Expanded Function Permits

LOCAL ANESTHESIA | RESTORATIVE FUNCTIONS | ANESTHESIA ASSISTANT | NITROUS OXIDE INHALATION ANALGESIA | NEW TECHNOLOGY

A dental hygienist may be authorized by permit to provide anesthesia assistant duties and/or provide restorative functions. The permit must be renewed when the license is renewed including evidence of 2 hours of continuing education pertaining to the expanded duty. A dental hygienist is authorized by permit to provide local anesthesia; renewal of the local anesthesia permit is not required, continuing education for local anesthesia is not required.

Local Anesthesia

A licensed dental hygienist may apply for a permit to administer local anesthesia to a patient who is at least eighteen years old, under the direct supervision of a licensed dentist. A license applicant must include the permit application to receive the local anesthesia endorsement.

To be considered for a permit, a hygienist must have successfully completed a didactic and clinical course in local anesthesia within the last twenty-four months sponsored by a dental or dental hygiene program accredited by the Commission on Dental Accreditation of the American Dental Association resulting in the dental hygienist becoming clinically competent in the administration of local anesthesia.

A licensed dental hygienist applying for a local anesthesia permit who has been permitted to administer local anesthesia in another state and who has continuously administered local anesthesia during the past three years must provide verification of the permit and continuous use to the North Dakota Board of Dental Examiners.

Verification may consist of:

A letter from the accredited school with the school seal affixed. Photocopies will not be accepted.
A notarized copy of the certification of the local anesthesia course completed.
A notarized letter stating that the licensed dental hygienist has administered local anesthesia within the last three years.
A notarized copy of the dental hygiene transcript with the local anesthesia course recorded.

A licensed dental hygienist requesting a permit to administer anesthesia who cannot provide verification must retake and successfully pass a didactic and clinical course in local anesthesia sponsored by a dental or dental hygiene program accredited by the Commission on Dental Accreditation of the American Dental Association.

Local Anesthesia Permit Application

Restorative Duties

The Board may issue a permit authorizing a dental hygienist to provide restorative duties if the applicant successfully completes the following:

Completes a board approved course;
Passes the Western Regional Examining Board’s restorative examination or other equivalent examination approved by the Board;
Completes the restorative function component of the Dental Assisting National Board’s certified restorative functions dental assistant examination.

RDH/RDA restorative procedures allowed under direct supervision of a dentist:

Place, carve, and adjust Class I, II and Class V supragingival amalgam or glass ionomer restorations with hand instruments or a slow-speed handpiece;
Adapt and cement stainless steel crowns;
Place, contour, and adjust Class I, II and Class V supragingival composite restorations where the margins are entirely within the enamel with hand instruments or a slow-speed handpiece.

Restorative Functions Permit Application

Anesthesia Assistant Duties

Dental Anesthesia Assistant Permit; Class I and Class II

Class I Permit:

The Board may issue a Class I permit allowing the permitholder to provide anesthesia assistance under the contiguous supervision of a dentist who is authorized to provide moderate sedation, deep sedation, or general anesthesia once the applicant successfully:

Completes a board-approved dental anesthesia assistant education and training course;
Submits current certification status from the AAOMS dental anesthesia assistant national certification or a board-approved competency examination.;
Submits proof of current BLS, ACLS or PALS;
Provides proof of the anesthesia permit issued to the dentist who will be supervising the anesthesia assistant’s services.

An individual authorized by a Class I permit may provide the following duties under contiguous supervision of a dentist who is authorized to provide moderate sedation, deep sedation, or general anesthesia:

Initiate and discontinue an IV line for a patient being prepared to receive IV medication, sedation or general anesthesia; and
Adjust the rate of intravenous fluids infusion only to maintain or keep the line patent or open.
Prepare anesthesia equipment and perform patient monitoring; and
Assist with emergency treatment and protocols.

Class II Permit:

The Board may issue a Class II permit authorizing the permitholder to provide anesthesia assistance under the direct visual supervision of a dentist who is authorized to provide moderate sedation, deep sedation, or general anesthesia once the applicant:

Completes a board-approved dental anesthesia assistant education and training course;
Submits proof of current dental anesthesia assistant national certification or a board approved competency examination;
Has successfully completed hands-on training in IV access or phlebotomy that includes live experience starting and maintaining intravenous lines;
Holds current and valid BLS, ACLS, or PALS; and
Provides proof of the anesthesia permit issued to the dentist who will be supervising the anesthesia assistant services.

