Dentistry

Dental Anesthesia/Sedation Certification

Questions and Answers on Dental Anesthesia/Sedation Certification for New York State Licensed Dentists

New York State licensed dentists who use general anesthesia, deep sedation, or conscious sedation (parenteral or enteral route with or without inhalation agents) must meet specific requirements and be certified by the New York State Education Department. The relevant section of Education Law is Article 133, Section 6605-a of Title VIII; the relevant section of the Regulations of the Commissioner of Education is Part 61.10.

Nothing in the law or regulations limit a dentist's use of local anesthesia, a dentist's use of nitrous oxide, or a dentist's use of any other substance or agent for a purpose other than achieving deep sedation, conscious sedation, or general anesthesia.

What follows is basic information about the requirements. It is not a substitute for reading the provisions of the law or regulation. If you have additional questions, you may call the State Board for Dentistry at 518-474-3817 ext. 550, fax 518-473-6995 or e-mail dentbd@mail.nysed.gov.

General Information

1. What is "general anesthesia?"

   General anesthesia is an induced state of unconsciousness, accompanied by partial or complete loss of protective reflexes, including the inability to continually maintain an airway independently and respond purposefully to physical stimulation or verbal command, and is produced by a pharmacologic and/or non-pharmacologic method.

2. What is "deep sedation?"

   Deep sedation is an induced state of depressed consciousness accompanied by partial loss of protective reflexes, including the inability to continually maintain an airway independently and/or to respond purposefully to physical stimulation or verbal command. It is produced by a pharmacologic and/or non-pharmacologic method.

3. What is "conscious sedation?"

   Conscious sedation is a minimally depressed level of consciousness in which the patient can independently and continuously maintain an airway and respond appropriately to physical stimulation and verbal command and that is produced by a pharmacologic and/or non-pharmacologic method. Patients whose only response is reflex withdrawal from repeated painful stimuli are not considered to be in a state of conscious sedation.

4. What is "parenteral?"

   Parenteral is a technique of administration in which the drug bypasses the gastrointestinal tract, including but not limited to intramuscular, intravenous, intranasal, submucosal, subcutaneous, and intraocular administration.

5. What is "enteral?"

   Enteral is a technique of administration in which the agent is absorbed through the gastrointestinal tract or oral mucosa, including but not limited to oral, rectal, and sublingual administration.

6. What is "inhalation?"

   Inhalation is a technique of administration in which a gaseous or volatile agent is introduced into the pulmonary tree and whose primary effect is due to the absorption through the pulmonary bed.

Certification

7. When am I required to obtain a dental anesthesia/sedation certificate?

   If you use general anesthesia, deep sedation, conscious sedation (parenteral or enteral route with or without inhalation agents) in the practice of dentistry, at any location other than a general hospital, you must obtain a dental anesthesia/sedation certificate. You must be a New York State licensed dentist to be eligible to obtain a dental anesthesia/sedation certificate.

   There are three different certificates.

   • If you use general anesthesia, deep sedation, or conscious sedation (enteral or parenteral route with or without inhalation agents) you must obtain a Dental General Anesthesia certificate.
   • If you use conscious sedation (parenteral or enteral route with or without inhalation agents) you must obtain a Dental Parenteral Conscious Sedation certificate.
   • If you use conscious sedation (enteral route only with or without inhalation agents) you must obtain a Dental Enteral Conscious Sedation certificate.
   
   
   
8. How do I obtain the application for certification?

   The application forms are available in PDF format. You may obtain print versions of the Dental General Anesthesia, Dental Parenteral Conscious Sedation, or Dental Enteral Conscious Sedation applications by contacting the Forms Management Unit at 518-474-3817 ext. 320 or e-mail opforms@mail.nysed.gov.

9. I currently hold a certificate authorizing me to use "General Anesthesia and Parenteral Sedation in the Practice of Dentistry." How do these requirements affect me?

   Your current certificate is valid until its expiration date. Approximately four months prior to that date, you will receive an application to reregister to practice and to apply for a Dental General Anesthesia certificate which will allow you to administer levels of sedation indicated in question #7 above for Dental General Anesthesia. You will be required to attest that you hold a valid course completion card for Advanced Cardiac Life Support (ACLS). If you reregister to practice and attest that you hold a valid ACLS course completion card, you are eligible to receive a Dental General Anesthesia certificate. A licensed dentist who holds a certificate to administer general anesthesia and parenteral sedation may also administer conscious sedation using the parenteral or enteral route with or without inhalation agents. You will be expected to meet the practice requirements detailed below.

