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: 

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 Duties

The Board may issue a permit authorizing a dental hygienist to provide restorative duties if the applicant meets the requirements set forth in NDAC 20-04-01-03.1(3)(a):

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.

RDH/RDA Restorative procedures allowed under direct supervision of a dentist are set forth NDAC 20-03-01-01.1(1), which includes:

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

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

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:

1. Completes a board-approved dental anesthesia assistant education and training course;
2. Submits current certification status from the AAOMS dental anesthesia assistant national certification or a board-approved competency examination;
3. Submits proof of current BLS, ACLS or PALS;
4. 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:

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 anesthesia equipment and perform patient monitoring; and
4. 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:

1. Completes a board-approved dental anesthesia assistant education and training course;
2. Submits proof of current dental anesthesia assistant national certification or a board approved competency examination;
3. Has successfully completed hands-on training in IV access or phlebotomy that includes live experience starting and maintaining intravenous lines;
4. Holds current and valid BLS, ACLS, or PALS; and
5. 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::

1. Draw up and prepare 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 Dental Anesthesia Assistant Permits Listed Above:

The requirements listed above for dental anesthesia assistant 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 - 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

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).

New Technology - NDBDE Policy

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, it is the NDSBDE 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.