Expanded Function Permits

LOCAL ANESTHETIC | RESTORATIVE CARE FUNCTIONS | CLASS I AND CLASS II ANESTHESIA DUTIES  | NITROUS OXIDE INHALATION ANALGESIA | NEW TECHNOLOGY

A dental hygienist may be authorized by permit to administer local anesthetic, carry out anesthesia related duties, provide restorative care, and administer nitrous oxide. 

Local Anesthetic Permit (for RDHs)

The laws setting forth the criteria for being granted a permit to administer local anesthetic may be found at NDAC 20-04-01-03. The scope and supervision required for the administration of local anesthetic are found at NDAC 20-04-01-03, 20-04-01-01(3), 20-04-01-01(4)(cc). Prohibitions related to the administration of local anesthetic are found at NDAC 20-04-01-02(3). Dentists and dental hygienists are strongly encouraged to have a full understanding of these laws. A summary, however, is proivded below for convenience. 

To be considered for a permit, a hygienist must either:
 

A. Submit evidence that the hygienist successfully completed a didactic and clinical course in local anesthesia within the last five years 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; or

B. Submit evidence that the hygienist has been authorized to administer local anesthesia in another jurisdiction and provide verification of clinical competency during the previous five years. Verification may consist of

1. A letter from the accredited school with the school seal affixed. Photocopies will not be accepted.
2. A notarized copy of the certification of the local anesthesia course completed.
3. A notarized letter stating that the licensed dental hygienist has administered local anesthesia within the last three years.
4. 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 Care Permit (for RDHs and RDAs)

A dental hygienst may apply for a restorative care permit as explained at NDAC 20-04-01-03.1. The criteria for being granted a restorative care permit may be found at NDAC 20-03-01-01.2(3). The scope and supervision required for a restorative permit are found at NDAC 20-03-01-01.1(1) Prohibitions related to the restorative care functions are found at NDAC 20-04-01-02(3). Dentists and dental hygienists are strongly encouraged to have a full understanding of these laws. A summary, however, is proivded below for convenience. 

The Board may issue a restorative care permit to a dental hygienist if the applicant has either:

1. Successfully completed a Board-approved curriculum from a program accredited by the commission on dental accreditation of the American dental association or other Board-approved course and successfully passed a dental testing agency examination approved by the Board, within the last five years. The course must include a clinical and written examination. The Board may require successful completion of the restorative function component of the dental assisting national board's certified restorative functions dental assistant certification examination; or
2. Successfully passed a Board-approved dental testing agency examination over five years from the date of application, and successfully completed the restorative function component of the dental assisting national board's certified restorative functions dental assistant certification examination or other Board-approved examination and provides evidence from another state or jurisdiction where the applicant legally is or was authorized to perform restorative functions and certification from the supervising dentist of successful completion of at least twenty-five restorative procedures within the immediate five years from the date of application.

1. Completes a board approved course;
2. Passes a restorative examination approved by the Board;
3. The Board may also require completion of the restorative function component of the Dental Assisting National Board’s certified restorative functions dental assistant examination.

 

The University of Minnesota offers a ND Board approved course for Restorative Expanded Duties / 80-hour course. Successful completion of this course qualifies a registered dental hygienist or registered dental assistant for application of the Restorative Procedures Permit.

Restorative Functions Permit Application

Class I and Class II Anesthesia Permits 

Class I Permit:

A dental hygienst or registered dental asssitant, or any other individual, may apply for a Class I anesthesia permit care permit as explained at NDAC 20-03-01-01.2(1). The scope of work of a Class I anesthesia permit holder is found at NDAC 20-03-01-01.1(2). Prohibitions related to anesthesia-related functions are found at NDAC 20-04-01-02. Dentists and dental hygienists are strongly encouraged to have a full understanding of these laws. A summary, however, is proivded below for convenience. 

The Board may issue a Class I permit once the applicant:

1. Submits evidence of completing hands-on training in intravenous access or phlebotomy that includes live experience in starting and maintaining intravenous lines, and infection control. The evidence may be either a certificate of completion issued by a board-approved dental anesthesia assistant education and training course or an attestation by a supervising dentist who provided the training. A supervising dentist providing the training shall retain documentation of the training and provide it to the board upon request.
2. Submits proof of current certification status from the American association of oral and maxillofacial surgeon's dental anesthesia assistant national certification evidence of completing a board-approved competency examinationdental anesthesia assistant education and training course that includes vital sign monitoring, training on emergency oxygen administration, suction, use of advanced automated external defibrillators, and crash cart equipment.
3. Holds current and valid certification for health care provider basic life support, advanced cardiac life support, or pediatric advanced life support; and
4. Provides a copy of a valid North Dakota general anesthesia, deep sedation, or moderate sedation permit of the dentist where the registered dental assistantindividual will be performing anesthesia assistant 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:

1. Initiate and discontinue an IV line for a patient being prepared to receive IV medication, sedation or general anesthesia; and
2. Adjust the rate of intravenous fluids infusion only to maintain or keep the line patent or open
3. Prepare and monitor anesthesia equipment and perform patient monitoring;
4. Perform patient monitoring including vital signs, adverse events, and patient positioning; and
5. Assist with emergency treatment and protocols, including the use of suction, automated defibrillators, and crash cart equipment.

