Part 61, Dentistry, Dental Hygiene, and Registered Dental Assisting

1. To meet the professional education requirement, the applicant shall present evidence of the completion of not less than 60 semester hours of preprofessional education including courses in general chemistry, organic chemistry, biology or zoology and physics and a program of professional education consisting of either:
   1. the completion of a program of dental education of not less than four academic years, or the equivalent thereof, registered by the department or accredited by an accrediting organization acceptable to the department; or
   2. the completion of not less than four academic years of dental education satisfactory to the department, culminating in a degree, diploma or certificate in dentistry recognized by the appropriate civil authorities of the country in which the school is located as acceptable for entry into, practice in the country in which the school is located.
2. Where a program of dental education is completed in an unregistered and unaccredited foreign dental school as provided in paragraph (a)(2) of this section, the applicant shall complete not less than two academic years of study satisfactory to the department in a registered or accredited dental school program including such subjects as may be necessary for certification by such registered or accredited school that the candidate has achieved the level of knowledge and clinical proficiency expected of a graduate of the school.
3. Courses failed in a school of dentistry, for which credit has been granted toward meeting the requirements of another school of dentistry may not be counted toward meeting the requirements of this Part.
4. A program of dental education shall be considered completed upon certification of completion by the school in which such program was taken and proof that the applicant has been awarded the appropriate dental degree, diploma or certificate.

1. Individuals, who on or before December 31, 2006 have completed all the education requirements for licensure and by that date have submitted an application for licensure and the required application fee, shall meet the examination requirements of this subdivision. Individuals who do not meet these conditions shall meet the examination requirements of subdivision (b) of this section.
   1. Content. The examination shall consist of three parts:
      1. Parts I and II. Designed to sample knowledge from all areas related to dentistry.
      2. Part III. An examination in clinical dentistry, the scope and content of which shall be determined by the State Board for Dentistry.
   2. The department may accept grades acceptable to the State Board for Dentistry on an examination of the National Board Dental Examinations as meeting the requirements of Parts I and II of the licensing examination, and satisfactory performance on the clinical examination administered by the Northeast Regional Board of Dental Examiners or another acceptable clinical testing agency for Part III of the licensing examination.
   3. To be admitted to Part III of the dental licensing examination a candidate who possesses acceptable credentials pursuant to section 61.1(a)(2) of this Part shall provide evidence satisfactory to the department of having passed Parts I and II of the dental licensing examination.
   4. Special examination conditions.
      1. An applicant who has completed not less than two academic years in a program of dental education registered by the department, or accredited by an accrediting organization acceptable to the department may be admitted to Part I of the examination. Such applicant shall meet all requirements for admission to the licensing examination, except for the completion of professional education.
      2. An applicant attending a program of dental education registered by the department, or accredited by an accrediting organization acceptable to the department, may be admitted to Parts II and III during the last year of study.
   5. Candidates seeking admission to Part III of the dental licensing examination shall be required to show proof of professional liability insurance coverage prior to commencement of the examination.
   6. Passing score. The passing score in each subject of each part shall be 75.0, as determined by the State Board for Dentistry.
   7. A candidate who fails to pass any subject of Part III shall retain credit for subjects of that Part passed and shall be reexamined in all remaining subjects at each subsequent examination, except that a candidate who fails to pass all subjects during three administrations of Part III shall be required to be examined in the entire Part at a subsequent administration. Before admission to the third administration of Part III may be granted, such candidate shall present evidence satisfactory to the department of the completion of not less than 40 clock hours of instruction acceptable to the State Board for Dentistry in each subject failed twice. Such instruction shall be completed in a dental school registered by the department or accredited by an accrediting organization acceptable to the department and shall be completed subsequent to the second failure.
   8. It shall be the responsibility of each candidate to obtain patients for applicable subjects of Part III.
   9. In accordance with section 6604(4) of the Education Law, individuals, who on or before December 31, 2006 have completed all the education requirements for licensure and by that date have submitted an application for licensure and the required application fee, may substitute successful completion of a residency program that meets the requirements of section 61.18 of this Part in lieu of successful completion of Part III, the examination in clinical dentistry.
2. Individuals who do not meet the conditions prescribed in the opening paragraph of subdivision (a) of this section shall meet the examination requirements of this subdivision.
   1. Content. The examination shall consist of two parts designed to sample the knowledge from all areas related to dentistry.
   2. The department may accept grades acceptable to the State Board for Dentistry on an examination of the National Board Dental Examinations as meeting the requirements of Parts I and II of the licensing examination.
   3. Special examination conditions.
      1. An applicant who has completed not less than two academic years in a program of dental education registered by the department, or accredited by an accrediting organization acceptable to the department may be admitted to Part I of the examination. Such applicant shall meet all requirements for admission to the licensing examination, except for the completion of professional education.
      2. An applicant attending a program of dental education registered by the department, or accredited by an accrediting organization acceptable to the department, may be admitted to Part II during the last year of study.
   4. Passing score. The passing score in each subject of each part shall be 75.0, as determined by the State Board for Dentistry.

