MINIMAL SEDATION: A minimally depressed level of consciousness, produced by a pharmacological method, that retains the patient’s ability to independently and continuously maintain an airway and respond normally to tactile stimulation and verbal command. Although cognitive function and coordination may be modestly impaired, ventilatory and cardiovascular functions are unaffected.
Note: In accord with this particular definition, the drug(s) and/or techniques used should carry a margin of safety wide enough never to render unintended loss of consciousness. Further, patients whose only response is reflex withdrawal from repeated painful stimuli would not be considered to be in a state of minimal sedation.
If more than one enteral drug is administered to achieve the desired sedation effect, with or without the conciomitant use of nitrous oxide, the guidelines for moderate sedation must apply.
DOSING FOR MINIMAL SEDATION VIA THE ENTERAL ROUTE - Minimal sedation may be achieved by administration of a drug, either singly or in divided doses, by the enteral route to achieve the desired clinical effect, not to exceed the maximum recommended dose (MRD). A permit for minimal sedation must be obtained if any enteral dosing is in combination with nitrous oxide inhalation analgesia.
Administrative Rule 20-02-01-05 (1) states that a dentist "may not use any form of sedation if the intent is beyond anxiolysis on any patient unless such dentist has a permit, currently in effect, issued by the board, and renewable biennially thereafter, authorizing the use of general sedation, deep sedation, moderate conscious sedation or minimal sedation when used in combination with inhalation."
A dentist who wishes to administer minimal sedation in the dental office must be familiar with:
The Board must be satisfied that the applicant is in compliance with the American Dental Association's most recent policy statement: The Use of Sedation and General Anesthesia by Dentists. A dentist must complete and submit the permit application and fee. The application is reviewed and must be approved by the Anesthesia Committee prior to a site evaluation. A site evaluation is required within 60 days of submitting the application. The site evaluation fee is payable directly to the Board's designated site evaluator. The Anesthesia Committee will notify the permit applicant once the completed site evaluation form has been reviewed by the Board. If you have questions after you have reviewed the permit application and/or site evaluation forms, please contact the Board.
Applicant must provide documentation of a total of 20 clinically-oriented experiences during which competency in enteral and/or combined inhalation-enteral minimal sedation techniques is demonstrated.
The clinically-oriented experiences shall include 10 documented experiences which may include group observations on patients undergoing enteral and/or combination inhalation-enteral minimal sedation;
And, 10 documented clinically experiences whereby the applicant observes the patient in a one-on-one clinical setting with an experienced sedation/anesthesia provider. An experienced provider includes an OMFS, or other sedation/anesthesia practitioner who has a minimum of three years of experience. Clinical experience in managing a compromised airway is critical to the prevention of life-threatening emergencies. An applicant is not authorized to administer sedation.
The educational course may be completed in a predoctoral dental education curriculum or a postdoctoral continuing education competency course. Competency courses in combination inhalation-enteral minimal sedation techniques must afford participants with sufficient clinical understanding to enable them to achieve competency. The course director must certify the competency of participants upon satisfactory completion of the course. Records of the course instruction must be maintained and available.
The course should be directed by a dentist or physician qualified by experience and training. This individual should have had at least three years of experience, including the individual’s formal postdoctoral training in anxiety and pain control. Dental faculty with broad clinical experience in the particular aspect of the subject under consideration should participate. In addition, the participation of highly qualified individuals in related fields, such as anesthesiologists, pharmacologists, internists, and cardiologists and psychologists, should be encouraged. The faculty should provide a mechanism whereby the participant can evaluate the performance of those individuals who present the course material.
Facilities: Competency courses must be presented where adequate facilities are available for proper patient care, including drugs and equipment for the management of emergencies. Guidelines for Teaching Pain Control and Sedation to Dentists and Dental Students.
UTILIZATION OF OTHER QUALIFIED SEDATION PROVIDER: Administration of minimal sedation or moderate sedation by another qualified dentist or independently practicing qualified anesthesia healthcare provider requires the operating dentist to maintain CPR or BLS and ACLS. At least one clinical staff must maintain current certification in Basic Life Support for Healthcare Providers. The dentists and sedation provider, i.e., CRNA must be present for the site evaluation.
If you are due for a site re-evaluation or if your initial application has been approved and you are prepared to schedule a site evaluation, contact: