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

Acceptable accrediting body means 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.

General anesthesia means a drug-induced loss of consciousness during which patients are not arousable, even by painful stimulation. The ability to independently maintain ventilatory function is often impaired. Patients often require assistance in maintaining a patent airway, and positive pressure ventilation may be required because of depressed spontaneous ventilation or drug-induced depression of neuromuscular function. Cardiovascular function may be impaired.

Deep sedation means a drug-induced depression of consciousness during which patients cannot be easily aroused but respond purposefully following repeated or painful stimulation. The ability to independently maintain ventilatory function may be impaired. Patients may require assistance in maintaining a patent airway, and spontaneous ventilation may be inadequate. Cardiovascular function is usually maintained.

Conscious (moderate) sedation means a drug-induced depression of consciousness during which patients respond purposefully to verbal commands, either alone or accompanied by light tactile stimulation. Reflex withdrawal from a painful stimulus is not considered a purposeful response. No interventions are required to maintain a patent airway, and spontaneous ventilation is adequate. Cardiovascular function is usually maintained.

Parenteral means 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.

Enteral means 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.

Inhalation means 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.

Continual or continually means repeated regularly and frequently in a steady succession.

Continuous or continuously means prolonged without any interruption in time.

Patent means open, unobstructed, or not closed.

Time-oriented anesthesia record means an organized document which shows at appropriate time intervals, drugs and doses administered, and physiologic data obtained through patient monitoring, during the course of conscious (moderate) sedation, deep sedation, or general anesthesia, to include the preoperative, intraoperative and recovery stages of treatment.

American Society of Anesthesiologists (ASA) Patient Physical Status Classification

• ASA I – A normal healthy patient
• ASA II – A patient with mild systemic disease
• ASA III – A patient with severe systemic disease
• ASA IV – A patient with severe systemic disease that is a constant threat to life
• ASA V – A moribund patient who is not expected to survive without the operation
• ASA VI- A declared brain-dead patient whose organs are being removed for donor purposes
• E – Emergency operation of any variety (used to modify one of the above classifications, i.e., ASA III-E)

Yes, under the following specified conditions:

• The supervising dentist must be currently certified by NYSED to administer the same level/type of anesthesia that will be provided to the patient (8 NYCRR §61.10(d)); and
• The nurse is a licensed and registered RN AND a Certified Registered Nurse Anesthetists (CRNA):
  • Acute care nurse practitioners (with more than 3,600 hours of nurse practitioner experience) who are CRNAs may order, prescribe, and administer anesthetic agents to dental patients in the private dental office. The supervising dentist must be physically present in the office while the CRNA provides anesthesia care to a dental patient. The CRNA may also provide anesthesia to a dental patient for a dentist who may not have NYSED anesthesia certification as long as the supervising dentist (anesthesia certificate holder) is also physically in the office.
  • In cases where the CRNA is not a nurse practitioner, the supervising dentist must order or prescribe anesthetic agents and other medications and remains medically responsible for the anesthesia care rendered to the patient, including the patient's response to the anesthesia. For this reason, the supervising dentist must be present and immediately available to intervene in the event of an adverse outcome while the patient is receiving anesthesia care from the CRNA. The supervising dentist may not assume any duties that interfere with this function (such as administering anesthesia to a different patient).

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 518-473-0567, e-mail dentbd@nysed.gov.

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