1. Limited permits may be issued in accordance with Education Law, section 6605(1) and (2) to graduates from:
   1. registered programs or those accredited by an accrediting organization acceptable to the department; or
   2. dental education programs not registered by the department or accredited by an accrediting organization acceptable to the department but who have met all requirements of section 61.1(a)(2) and (b) of this Part.
2. A hospital or dental facility approved by an appropriate agency as used in subdivision (1) of section 6605 of the Education Law shall mean an institution accredited for teaching purposes by the Commission on Dental Accreditation of the American Dental Association.
3. Direction or supervision of a licensed dentist as used in section 6605(1) of the Education Law shall mean that a supervising dentist shall be present on the premises at all times when professional services are being rendered by the holder of a limited permit and shall exercise that degree of supervision appropriate to the circumstances.
4. An application for a limited permit in dentistry shall be accompanied by an affidavit from the dentist who will supervise the professional services to be rendered under the limited permit, and the application and affidavit shall be in a form prescribed by the department.

1. For endorsement of a dental license issued by another jurisdiction of the United States or a Canadian province the applicant shall submit satisfactory evidence of:
   1. having met all requirements of section 59.6 of this Subchapter; and
   2. lawful and reputable practice in dentistry or not less than eight months during the two years next preceding the filing of the application.

A dental prescription for furnishing, constructing, reproducing or repairing prosthetic dentures or bridges to be used and worn as substitutes for natural teeth, or orthodontic or other appliance used for the correction of malocclusion or deformities of other structures, shall comply with the provision of subdivision (1) of section 6611 of the Education Law, and shall contain the following information:

1. the name of the laboratory to which the prescription is addressed;
2. the date on which it is written;
3. a clear description of the work to be done, with appropriate diagrams if necessary;
4. a clear specification of the character of materials to be used; and
5. the signature and license number of the dentist.

To meet the professional education requirement, the applicant shall present evidence of satisfactory completion of a program of education for dental hygienists registered by the department or accredited by an accrediting organization acceptable to the department.

1. Content. The examination shall consist of two parts:
   1. Part I. Designed to sample knowledge from all areas related to dental hygiene.
   2. Part II. An examination in dental hygiene practice, including both comprehensive and clinical components the scope and content of which shall be determined by the State Board for Dentistry.
2. The department may accept grades acceptable to the State Board for Dentistry on an examination of the National Board Dental Hygiene Examination as meeting the requirements of Part I of the licensing examination, and satisfactory performance on a clinical examination administered by a clinical testing agency acceptable to the department for Part II of the licensing examination.
3. Candidates seeking admission to Part II of the dental hygiene licensing examination shall be required to show proof of professional liability insurance coverage prior to the commencement of the examination.
4. Passing score. The passing score in each subject of each part of the examination shall be 75.0, as determined by the State Board for Dentistry.
5. A candidate who fails any component of Part II shall retain credit for components of that part passed, to the extent permitted by the testing agency.
6. Special examination conditions.
   1. An applicant who has completed not less than one academic year in a program of dental hygiene education registered by the department or accredited by an accrediting organization acceptable to the department may be admitted to Part I of the examination. Such applicant shall meet all requirements for admission to the licensing examination, except for the completion of professional education.
   2. An applicant attending a program of dental hygiene education registered by the department, or accredited by an accrediting organization acceptable to the department, may be admitted to Part II during the last year of study and prior to graduation.

For endorsement of a license as a dental hygienist issued by another jurisdiction of the United States, the applicant shall submit satisfactory evidence of:

1. having met all requirements of section 59.6 of this Subchapter; and
2. lawful and reputable practice as a dental hygienist of not less than eight months during the two years next preceding the filing of the application.

The practice of dental hygiene, in accordance with section 6606 of the Education Law, shall be performed either under the supervision of a licensed dentist or pursuant to a collaborative arrangement as defined in subdivision (f) of this section.

1. The degrees of supervision by the dentist as defined are follows:
   1. General supervision shall mean that a supervising dentist is available for consultation, diagnosis and evaluation, has authorized the dental hygienist to perform the services, and exercises that degree of supervision appropriate to the circumstances.
   2. Personal supervision shall mean that the dentist in the dental office or facility, personally diagnoses the condition to be treated, personally authorizes the procedure and, before dismissal of the patient, personally examines the condition after treatment is completed.
2. The following services may be performed under the general supervision of a licensed dentist:
   1. removing calcareous deposits, accretions and stains, including scaling and planing of exposed root surfaces indicated for a complete prophylaxis;
   2. applying topical agents indicated for a complete dental prophylaxis;
   3. removing excess cement from surfaces of the teeth;
   4. providing patient education and counseling relating to the improvement of oral health;
   5. taking and exposing dental radiographs;
   6. performing topical anticariogenic agent applications, including but not limited to topical fluoride applications, and performing topical anesthetic applications;
   7. polishing teeth, including existing restorations;
   8. taking and assessing medical history including the measuring and recording of vital signs as an aid to diagnosis by the dentist and to assist the dental hygienist in providing dental hygiene services;
   9. performing dental or/or periodontal assessments as an aid to diagnosis by the dentist and to assist the dental hygienist in providing dental hygiene services;
   10. applying pit and fissure sealants;
   11. applying desensitizing agents to the teeth;
   12. placing and removing temporary restorations;
   13. making assessments of the oral and maxillofacial area as an aid to diagnosis by the dentist;
   14. taking impressions for study casts. Study casts shall mean only such casts as will be used for purposes of diagnosis and treatment planning by the dentist and for the purposes of patient education; and
   15. providing dental health care case management and care coordination services, which shall include, but not be limited to:
       1. community outreach;
       2. improving oral health outcomes;
       3. improving access to dental care by assisting people in establishing an ongoing relationship with a dentist, in order to promote the comprehensive, continuous and coordinated delivery of all aspects of oral health care; and
       4. assisting people to obtain dental health care.