10. I currently hold a certificate authorizing me to use "Parenteral Conscious Sedation in the Practice of Dentistry." How do these requirements affect me?

    Your current certificate is valid until its expiration date. Approximately four months prior to that date, you will receive an application to reregister to practice and to apply for a Dental Parenteral Conscious Sedation certificate which will allow you to administer the levels of sedation indicated in question #7 above for Dental Parenteral Conscious Sedation. You will be required to attest that you hold a valid course completion card for ACLS. If you reregister to practice and attest that you hold a valid course completion card for ACLS, you are eligible to receive a Dental Parenteral Conscious Sedation certificate. A licensed dentist who holds a certificate to administer conscious sedation using a parenteral route may also administer conscious sedation using an enteral route with or without inhalation agents. You will be expected to meet the practice requirements detailed below.

Education Required for Certification

11. What education is required for a Dental General Anesthesia certificate?

    Education completed on or after January 1, 2002:

    • At least two years of post-doctoral education in anesthesia or a graduate level program in oral and maxillofacial surgery. In either case, education must be acceptable to the Department and accredited by an acceptable accrediting body.
      
      

    Education completed prior to January 1, 2002:

    • At least one year of post-doctoral education in anesthesia or at least two years of education in an approved specialty program or residency. In either case, education must be acceptable to the NYS Education Department. The application for certification must be submitted prior to January 1, 2004. Individuals who apply on or after Janaury 1, 2004 must meet the education requirements that became effective January 1, 2002.
      
      
12. What education is required for a Dental Parenteral Conscious Sedation certificate?

    Education completed after January 1, 2002:

    • Post-doctoral education which includes at least 60 clock hours of coursework and an additional clinical experience demonstrating the successful use of parenteral conscious sedation on no fewer than 20 patients. Education completed must be acceptable to the Department and accredited by an acceptable accrediting body.
      
      

13. Education completed prior to January 1, 2002:

    • A minimum of 60 clock hours of post-doctoral education, 20 hours of which must consist of the successful use of parenteral conscious sedation on no fewer than 20 patients. Education completed must be acceptable to the Department. The application for certification must be submitted prior to January 1, 2004. Individuals who apply on or after January 1, 2004 must meet the education requirements that became effective January 1, 2002.
      
      
14. What education is required for a Dental Enteral Conscious Sedation certificate?

    Pre-doctoral or post-doctoral education consisting of a specialty program or residency accredited by an acceptable accrediting body which includes coursework in Basic Life Support and additional coursework consisting of at least 18 clock hours, including but not limited to, instruction in nitrous oxide use and emergency management. In addition to the coursework, 20 clinically-oriented experiences in the use of enteral conscious sedation techniques must be completed. These clinically-oriented experiences may include group observations of patients undergoing enteral conscious sedation techniques; or

    Post-doctoral coursework the Department approves which is equivalent to coursework approved by an acceptable accrediting body and includes coursework in Basic Life Support and at least 18 clock hours of additional coursework, including but not limited to, instruction in nitrous oxide use and emergency management. In addition to the coursework, 20 clinically-oriented experiences in the use of enteral conscious sedation techniques must be completed. These clinically-oriented experiences may include group observations of patients undergoing enteral conscious sedation techniques.

15. What does "acceptable accrediting body" mean?

    Acceptable accrediting body is an accrediting body which is accepted by the Department as a reliable authority for the purpose of accrediting educational programs in anesthesia, applying its criteria for granting accreditation in a fair, consistent, and nondiscriminatory manner, and which accredits such programs on a national basis, for instance, the American Dental Board of Anesthesiology.

Practice Requirements

15. Are there other requirements I am expected to meet?

    Yes. You are responsible for all aspects of the anesthesia/sedation procedure including life support procedures, monitoring, recovery, and recordkeeping and must adhere to the following practice requirements.

    Patient Care

    You may not administer general anesthesia or deep sedation or conscious sedation to more than one patient at a time and must ensure that you or a licensed physician, a registered professional nurse, or a licensed practical nurse personally monitors the patient's recovery.

    You must monitor vital signs, including:

    • blood pressure;
    • pulse;
    • electrical activity of the heart continuously (except when using enteral conscious sedation); and
    • oxygen saturation continuously with a pulse oximeter or an equivalent device (except when using enteral conscious sedation and the patient's conduct prohibits it).

