Minimal Sedation

Education | Renewal | Non-Renewal of Permit | Satellite | Site Evaluation

 

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. 

A minimal sedation permit is not required if the total aggregate dose does not exceed 1.5x the maximum FDA  recommended dose of a single enteral drug, as printed in FDA approved labeling for unmonitored home use. Use of multiple agents in dosing requires a permit. A permit for minimal sedation must be obtained if any enteral dosing is in combination with nitrous oxide inhalation analgesia. 

A dentist who wishes to administer minimal sedation in the dental office should be familiar with the ADA Guidelines for the Use of Sedation and General Anesthesia by Dentists, ADA Guidelines for Teaching Pain Control and Sedation for Dentists and Dental Students and the requirements of application. 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. An 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.

Minimal Sedation Education Requirements 

  • Applicant must provide a copy of current certification in Basic Life Support for Healthcare Providers and ACLS;
  • Completed a nitrous oxide competency course; 
  • Applicant must provide documentation of successful completion of an educational program consistent with the ADA’s Guidelines for Teaching Pain Control and Sedation to Dentists and Dental Students; the course shall be a minimum of 16 hours.
  • 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 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.      

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 sedation provider, i.e., CRNA must be present for the site evaluation. 

Renewal 

  • Both the permit and the site evalulation are subject to expiration and renewal. 
  • Four hours of the 32 hour CE requirement for renewal of license must pertain to sedation.
  • Non-renewal of Permit 

  • Late renewals result in the permit expiring.
  • It is unlawful for a dentist to provide minimal sedation services without a permit. If the permit 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 31st deadline of odd numbered years.

Satellite Office 

  • All offices where sedation services are provided must comply with the minimum 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.

Site Evaluation

  • All providers of minimal sedation are required to have an evaluation at the location(s) where sedation or anesthesia services are rendered.
  • The purpose of the evaluations is to assess the patient’s anesthetic risk and assess a sites ability to provide emergency care; therefore, the site evaluation emphasizes recognition and management of emergencies and complications associated with office administration of sedation. An initial site evaluation must be completed within 60 days of the approval of the initial application. It is the applicant’s responsibility to schedule office evaluations with the Board’s designated anesthesia evaluator. 
  • A re-evaluation of the credentials, facilities, satellite facility, equipment, personnel, and procedures of a permit holder is required within five years of the anniversary of the previous site evaluation.  
  • It is the Anesthesia Committee’s prerogative to suspend privileges if a site evaluation is past due.

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:

Kellie Pierce, CRNA
4012 Edgewater Place
Mandan, ND 58554
piercecrna@aol.com
MINIMAL SEDATION PERMIT - INITIAL APPLICATION 
MINIMAL SEDATION - SITE EVALUATION FORM