3. The following services may be performed only under the personal supervision of a licensed dentist:
   1. placing or removing rubber dam;
   2. removing sutures;
   3. placing or removing matrix bands;
   4. applying a topical medication not related to a complete dental prophylaxis;
   5. placing and removing periodontal dressings;
   6. selecting and prefitting provisional crowns;
   7. selecting and prefitting orthodontic bands;
   8. removing orthodontic arch wires and ligature ties;
   9. taking impressions for space maintainers, orthodontic appliances, and occlusal guards;
   10. placing and removing temporary separating devices; and
   11. placing orthodontic ligatures.
4. The dental supportive services that a licensed dentist authorizes a registered dental assistant to perform under section 61.13(b)(18) of this Part, designated in such paragraph as other dental supportive services, may be performed by a licensed dental hygienist under the personal supervision of a licensed dentist who has delegated such function to the licensed dental hygienist, unless general supervision for such service is otherwise expressly prescribed in this section.
5. In accordance with section 29.1(b)(9) and (10) of this Title, a licensed dental hygienist performing services under the supervision of a licensed dentist or pursuant to a collaborative arrangement as defined in subdivision (f) of this section is not permitted to provide dental services or dental supportive services that the licensed dental hygienist knows or has reason to know that he or she is not competent to perform, and a licensed dentist is not permitted to delegate to a licensed dental hygienist dental services or dental supportive services that the licensed dentist knows or has reason to know that the licensed dental hygienist is not qualified by training, experience or by licensure to perform.
6. Collaborative arrangement.
   1. Definitions. As used in this subdivision:
      1. Collaborative arrangement shall mean an agreement between a registered dental hygienist working for a hospital and a licensed and registered dentist who has a formal relationship with the same hospital.
      2. Hospital shall mean a hospital as defined by Public Health Law section 2801(1).
   2. Requirements. A registered dental hygienist providing services pursuant to a collaborative arrangement shall:
      1. only provide those services that may be provided under general supervision as specified in subdivision (b) of this section, provided that the physical presence of the collaborating dentist is not required for the provision of such services;
      2. instruct individuals to visit a licensed dentist for comprehensive examination or treatment;
      3. possess and maintain certification in cardiopulmonary resuscitation in accordance with the requirements for dentists set forth in section 61.19 of this Part and the following:
         1. at the time of his or her registration renewal, the dental hygienist shall attest to having met the cardiopulmonary resuscitation requirement or attest to meeting the requirements for exemption as defined in clause (b) of this subparagraph;
         2. a dental hygienist may be granted an exemption to the cardiopulmonary resuscitation requirement if he or she is physically incapable of complying with the requirements of this subparagraph. Documentation of such incapacity shall include a written statement by a licensed physician describing the dental hygienist’s physical incapacity. The dental hygienist shall also submit an application to the department for exemption which verifies that another individual will maintain certification and be present at the location where the dental hygienist provides dental hygiene services, pursuant to a collaborative arrangement, while the dental hygienist is treating patients;
         3. each dental hygienist shall maintain for review by the department records of compliance with the cardiopulmonary resuscitation certification requirement, including the dental hygienist’s cardiopulmonary resuscitation certification card; and
      4. provide collaborative services only pursuant to a written agreement that is maintained in the practice setting of the dental hygienist and collaborating dentist. Such written agreement shall include:
         1. provisions for:
            1. referral and consultation;
            2. coverage for emergency absences of either the dental hygienist or collaborating dentist;
            3. resolution of disagreements between the dental hygienist and collaborating dentist regarding matters of treatment, provided that, to the extent a disagreement cannot be resolved, the collaborating dentist’s treatment shall prevail;
            4. the periodic review of patient records by the collaborating dentist; and
            5. such other provisions as may be determined by the dental hygienist and collaborating dentist to be appropriate; and
         2. protocols, which may be updated periodically, identifying the services to be performed by the dental hygienist in collaboration with the dentist and reflecting accepted standards of dental hygiene. Protocols shall include provisions for:
            1. case management and care coordination, including treatment;
            2. appropriate recordkeeping by the dental hygienist; and
            3. such other provisions as may be determined by the dental hygienist and collaborating dentist to be appropriate.
   3. Collaborative arrangements shall not supersede any law or regulation which requires identified services to be performed under the personal supervision of a dentist.

1. Definitions. For purposes of this section, the following definitions shall apply:
   1. 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.
   2. 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.
   3. 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.
