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New Jersey State Board of Dentistry
Frequently Asked Questions - Enteral Sedation Permits
- What is covered under the new regulation?
- When is the new rule effective?
- I advertise "Sleep Dentistry." May I continue to do so after I get permit?
- How does the Board define "deep sedation?"
- Sometimes I prescribe a dose of medication to control anxiety before a patient visit. Am I required to hold a permit?
- What kind of training is required for the issuance of an enteral sedation permit?
- Does the completion of a general practice, pediatric or other residency program qualify a dentist for an enteral sedation permit?
- Are permits renewable?
- Are there continuing education requirements to renew the permit?
- Are there exemptions for holders of G.A. and Parenteral Conscious Sedation (P.C.S.) permits?
- Are there any special staffing requirements when administering enteral sedation?
- Are any special supplies or equipment needed in my office?
- Is there any special patient evaluation or documentation required when administering enteral sedation?
- 1. What is covered under the new regulation?
The new rule defines enteral sedation to include the prescription or administration
of one or more pharmacological agents, used for the purpose of causing a depressed
level of consciousness, but not a loss of consciousness. Pharmacological agents
include any nonparenteral agent, but do not include any agent that is introduced
by intravenous, intramuscular, subcutaneous, submucosal or inhalation routes,
including nitrous oxide inhalation.
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- When is the new rule effective?
The regulation became effective upon its adoption on September 6, 2005. As of
July 1, 2006, any New Jersey dentists who wish to administer any pharmacological
agent in any dose for the purpose of inhibiting patient response beyond diminishing
patient anxiety must possess an enteral sedation permit. The Board will consider
applications beginning in the first quarter of 2006.
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- I advertise "Sleep Dentistry." May I continue to do so after I get permit?
No. The use of this term (and those below) is prohibited
effective with the adoption of the new rule, unless a dentist holds a General
Anesthesia (G.A.) permit. The Board is aware that some dentists have been advertising
the provision of "sleep dentistry" services as a way for very apprehensive patients
to undergo dental procedures. Patients are sedated and placed in a very "sleep-like" state
prior to the start of the dental services and are "awakened," or brought out
of this sedated state, once the procedures have been completed. The Board believes
that some dentists who advertise or offer "sleep dentistry" services and are
placing patients under deep sedation in order to achieve the desired sleep-like
state, are doing so without the benefit of a G.A. permit. If a patient is going
to be placed under deep sedation, which is necessary if a "sleep-like" state
is the desired effect, the Board believes that the dentist must possess a G.A.
permit in order to properly handle any untoward reaction the patient may experience
during the procedure. The new regulation provides that a dentist who uses or
advertises the terms "sleep," "sleep dentistry," or "sleep-like state," or any
other similar words, in connection with the provision of dental services, will
be considered to be inducing deep sedation. Such a dentist must possess a G.A.
permit.
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- How does the Board define "deep sedation?"
The term "deep sedation" is defined to mean the administration of pharmacological
and/or nonpharmacological agents, or a combination of the two, to induce a state
of depressed consciousness in a patient, which is accompanied by a partial loss
of protective reflexes, including the inability of the patient to continually
maintain an airway independently and/or to respond purposefully to painful physical
stimulation or verbal command. The new rules prohibit a dentist from administering,
dispensing or prescribing any pharmacological agent which will cause a patient
to lapse into this type of sedation unless the dentist possesses a G.A. permit
issued by the Board. The Board believes that the risks associated with this type
of sedation are such that only those dentists who are properly trained in the
administration of general anesthesia, and have satisfied the requirements necessary
to obtain a G.A. permit, should be authorized to employ it in their dental practices.
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- Sometimes I prescribe a dose of medication to control anxiety before a patient visit. Am I required to hold a permit?
No. The new rule only applies to the administration of pharmacological agents with the purpose of inhibiting patient response beyond diminishing patient anxiety.
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- What kind of training is required for the issuance of an enteral sedation permit?