 Class II Permit:

A dental hygienst or registered dental asssitant, or any other individual, may apply for a Class II anesthesia permit care permit as explained at NDAC 20-03-01-01.2(2). The scope of work of a Class II anesthesia permit holder is found at NDAC 20-03-01-01.1(3). Prohibitions related to anesthesia-related functions are found at NDAC 20-04-01-02. Dentists and dental hygienists are strongly encouraged to have a full understanding of these laws. A summary, however, is proivded below for convenience. 

The Board may issue a Class II permit once the applicant:

1. Submits evidence of acompleting the dental anesthesia assistant national course or an equivalent board-approved dental anesthesia assistant education and trainingpharmacology course.
2. Submits either proof of current dental anesthesia assistant national certification or an equivalent pharmacology certification, or proof of passage within the two years preceding application of a board-approved competency examination;
3. Submits evidence of successfully completedcompleting a board-approved hands-on training in intravenous access or phlebotomy that includes live experience starting and maintaining intravenous lines, and infection control. The evidence may be either a certificate of completion issued by a board-approved dental anesthesia assistant education and training course or an attestation by a supervising dentist who provided the training. A supervising dentist providing the training shall retain documentation of the training and provide it to the board upon request;
4. Holds current and valid certification for health care provider basic life support, advanced cardiac life support, or pediatric advanced life support; and
5. Provides a copy of a valid North Dakota general anesthesia, deep sedation, or moderate sedation permit of the dentist where the registered or

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::

1. Draw up, label, prepare, and waste medications;
2. Follow instructions to deliver medication into an intravenous line upon verbal command of the supervising dentist;
3. Adjust the rate of intravenous fluids infusion beyond a keep-open rate upon verbal command of the supervising dentist; and
4. 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

A Summary of Some of the Board-Approved Courses, Programs, Certifications, and Examinations Necessary to Meet the Criteria for Class I or Class II Anesthesia Permits Listed Above:

The requirements listed above for dental anesthesia permits must all be met in order for a permit to be issued. The requirements listed above refer to various education and training programs, certifications, and examinations. Below is an explanation of various courses, programs, certifications, and examinations that can help you meet the above requirements.

• Requirement “a” for both the Class I and Class II permit can be met by completing one of the following:
  • The  two-part 36 hour continuing education program comprised of self-study material and a standardized computer based exam offered by the dental anesthesia assistant national certification examination (DAANCE).
  • The  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 that is provided by the American Dental Society of Anesthesiology, (ASDA)
  • If you locate another dental assisting anesthesia program or course that you believe may meet this requirement, please submit documentation of it and request that the Board consider approving it.
     
• Requirement “b” for both the Class I and Class II permit can be met as follows:
  • By submitting a certification from DAANCE. The DAANCE certification is valid for five years. To recertify, permit holders must retake the DAANCE examination every five years.
  • If you locate another dental assisting anesthesia certification or examination that you believe may meet this requirement, please submit documentation of it and request that the Board consider approving it. NOTE: The ASDA CE course discussed above provides a certificate to those who complete its CE. That certificate demonstrating an applicant completed their program DOES NOT meet the anesthesia examination/certification requirements for the Board’s issuance of a Class I or Class II permit as listed in Requirement “b” further above.
     
• Requirement “c” for the Class II permit can be met by completing one the following:
  • The 3-day comprehensive IV sedation course provided by Sedation Consult, LLC: Allen Schwarz, DDS, CRNA (Sedation Consult). 
  • Certain courses that are offered by the Infusion Institute (Infusion Institute). Please submit documentation of the course before registering for it to ensure you have selected a course approved by the Board.
  • If you locate another course that you believe may meet this requirement, please submit documentation of it and request that the Board consider approving it.

Nitrous Oxide Inhalation Analgesia Permit (RDHs and RDAs)

A dental hygienst or registered dental assistant may apply for a nitrous oxide analgesia permit care permit as explained at NDAC 20-02-01-05(1)(f). Supervision levels for the administration of nitrous oxide are found at NDAC 20-03-01-01.1(4) and 20-04-01-01(3)(g).  Dentists, dental hygienists, and registered dental assistants are strongly encouraged to have a full understanding of these laws. A summary, however, is proivded below for convenience. 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 a dentist may authorize authorizing a dental hygienist or registered dental assistant who holds a nitrous oxide administration permit to administer nitrous oxide inhalation analgesia to a patient, the dentist shall provide and document training in the permit holder with training on the proper and safe operation of         the office’s nitrous oxide inhalation analgesia equipment. The dentist shall retain documentation of the training and provide it to the board upon request.

e. A patient receiving nitrous oxide inhalation analgesia must be continually monitored by authorized dental staff as set forth in articles 20-03 and 20-04. 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.

Board-approved Courses

Essentials of Nitrous Oxide for Dentistry Parts 1 & 2 (Online)

University of Minnesota School of Dentistry (umn.edu) (at this website, search “nitrous” for the most current course offering).

Nitrous Oxide/Oxygen Inhalation Analgesia Administration Course - Dakota College at Bottineau

Permit Application - Nitrous Oxide Inhalation Analgesia

New Technology 

New technologies have enhanced the preventive and therapeutic duties hygienists may provide. 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, 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.