   4. 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.
   5. 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.
   6. 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.
   7. 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.
   8. Continual or continually means repeated regularly and frequently in a steady succession.
   9. Continuous or continuously means prolonged without any interruption in time.
   10. Patent means open, unobstructed, or not closed.
   11. 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.
   12. American Society of Anesthesiologists (ASA) Patient Physical Status Classification:
       1. ASA I – A normal healthy patient;
       2. ASA II – A patient with mild systemic disease;
       3. ASA III – A patient with severe systemic disease;
       4. ASA IV – A patient with severe systemic disease that is a constant threat to life;
       5. ASA V – A moribund patient who is not expected to survive without the operation;
       6. ASA VI – A declared brain-dead patient whose organs are being removed for donor purposes;
       7. E – Emergency operation of any variety (used to modify one of the above classifications, i.e., ASA III-E).
2. Certification requirements.
   1. A licensed dentist shall not employ conscious (moderate) sedation, deep sedation, or general anesthesia in the practice of dentistry, at any location other than a general hospital, unless such dentist possesses a dental anesthesia certificate issued by the department pursuant to this section, except that such certification shall not be required for use of anesthesia as prescribed in section 6605-a(3) of the Education Law. For such certification the licensed dentist shall meet the requirements of this section, including the educational and training requirements prescribed in subdivision (c) of this section and the practice requirements prescribed in subdivision (d) of this section. Such certificates shall be issued for a three-year term.
   2. Effective January 1, 2018, certificates shall be issued in the titles:
      1. dental general anesthesia, which authorizes a licensed dentist to employ conscious (moderate) sedation (enteral or parenteral route with or without inhalation agents), deep sedation, and general anesthesia;
      2. dental parenteral conscious (moderate) sedation for patients 13 years old and older, which authorizes a licensed dentist to employ conscious (moderate) sedation (enteral or parenteral route with or without inhalation agents) on all patients 13 years old and older;
      3. dental parenteral conscious (moderate) sedation for patients 12 years old and younger, which authorizes a licensed dentist to employ conscious (moderate) sedation (enteral or parenteral route with or without inhalation agents) on all patients;
      4. dental, enteral conscious (moderate) sedation for patients 13 years old and older, which authorizes a licensed dentist to employ conscious (moderate) sedation (enteral route only with or without inhalation agents) on all patients 13 years old and older; and
      5. dental enteral conscious (moderate) sedation for patients 12 years old and younger, which authorizes a licensed dentist to employ conscious (moderate) sedation (enteral route only with or without inhalation agents) on all patients.
   3. Certificates to administer dental general anesthesia; dental parenteral conscious sedation and dental enteral conscious sedation only which were issued prior to January 1, 2018 shall continue to be valid until the expiration of their term, at which time the licensed dentist shall be required to submit an application to the department for renewal of his or her certificate pursuant to the applicable requirements set forth in this section:
      1. For renewal of a certificate in dental general anesthesia, a licensed dentist shall satisfy the requirements contained in paragraph (c)(3) of this section.
      2. For the first renewal period for a licensed dentist with an existing dental enteral or parenteral conscious sedation certificate issued prior to January 1, 2018 who seeks to administer dental enteral or dental parenteral conscious (moderate) sedation to patients 12 years old and younger, the licensee shall satisfy the requirements contained in paragraph (c)(3) of this section and submit to the department for review nine time-oriented anesthesia records of such patients who either were:
         1. treated by the licensed dentist utilizing conscious (moderate) sedation (enteral/parenteral) during his or her last triennial registration period; or
         2. patients where the licensed dentist was the supervising attending dentist or a faculty member supervising the student who was administering the conscious (moderate) sedation technique (enteral/parenteral) being administered during his or her last triennial registration period.
      3. If a licensed dentist who seeks to administer dental enteral or dental parenteral conscious (moderate) sedation to patients 12 years old and younger does not meet the aforementioned requirements, the department may issue him or her the corresponding certificate for patients 13 years old and older, if the licensed dentist meets the renewal requirements for said certificate as set forth in paragraph (c)(3) of this section.
   4. Upon the request of the department, the licensed dentist shall submit to the department copies of time-oriented anesthesia records that satisfy the recordkeeping requirements contained in paragraph (d)(8) of this section, with or without the patient charts, to verify that the licensed dentist is in compliance with the above-referenced recordkeeping requirements and ensure that the licensed dentist is practicing within the scope of the dental anesthesia certificate held by him or her. (5) Upon renewal of a dental anesthesia certification, the department may request copies of patient charts or time-oriented anesthesia records.
