the site evaluation form for your appropriate level of education and training requirements. PLEASE review new Administrative Rules pertaining to anesthesia and sedation found at this link in section 20-02-01-05 as well as the definitions related to the section in 20-01-02-01.

NDBDE SEDATION SUMMARY SPREADSHEET

Qualified Anesthesia Providers - CRNAs

A dentist who is not authorized by permit to provide anesthesia or sedation services AND who intends to use the services of a qualified anesthesia provider such as a Certified Registered Nurse Anesthetist (CRNA), anesthesiologist or another dentist holding an anesthesia permit, shall notify the Board prior to sedation services being provided and arrange a site evalutation with the Board's appointed anesthesia professional.  CRNAs are safe and effective anesthesia professionals who can also improve patient safety in office based dental practices. Dental offices who wish to provide conscious sedation services via contractual agreement with a CRNA  or other qualified sedation provider are subject to site evaluations. Dental offices providing sedation  should be prepared with appropriately trained staff and have requisite equipment to manage emergencies or adverse events. 

Permit Types

The Board authorizes sedation privileges by granting a permit to a qualified dentist. The education and training level attained by a dentist determine the type of permit that may be granted.  

1. MINIMAL SEDATION: UNDER RULES EFFECTIVE 7/1/2022  A PERMIT IS NOT REQUIRED FOR MINIMAL SEDATION; STANDARDS FOR ADMINISTRATION OF MINIMAL SEDATION EXIST: SEE 20-02-01-05(2).
2. MODERATE SEDATION:  Means a depressed level of consciousness that retains the patient’s ability to independently and continuously maintain an airway and respond appropriately to physical stimulation or verbal command and that is produced by a pharmacological or nonpharmacological method or a combination thereof. The drugs or technique, or both, should carry a margin of safety wide enough to render unintended loss of consciousness unlikely. Patients whose only response is reflex withdrawal from repeated painful stimuli would not be considered to be in a state of conscious sedation.  
3. DEEP SEDATION and GENERAL ANESTHESIA – Deep Sedation means a drug-induced depression of consciousness during which patients cannot be easily aroused but respond purposefully following repeated or painful stimulation. The ability to independently maintain ventilatory function may be impaired. Patients may require assistance in maintaining a patent airway, and spontaneous ventilation may be inadequate. Cardiovascular function is usually maintained. General Anesthesia means a drug-induced loss of consciousness during which patients are not arousable, even by painful stimulation. The ability to independently maintain ventilatory function is often impaired. Patients often require assistance in maintaining a patent airway, and positive pressure ventilation may be required because of depressed spontaneous ventilation or drug induced depression of neuromuscular function. Cardiovascular function may be impaired.

Initial Anesthesia & Sedation Permit Application

Permit Renewal

• Both the sedation permit and the inspection are subject to expiration and renewal. Sedation and anesthesia permits must be renewed at the time of license renewal. Site evaluations must be within 3 years of the previous evaluation.
• Six hours of anesthesia/sedation CE are required to maintain a sedation or anesthesia permit. In addition, two hours of closed claims coursework is required. Effective 1/1/2026, and every five years thereafter, successful completion of a board-approved anesthesia simulation course and the completion of anesthesia simutlation training will be required.
• Current BLS and  ACLS must be maintained at all times for moderate or deep sedation or general anesthesia. Practitioners utilizing sedation on children 10 and under must have PALS. 
• The Board no longer requires practitioners to submit evidence of CE; the licensee must maintain evidence of CE requirements for the purpose of a random CE audit.

Permits- Non-renewal or late renewal

• A dentist may not provide  moderate sedation deep sedation or general anesthesia services without a permit or with an expired permit. Providing  moderate, deep sedation and general anesthesia is prohibited and unlawful without a permit and is grounds for disciplinary action. If the renewal application is late, sedation privileges are suspended until a reinstatement is completed and formally approved by the Board’s Anesthesia Committee. A late fee is incurred when the permit renewal is postmarked after the December 31^st deadline of odd numbered years.

Site Evaluations

• All providers of anesthesia/sedation are required to have an evaluation at the location(s) where sedation or anesthesia services are rendered.
• The Board accepts the AAOMS inspection and evaluation for deep sedation and general anesthesia site evaluations. OMFS’s site evaluations shall be conducted by an OMFS. A Certified Registered Nurse Anesthetist (CRNA) shall provide site evaluations for general dentists seeking initial sedation privileges or a re-evaluation.
• An initial evaluation must be completed within 60 days of the approval of the initial anesthesia/sedation permit application. A licensed anesthesia or sedation provider authorized by the board shall reevaluate the credentials, facilities, equipment, personnel, and procedures of a permitholder within every three years following a successful initial application or renewal. It is the applicants responsibility to schedule the site evaluation. 
• In order to ensure the protection and safety of patients, every dental facility must be properly equipped, supplied and permitted for the administration of specific types of anesthesia and levels of sedation, and every dental hygienist or registered dental assistant must be properly educated, trained, and authorized to assist with the specific type of anesthesia or sedation being administered.
• SITE EVALUATION FORM

Satellite Office

• All offices where sedation services are provided must comply with the standards established by the Board for a sedation practice.
• Anesthesia or sedation permit holders providing services at satellite clinics are responsible for ensuring that each office location has been evaluated.

Capnography 

Following the lead of the American Society of Anesthesiologists (ASA), the American Heart Association and other organizations that develop parameters of care and practice guidelines for their dental and medical surgical specialists, the AAOMS Board of Trustees approved the following revised guidelines requiring capnography equipment in the OMS office beginning January 2014:

During moderate or deep sedation and general anesthesia the adequacy of ventilation shall be evaluated by continual observation of qualitative clinical signs and monitoring for the presence of exhaled carbon dioxide unless precluded or invalidated by the nature of the patient, procedure or equipment; and

Improvements in monitoring exhaled CO₂ during anesthesia continue to evolve. Anesthesia Evaluations require capnography for moderate sedation, deep sedation and general anesthesia unless precluded or invalidated by the nature of the patient, procedure or equipment.

The statements appear in the 2012 Parameters of Care: Clinical Practice Guidelines for Oral and Maxillofacial Surgery (AAOMS ParCare 12), version 5.0, which is also a component of the revised Office Anesthesia Evaluation Manual, 8th edition.