An individual authorized by a Class II permit may provide the following duties under direct visual supervision of a dentist who is authorized to provide moderate sedation, deep sedation, or general anesthesia::

Draw up and prepare medications;
Follow instructions to deliver medication into an intravenous line upon verbal command of the supervising dentist;
Adjust the rate of intravenous fluids infusion beyond a keep-open rate upon verbal command of the supervising dentist; and
Adjust an electronic device to provide medications such as an infusion pump upon verbal command of the supervising dentist.

Anesthesia Assistant Permit Application

Anesthesia Assistant Courses Accepted by the NDBDE

The Dental Anesthesia Assistant National Certification Examination (DAANCE) is a two-part 36 hour continuing education program comprised of self-study material and a standardized computer based exam. The course is designed for auxiliary who assist a dentist or OMFS with a valid North Dakota sedation or anesthesia permit. DAANCE certification is valid for five years. To recertify, permit holders must retake the DAANCE examination every five years and maintain current BLS and/or ACLS certifications. Note: Online CPR certifications are not accepted. The course meets the requirements for a North Dakota Class I Dental Anesthesia Assistant Permit.
Sedation Consult, LLC: Allan Schwartz, DDS, CRNA provides a 3 day course, Monitoring Sedation/General Anesthesia & I.V. Certification meets the requirements for requirements of North Dakota Class II Dental Anesthesia Assistant Permit.
The American Dental Society of Anesthesiology is a two-day, 12 hour CE sedation course for auxiliaries featuring an in-depth approach designed especially for those who work in general anesthesia and moderate sedation practices. The course provides a certificate for the completion of the CE but does not provide certification or testing therefore to achieve Permit I, the DAANCE exam would also be required.

Nitrous Oxide Inhalation Analgesia - Effective 7/1/2022 - New Administrative Rule 20-02-01-05(1)

1. The following standards apply to the administration of nitrous oxide inhalation analgesia:

a. Inhalation equipment must have a fail-safe system that is appropriately checked and calibrated. The equipment also must have either a functioning device that prohibits the delivery of less than thirty percent oxygen or an appropriately calibrated and functioning in-line oxygen analyzer with audible alarm. A scavenging system must be available if gases other than oxygen or air are used.

b. Patient dental records must include the concentration administered and duration of administration.

c. A dentist may not delegate monitoring of nitrous oxide inhalation analgesia once the patient has ingested an enteral drug for the purpose of minimal sedation.

d. Before authorizing a dental hygienist or registered dental assistant to administer nitrous oxide inhalation analgesia, the dentist must have provided and documented training in the proper and safe operation of the nitrous oxide inhalation analgesia equipment.

e. A patient receiving nitrous oxide inhalation analgesia must be continually monitored by authorized dental staff. A dental hygienist or a registered dental assistant may terminate or reduce the amount of nitrous oxide previously administered by the authorized nitrous oxide inhalation analgesia provider.

f. The board may issue a permit authorizing the administration of nitrous oxide inhalation to a dentist or dental hygienist or registered dental assistant if the following requirements are met:

(1) Evidence of successful completion of a twelve-hour, board-approved course of training or course provided by a program accredited by an accrediting body recognized by the United States department of education, and either:

(a) Completed the course within thirteen months before application; or

(b) Completed the course more than thirteen months before application, has legally administered nitrous oxide inhalation analgesia for a period of time during the three years preceding application, and provides written documentation from a dentist that has employed or supervised the applicant, attesting to the current clinical proficiency of the applicant to administer nitrous oxide inhalation analgesia.

(2) Evidence of current certification in basic life support by the American heart association for the health care provider, or an equivalent program approved by the board.

Permit Application - Nitrous Oxide Inhalation Analgesia

Board-approved Courses

Nitrous Oxide Course

UMN Nitrous Oxide Administration Course

New Technology - NDBDE Policy

New technologies have enhanced the preventive and therapeutic duties hygienists may provide. It is the position of the Board that any services provided by a licensee, regardless of the devise used, must be within the scope of practice for each licensee. Whenever a new treatment modality is brought forward, it is the NDBDE policy that the dentist must have adequate proficiency and training related to the technology. Licensees utilizing new technology must maintain documentation of satisfactory completion of Board approved continuing education or training. Neither the particular technology utilized nor amendments to scope of practice alter the fact that all licensees are responsible for their individual actions with the dentist ultimately responsible for all care provided in each dental office.

Contact the Board's Executive Director if you have questions regarding regulations governing the practice of dental hygiene in North Dakota.