3. Educational and training requirements.
   1. Initial certification.
      1. Certificate in dental general anesthesia. A licensed dentist shall meet the educational and training requirements in this subparagraph for the initial certificate in dental general anesthesia. The licensed dentist shall successfully complete:
         1. a course in advanced cardiac life support (ACLS), or its equivalent as determined by the department, and have current documentation of course completion attesting to this fact; and
         2. if the licensed dentist is administering general anesthesia to patients 12 years old and younger, a course in pediatric advanced life support (PALS), or its equivalent as determined by the department, and have current documentation of course completion attesting to this fact; and
         3. either:
            1. for post-doctoral education completed prior to January 1, 2002, at least one year of such education in anesthesia acceptable to the department, which shall include but not be limited to, coursework in anesthesia, anxiety and pain control, establishing and maintaining emergency airway, and use and interpretation of appropriate monitoring; or at least two years of such education in an approved specialty program or residency, which includes acceptable training and experience, including but not limited to, instruction in general anesthesia and parenteral sedation; provided that the candidate has applied to the department for the initial certificate to employ conscious (moderate) sedation (enteral or parenteral route with or without inhalation agents), deep sedation, and general anesthesia prior to January 1, 2004; or
            2. at least two years of post-doctoral education acceptable to the department and accredited by an acceptable accrediting body, which shall include but not be limited to coursework in anesthesia and anxiety and pain control; and one year devoted exclusively to clinical training in general anesthesia and related subjects such as establishing and maintaining an emergency airway and use and interpretation of appropriate monitoring prior to January 1, 2019; or
            3. at least three years of post-doctoral education acceptable to the department and accredited by an acceptable accrediting body, which shall include but not be limited to coursework in anesthesia and anxiety and pain control; and one year devoted exclusively to clinical training in general anesthesia and related subjects such as establishing and maintaining an emergency airway and use and interpretation of appropriate monitoring as of January 1, 2019; or
            4. a graduate level program in oral and maxillofacial surgery acceptable to the department and accredited by an acceptable accrediting body, which shall include but not be limited to instruction in general anesthesia, parenteral sedation, and anxiety and pain control.
      2. Certificate in dental parenteral conscious (moderate) sedation for patients 13 years old or older. A licensed dentist shall meet the educational and training requirements of this subparagraph for the initial certificate in dental parenteral conscious (moderate) sedation for patients 13 years old and older. The licensed dentist shall successfully complete:
         1. a course in advanced cardiac life support (ACLS), or its equivalent as determined by the department, and have current documentation of course completion attesting to this fact; and
         2. pre-doctoral or post-doctoral education acceptable to the department and accredited by an acceptable accrediting body, which shall include a formal course consisting of at least 60 clock hours of coursework that is provided through didactic instruction and/or an anesthesia rotation, which has been previously approved by the department. Simulation experiences may be part of the required coursework, which shall include but not be limited to, coursework in patient evaluation and monitoring, management of emergencies, rescue of patients from deep sedation, management of the pediatric and adult airways, pediatric and adult cardiac and pulmonary anatomy and physiology, pediatric and adult pharmacology, and the control of pain and anxiety; and in addition to the 60 clock hours of coursework, a clinical experience demonstrating the successful use of dental parenteral conscious (moderate) sedation on no fewer than 20 live dental patients via the intravenous route who shall be 13 years old or older in a 1 doctor/student to 1 patient ratio. Provided, however, that the Department, in its discretion, may accept a clinical experience demonstrating the successful use of dental parental conscious (moderate) sedation on no fewer than 15 live dental patients via the intravenous route who shall be 13 years old or older in a 1 doctor/student to 1 patient ratio and up to 5 Objective Structured Clinical Examinations (OSCE’s) in a 1 doctor/student to 1 OSCE ratio for a total of 20 patients to meet the live dental patient requirement of this clause if such requirement cannot be met due to the State of Emergency declared by the Governor pursuant to an Executive Order for the COVID-19 crisis. The student/licensed dentist enrolled in the course shall have his or her name listed on the anesthesia record and shall be the individual administering the medications and documenting said administration, as well as the physiologic findings required on the anesthesia record. The patients shall be monitored, at a minimum, pursuant to the practice requirements as set forth in subdivision (d) of this section. If the clinical portion of the course is given outside a teaching institution, a formal memorandum of understanding (MOU) between the teaching institution and the clinical teaching center (facility) shall be in place attesting that the clinical facility is held to the same practice standards as the teaching institution.
