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Moderate Sedation

Education Requirements | Permits | Satellite Office | Site Evaluation | CRNA 

LINK: Effective July 1, 2022 - New Sedation and Anesthesia Administrative Rules

Moderate Sedation 

Before administering moderate sedation, a dentist licensed under North Dakota Century Code chapter 43-28 must have a permit issued by the NDBDE, renewable biennially thereafter.  An applicant for an initial permit must submit a completed application and application fee and meet the requirements of application.  

Educational Requirements 

A dentist who wishes to administer moderate parenteral or enteral sedation in the dental office should be familiar new requirements of the NDBDE's  Administrative Rules effective July 1, 2022. Following successful completion of a comprehensive sixty-hour predoctoral dental school post graduate education or continuing education in moderate sedation, a dentist must complete and submit the permit application and fee. The application is reviewed and approved by the Anesthesia Committee. A site evaluation is required within 60 days of submitting the application. A site evaluation fee is payable directly to the 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.

CRNAs and Dental Office Sedation

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 evaluation 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 providing sedation  should be prepared with appropriately trained staff and have requisite equipment to manage emergencies or adverse events. Administration of moderate sedation by another qualified dentist or independently practicing qualified anesthesia healthcare provider requires the operating dentist and his/her clinical staff to maintain current certification in Basic Life Support for Healthcare Providers. Dental offices who wish to provide sedation services via contractual or other agreement with a CRNA or other qualified provider are subject to site evaluations. 

SEDATION SUMMARY SPREADSHEET

Moderate  Sedation Education Requirements 

• Current certification in Advanced Cardiac Life Support or Pediatric Advanced LIfe Support, if treating pediatric patients.
• Current certification in Basic Life Support.  
• A comprehensive training program with a minimum of 60 hours in moderate parenteral sedation that satisfies the requirements as prescribed in the ADA Guidelines for Teaching Pain Control and Sedation to Dentists and Dental Students and ADA Guidelines for the Use of Sedation and General Anesthesia by Dentists. The NDBDE requires management of 20 adult live patient clinical case experiences by the intravenous route. Additional supervised clinical experience is required to manage children and medically compromised adults. 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 formal postdoctoral training in anxiety and pain control. Applicants must provide documentation of cases. 
• Administering intranasal versed or fentanyl, or both is considered deep sedation. A permitholder may not administer or employ any agents that have a narrow margin for maintaining consciousness, including ultra-short acting barbiturates, propofol, ketamine, or similarly acting drugs, agens, or techniques, or any combination thereof that likely would render a patient deeply sedated, generally anesthetized, or otherwise not meeting the conditions of moderate sedation. 
• Initial Anesthesia & Sedation Permit Application

Renewal of Permit 

• Both the sedation permit and the inspection are subject to expiration and renewal.
• The sedation/anesthesia permit must be renewed biennially, concurrent with the dentist’s license 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.
• Once a permit has expired, sedation privileges are suspended until a reinstatement is completed and formally approved by the Board’s Anesthesia Committee. It is unlawful to provide sedation without the appropriate permit. A late fee is incurred when the permit renewal is postmarked after the December 31^st deadline of odd numbered years.

Satellite Office

• All offices including satellite clinics where sedation services are provided by a dentist authorized by permit or by another authorized sedation provider, must comply with the minimum standards established by the Board and are responsible for ensuring that each office location has been evaluated prior to the five year anniversary of the last evaluation. Site evaluations are required every five years unless noted otherwise.

Site Evaluations

• The purpose of the evaluation 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.
• It is the applicants responsibility to schedule and complete the initial site evaluation within 60 days of submitting the permit application. It is the applicants responsibility to schedule office re-evaluations with the Board's designated evaluator. Pursuant to N.D.A.C. 20-02-01-05(5), all site re-evaluations are conducted within three years of anniversary of the previous site evaluation. 
• It is the Anesthesia Committee’s prerogative to suspend privileges if the sedation permit holder’s site evaluation is overdue or incomplete.

Moderate Sedation Permit - Initial Application

 Moderate Sedation - Site Evaluation