    You must:

    • evaluate ventilation by observation and/or auscultation;
    • have a device capable of measuring body temperature readily available during the administration of general anesthesia or deep sedation;
    • continually monitor body temperature when agents implicated in precipitating malignant hyperthermia are used; and
    • provide specific dietary instructions and appropriate oral or written instructions to the patient and/or the patient's guardian based on the techniques used and the patient's physical state.

    Facility

    Your facility must:

    • have a defibrillator that is immediately accessible (required for use of general anesthesia, deep sedation and parenteral conscious sedation);
    • be readily accessible for emergency equipment; and
    • have a protocol for handling emergencies, including transport to an emergency facility, posted in each treatment and recovery area.

    Recordkeeping and Reporting

    You must maintain patient records including, but not limited to:

    • medical history of the patient;
    • appropriate informed consent obtained prior to the performance of the procedure;
    • time oriented anesthetic records based on the level of anesthesia administered, that reflect pre-operative, intra-operative, and pre-discharge monitoring of:
    • blood pressure;
    • pulse;
    • oxygen saturation (when using enteral conscious sedation and the patient's conduct prohibits monitoring, the record must document this fact); and
    • drugs and dosages used prior, during, and post procedure, including inhalation agents and persons present during the administration of the drugs.

    If you hold a Dental Enteral Conscious Sedation certificate, you must maintain a valid course completion card for Basic Life Support for you and the staff member (see below) you have in the operatory during the administration of enteral conscious sedation.

    Mortality or morbidity during or related to the administration of general anesthesia, deep sedation, or conscious sedation must be reported to the New York State Board for Dentistry within 30 days of the occurrence.

    Personnel

    A minimum of three individuals must be present in the operatory during the administration of general anesthesia or deep sedation - a licensed dentist or licensed physician qualified to administer the anesthetic drugs or agents and two additional individuals who have valid course completion cards in Basic Life Support.

    A minimum of two individuals must be present in the operatory during the administration of conscious sedation using the parenteral or enteral route - a licensed dentist or licensed physician qualified to administer the sedation and one additional individual who has a valid course completion card in Basic Life Support.

Education and Training Required to Maintain Certification

16. What are the requirements for renewing my anesthesia/sedation certificate?

    To renew your Dental General Anesthesia certificate, you must have a valid course completion card for Advanced Cardiac Life Support and the two individuals who will assist you in the operatory must have valid course completion cards for Basic Life Support.

    To renew your Dental Parenteral Conscious Sedation certificate, you must have a valid course completion card for Advanced Cardiac Life Support and the individual who will assist you in the operatory must have a valid course completion card for Basic Life Support.

    To renew your Dental Enteral Conscious Sedation certificate, you and the individual who will assist you in the operatory must have valid course completion cards for Basic Life Support. You must also have proof of completion of the six clock hours of education in sedation techniques, including but not limited to, coursework in medications and recognition and management of complications and emergencies, completed during your previous registration period.

17. What life support courses are acceptable?

    You must take courses for which a course completion card is issued. These include:

    Basic Life Support

    • American Red Cross Community CPR - initial course is 6.5 hours and the recertification course is 3 hours, course completion card is valid for one year; or
    • American Heart Association BLS Heartsaver Plus Course (Healthcare Provider Basic) - initial course is 6-8 hours and the renewal varies from 1-6 hours based on level of competency, course completion card is valid for two years.
    
    
    

    Advanced Cardiac Life Support

    • American Heart Association Advanced Cardiac Life Support - initial course is approximately 16 hours, course completion card is valid for two years; or
    • American Heart Association Pediatric Advanced Life Support Course (PALS) - initial course is approximately 16 hours, course completion card is valid for two years.
    
    
    
18. May I count the courses that I am required to complete to maintain my Dental Enteral Conscious Sedation certificate toward meeting the continuing education requirement?

    If the courses fulfill all aspects of the continuing education requirements currently in place, they may be credited toward meeting the continuing education requirement.

Contacts for Further Information

19. What if I have questions or need further information?

    You should contact the Office of the State Board for Dentistry, New York State Education Department, Office of the Professions, State Education Building - 2nd Floor, 89 Washington Avenue, Albany, New York 12234, telephone 518-474-3817, ext. 550, fax 518-473-6995, e-mail dentbd@mail.nysed.gov.

    Please visit this Web site periodically for current information related to the practice of your profession.