      3. Certificate in dental parenteral conscious (moderate) sedation for patients 12 years old and younger. A licensed dentist shall meet the educational and training requirements of this subparagraph for the initial certificate in dental parenteral conscious (moderate) sedation for patients 12 years old and younger. The licensed dentist shall successfully complete:
         1. a course in advanced cardiac life support (ACLS), or its equivalent as determined by the department, and have current documentation of course completion attesting to this fact;
         2. a course in pediatric advanced life support (PALS), or its equivalent as determined by the department, and have current documentation of course completion attesting to this fact; and
         3. pre-doctoral or post-doctoral education accredited by an acceptable accrediting body, which shall include a formal course consisting of at least 60 clock hours of coursework that is provided through didactic instruction and/or an anesthesia rotation, which has been previously approved by the department. Simulation experiences can be part of the coursework which shall include but not be limited to, coursework in patient evaluation and monitoring, management of emergencies, rescue of patients from deep sedation, management of the pediatric and adult airways, pediatric and adult cardiac and pulmonary anatomy and physiology, pediatric and adult pharmacology, and the control of pain and anxiety; and in addition to the 60 clock hours of coursework, a clinical experience, acceptable to and previously approved by the department, demonstrating the successful use of dental parenteral conscious (moderate) sedation by the intravenous route on no fewer than 15 live dental patients who shall be 12 years old or younger and five live dental patients who shall be 13 years old or older in a 1 doctor/student to 1 patient ratio. Provided, however, that the Department, in its discretion, may accept a clinical experience demonstrating the successful use of dental parental conscious (moderate) sedation by the intravenous route on no fewer than 12 live dental patients who shall be 12 years old or younger and three live dental patients who shall be 13 years old or older and up to five Objective Structured Clinical Examinations (OSCE’s), for a total of 20 patients, all in a 1 doctor/student to 1 patient ratio to meet the live dental patient requirement of this clause if such requirement cannot be met due to the State of Emergency declared by the Governor pursuant to an Executive Order for the COVID-19 crisis. The student/licensed dentist enrolled in the course shall have his or her name listed on the anesthesia record and shall be the individual administering the medications and documenting said administration, as well as the physiologic findings required on the anesthesia record. The patients shall be monitored, at a minimum, pursuant to the practice requirements as set forth in subdivision (d) of this section. If the clinical portion of the course is given outside a teaching institution, a formal memorandum of understanding (MOU) between the teaching institution and the clinical teaching center (facility) shall be in place attesting that the clinical facility is held to the same practice standards as the teaching institution.
      4. Certificate in dental enteral conscious (moderate) sedation for patients 13 years old and older. A licensed dentist shall meet the educational and training requirements of this subparagraph for the initial certificate in dental enteral conscious (moderate) sedation for patients 13 years old and older. The licensed dentist shall successfully complete:
         1. a course in advanced cardiac life support (ACLS), or its equivalent as determined by the department, and have current documentation of course completion attesting to this fact; and
         2. pre-doctoral education or post-doctoral education accredited by an acceptable accrediting body, and which shall include a formal course consisting of at least 60 clock hours of coursework that is provided through didactic instruction and/or an anesthesia rotation, which has been previously approved by the department. Simulation experiences may be part of the required coursework which shall include but not be limited to, coursework in patient evaluation and monitoring, management of emergencies including IV access, rescue of patients from deep sedation, management of the pediatric and adult airways, pediatric and adult cardiac and pulmonary anatomy and physiology, pediatric and adult pharmacology, and the control of pain and anxiety; and in addition to the 60 clock hours of coursework, a clinical experience, acceptable to and previously approved by the department, demonstrating the successful use of dental enteral conscious (moderate) sedation on no fewer than 10 live clinical dental patients who shall be 13 years old or older and who are physically present in the same location as the students. Provided, however, that the Department, in its discretion, may accept a clinical experience demonstrating the successful use of dental enteral conscious (moderate) sedation on no fewer than eight live clinical dental patients who shall be 13 years old or older and who are physically present in the same location as the students and up to two Objective Structured Clinical Examinations (OSCE’s) for a total of 10 patients to meet the live clinical dental patient requirement of this clause if such requirement cannot be met due to the State of Emergency declared by the Governor pursuant to an Executive Order for the COVID-19 crisis. The students may be in groups no larger than five. The patients shall be monitored, at a minimum, pursuant to the practice requirements as set forth in subdivision (d) of this section. If the clinical portion of the course is given outside a teaching institution, a formal memorandum of understanding (MOU) between the teaching institution and the clinical teaching center (facility) shall be in place attesting that the clinical facility is held to the same practice standards as the teaching institution.
      5. Certificate in dental enteral conscious (moderate) sedation for patients 12 years old and younger. A licensed dentist shall meet the educational and training requirements in this subparagraph for the initial certificate in dental enteral conscious (moderate) sedation for patients 12 years old and younger. The licensed dentist shall successfully complete:
         1. a course in advanced cardiac life support (ACLS), or its equivalent as determined by the department, and have current documentation of course completion attesting to this fact;
         2. a course in pediatric advanced life support (PALS), or its equivalent as determined by the department and have current documentation of course completion attesting to the fact; and
         3. pre-doctoral or post-doctoral education acceptable to the department and accredited by an acceptable accrediting body, which shall include a formal course consisting of at least 60 clock hours of coursework that is provided through didactic instruction and/or an anesthesia rotation, which has been previously approved by the department. Simulation experiences can be part of the coursework which shall include but not be limited to coursework in patient evaluation and monitoring, management of emergencies, including IV access, rescue of patients from deep sedation, management of the pediatric and adult airways, pediatric and adult cardiac and pulmonary anatomy and physiology, pediatric and adult pharmacology, and the control of pain and anxiety; and in addition to the 60 clock hours of coursework, a clinical experience demonstrating the successful use of dental enteral conscious (moderate) sedation on no fewer than 15 live clinical dental patients 12 years old or younger and 5 live clinical dental patients 13 years old or older in a 2:1 doctor/student to patient ratio. Provided, however, that the Department, in its discretion, may accept a clinical experience demonstrating the successful use of dental enteral conscious (moderate) sedation on no fewer than 12 live clinical dental patients 12 years old or younger and three live clinical dental patients 13 years old or older in a 2:1 doctor/student to patient ratio for both age groups, as well as up to five Objective Structured Clinical Examinations (OSCE’s) in a 1 doctor/student to 1 OSCE ratio for a total of 20 patients to meet the live clinical dental patient requirement of this clause if such requirement cannot be met due to the State of Emergency declared by the Governor pursuant to an Executive Order for the COVID-19 crisis. For the purpose of this section, a 2:1 doctor/student to patient ratio means the doctor/student providing dental care to the patient and a second doctor/student monitoring and documenting the sedation care can receive credit for the procedure as it relates to the minimum number of sedations required for certification. Both of these doctors/students shall be with the patient during the entire time of treatment and cannot be involved with any other activities or responsibilities. Only the two doctors/students involved in direct patient care/monitoring can receive credit for treating the patient undergoing the procedure and sedation. The student/licensed dentist enrolled in the course shall have his or her name listed on the anesthesia record and shall be the individual administering the medications and documenting said administration, as well as the physiologic findings required on the anesthesia record. The patients shall be monitored, at a minimum, pursuant to the practice requirements set forth in subdivision (d) of this section. If the clinical portion of the course is given outside a teaching institution, a formal memorandum of understanding (MOU) between the teaching institution and the clinical teaching center (facility) shall be in place attesting that the clinical facility is held to the same practice standards as the teaching institution.