A dentist applying for this new permit must submit certification verifying that
the dentist has completed Board-approved postdoctoral course work at an accredited
dental school, or in a college or university clinical setting, which has prepared
the applicant to administer enteral sedation safely and effectively. The course
work must consist of a minimum of 40 hours of didactic training in basic enteral
sedation, physical evaluation, recognition and management of complications and
emergencies, and patient monitoring. A list of approved courses is posted on
the Board’s Web site.
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- Does the completion of a general practice, pediatric or other residency program qualify a dentist for an enteral sedation permit?
It depends on when the program was completed.
Any dentist who has completed a general practice residency or has graduated from
a postdoctoral training program within three years of application will qualify
for the issuance of an enteral sedation permit. A dentist completing a general
practice residency or a postdoctoral training program more than three years prior
to application may qualify for a permit if he or she has completed a Board-approved
program of 20 hours of didactic training in enteral sedation within the three
years immediately preceding the date of application. The general practice residency
or postdoctoral training program must include a minimum of 60 hours of training
in anesthesia or conscious sedation. The Board believes that the modifications
of the course-work requirement are warranted because the training obtained by
dentists who have completed a general practice residency or postdoctoral training
program is comprehensive and will adequately prepare them to safely and effectively
administer enteral sedation. A list of approved courses is posted at www.njconsumeraffairs.gov/dentistry/esplist.htm.
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- Are permits renewable?
Enteral sedation permits are renewed every two years.
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- Are there continuing education requirements to renew the permit?
Yes. Every holder of an enteral sedation permit
is required to complete at least 20 hours of continuing education in every biennial
period in physiology, pharmacology, patient evaluation, patient monitoring or
medical emergencies. The 20 hours of training must be completed consistent with
the requirements imposed by the Board pursuant to its existing continuing education
rule for dentists. The Board has determined that completion of the 20 hours of
continuing education required for the maintenance of an enteral sedation permit
may be counted toward satisfaction of the total number of credits required for
a dentist to renew a license.
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- Are there exemptions for holders of G.A. and Parenteral Conscious Sedation (P.C.S.) permits?
Holders of G.A. or P.C.S. permits are not required to hold an enteral sedation permit to administer enteral sedation. The minimum training and standards imposed by the Board for those permits are higher than they would be under an enteral sedation permit and, therefore, the Board is confident that the holders of G.A. and P.C.S. permits are already qualified to administer enteral sedation without an additional permit.
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- Are there any special staffing requirements when administering enteral sedation?
Yes. The enteral sedation permit holder must certify, on the initial application and upon permit renewal, that he or she employs a licensed health care professional who is present in the office and is trained to assist in the monitoring of the patient whenever enteral sedation is employed.
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- Are any special supplies or equipment needed in my office?
Yes. The regulations require the dentist to provide
for appropriate monitoring of the patient during the administration of the sedation,
to be prepared to manage any reasonably foreseeable complications and to be in
attendance in the peratory until the patient's protective reflexes have returned
and the patient is determined by the dentist to be stable and ambulatory. Therefore,
it is necessary that the dentist possess basic equipment and supplies to address
emergency situations. At a minimum, a permit holder's office must contain suction
equipment capable of aspirating gastric contents from the mouth and pharynx;
a portable oxygen delivery system; a blood pressure cuff and stethoscope; a
pulse oximeter; an emergency drug kit; and back-up lighting, suction and pulse
oximeter devices that can operate by means of battery or generator power.
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- Is there any special patient evaluation or documentation required when administering enteral sedation?
Prior to the administration of enteral sedation the dentist is required to perform
a physical evaluation of the patient and take a complete medical history, which
must include the patient's medications, allergies and sensitivities. The patient
history must be maintained in the patient record for at least seven years. In
addition, N.J.A.C. 13:30-8.4 (l) requires that the patient record contain specific
notations on the use of enteral sedation, including the type of agent, dosage,
duration of the sedation, the patient's vital signs during the drug administration,
and any untoward reactions the patient may have suffered.
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