   2. Certification through endorsement. For endorsement of a dental anesthesia certificate from another jurisdiction of the United States or Canada, the applicant shall submit to the department a certificate of good standing from said jurisdiction and currently be registered to practice dentistry in the State of New York, and shall submit satisfactory evidence of having met the following requirements for the requested certificate:
      1. General anesthesia: Certificate of completion of a Commission on Dental Accreditation (CODA) accredited oral and maxillofacial surgery program or a CODA accredited dental anesthesia program.
      2. Dental parenteral conscious (moderate) sedation for patients 13 years old and older:
         1. if the applicant has ever had any patients with irreversible morbidity or mortality due to the sedation provided by him or her, the applicant must provide an explanation of the incident(s) to the department for review, in a form prescribed by the department. Depending on the circumstances, the department may require remediation before a dental parenteral conscious (moderate) sedation for patients 13 years old and older certificate will be issued;
         2. provide 20 anesthesia records of patients that the applicant has administered parenteral conscious (moderate) sedation (by the intravenous route) in the licensed jurisdiction, within the three years immediately preceding the applicant’s submission of his or her application to the department for review with no patients having had irreversible morbidity or mortality due to the sedation provided by the applicant. These records shall include monitoring that is required by clause (d)(4)(ii)(b) of this section for the administration of parenteral conscious (moderate) sedation; and
         3. provide current documentation of completion of a course in advanced cardiac life support (ACLS) from a department approved course sponsor, or its equivalent as determined by the department.
      3. Dental parenteral conscious (moderate) sedation for patients 12 years old and younger:
         1. if the applicant has ever had any patients with irreversible morbidity or mortality due to the sedation provided by him or her, the applicant must provide an explanation of the incident(s) to the department for review, in a form prescribed by the department. Depending on the circumstances, the department may require remediation before a dental parenteral conscious (moderate) sedation for patients 12 years old and younger certificate will be issued;
         2. have a certificate to provide parenteral conscious (moderate) sedation for, at least, the three years immediately preceding the applicant’s submission of his or her application to the department for review;
         3. provide 15 anesthesia records of patients 12 years old and younger and five anesthesia records of patients 13 years old and older, that the applicant has administered parenteral conscious (moderate) sedation (via the intravenous route) in the licensed jurisdiction, within the three years immediately preceding the applicant’s submission of his or her application to the department for review with no patients having had irreversible morbidity or mortality due to the sedation provided by the applicant. These records shall include monitoring that is required by clause (d)(4)(ii)(b) of this section for the administration of parenteral conscious (moderate) sedation;
         4. provide current documentation of completion of a course in advanced cardiac life support (ACLS) from a department approved sponsor, or its equivalent as determined by the department; and
         5. provide current documentation of completion of a course in pediatric advanced life support (PALS) from a department approved sponsor, or its equivalent as determined by the department.
      4. Dental enteral conscious (moderate) sedation for patients 13 years old and older:
         1. if the applicant has ever had any patients with irreversible morbidity or mortality due to the sedation provided by him or her, the applicant must provide an explanation of the incident(s) to the department for review, in a form prescribed by the department. Depending on the circumstances, the department may require remediation before a dental enteral conscious (moderate) sedation for patients 13 years old and older certificate will be issued;
         2. provide 20 anesthesia records of patients that the applicant has administered enteral conscious (moderate) sedation in the licensed jurisdiction, within the three years immediately preceding the applicant’s submission of his or her application to the department for review, in a form prescribed by the department. These records shall include monitoring that is required by clause (d)(4)(ii)(b) of this section for the administration of enteral conscious (moderate) sedation; and
         3. provide current documentation of completion of a course in advanced cardiac life support (ACLS) from a department approved course sponsor, or its equivalent as determined by the department.
      5. Dental enteral conscious (moderate) sedation for patients 12 years old and younger:
         1. if the applicant has ever had any patients with irreversible morbidity or mortality due to the sedation provided by him or her, the applicant must provide an explanation of the incident(s) to the department for review, in a form prescribed by the department. Depending on the circumstances, the department may require remediation before a dental enteral conscious (moderate) sedation certificate for patients 12 years old and younger will be issued;
         1. have a certificate to provide enteral conscious (moderate) sedation for at least the three years immediately preceding the applicant’s submission of his or her application to the department for review;
         3. provide 15 anesthesia records of patients 12 years old and younger and 5 anesthesia records of patients 13 years old and older, that the applicant has administered enteral conscious (moderate) sedation in the licensed jurisdiction, within the three years immediately preceding the applicant’s submission of his or her application to the department for review. These records shall include monitoring that is required by clause (d)(4)(ii)(b) of this section for the administration of enteral conscious (moderate) sedation;
         4. provide current documentation of completion of a course in advanced cardiac life support (ACLS) from a department approved sponsor, or its equivalent as determined by the department; and
         5. provide current documentation of completion of a course in pediatric advanced life support (PALS) from a department approved sponsor, or its equivalent as determined by the department.
   3. Renewal of certification. A licensed dentist shall meet the educational and training requirements of this paragraph for the renewal of certification.
      1. For the renewal of certificates in dental general anesthesia, a licensed dentist shall successfully complete:
         1. a course in advanced cardiac life support (ACLS), or its equivalent as determined by the department, and have current documentation attesting to this fact;
         2. a course in pediatric advanced life support (PALS), or its equivalent as determined by the department and have current documentation of course completion attesting to the fact if the dentist with the general anesthesia certificate is providing conscious (moderate) sedation, deep sedation or general anesthesia to patients 12 years old or younger; and
         3. an additional 12 clock hours of education (exclusive of the ACLS and PALS requirements contained in clauses [a] and [b], respectively, of this subparagraph) in anesthesia/sedation techniques approved by an acceptable accrediting body and the department, including but not limited to, coursework in medications and recognition and management of complications and emergencies including rescue from deeper levels of sedation as may occur in both the pediatric and adult patient populations.
      2. For the renewal of certificates in dental, parenteral conscious (moderate) sedation for patients 12 years old and younger, and dental enteral conscious (moderate) sedation for patients 12 years old and younger, the licensed dentist shall successfully complete:
         1. a course in advanced cardiac life support (ACLS), or its equivalent as determined by the department, and have current documentation attesting to this fact; and
         2. a course in pediatric advanced life support (PALS), or its equivalent as determined by the department and have current documentation of course completion attesting to this fact; and
         3. an additional 12 clock hours of education (exclusive of the ACLS and PALS requirements contained in clauses [a] and [b], respectively, of this subparagraph) in anesthesia/sedation techniques, approved by an acceptable accrediting body and the department, including but not limited to, coursework in medications and recognition and management of complications and emergencies including rescue from deeper levels of sedation as may occur in both the pediatric and adult patient populations.
      3. For the renewal of certificates in dental parenteral and enteral conscious (moderate) sedation for patients 13 years old and older the licensed dentist shall successfully complete:
         1. a course in advanced cardiac life support (ACLS), or its equivalent as determined by the department, and have current documentation attesting to this fact; and
         2. an additional 12 clock hours of education (exclusive of the ACLS requirement contained in clause [a] of this subparagraph) in anesthesia/sedation techniques, approved by an acceptable accrediting body and acceptable to and previously approved by the department, including but not limited to, coursework in medications and recognition and management of complications and emergencies, including rescue from deeper levels of sedation as may occur in both the pediatric and adult patient populations.
      4. The coursework required to be completed for the renewal of certification may be creditable toward meeting the dentist's continuing education requirement, provided that it meets all requirements of section 61.15 of this Part.
4. Practice requirements. All licensed dentists who administer conscious (moderate) sedation or deep sedation or general anesthesia shall meet the practice requirements of this subdivision.
   1. A licensed dentist who employs conscious (moderate) sedation using an enteral or parenteral route with or without inhalation agents or deep sedation or general anesthesia shall have current documentation of course completion in advanced cardiac life support (ACLS), or its equivalent as determined by the department. A licensed dentist who employs conscious (moderate) sedation using an enteral or parenteral route with or without inhalation agents or deep sedation or general anesthesia to patients 12 years old or younger shall have current documentation in pediatric advanced life support (PALS), or its equivalent as determined by the department.
   2. A licensed dentist shall not administer conscious (moderate) sedation (enteral or parenteral route with or without inhalation agents) or deep sedation or general anesthesia to more than one patient at a time except when supervising no more than two dental students or residents at one time in a teaching institution. A licensed dentist, a licensed physician, a registered professional nurse, or a licensed practical nurse shall personally monitor recovery from conscious (moderate) sedation or deep sedation or general anesthesia.
   3. A licensed dentist who uses conscious (moderate) sedation (enteral or parenteral route with or without inhalation agents) or deep sedation or general anesthesia for a patient shall be responsible for all aspects of the procedure including pre-operative preparation and evaluation, life support procedures, monitoring, recovery, discharge, and recordkeeping.
   4. At a minimum, the following practice requirements shall be followed:
      1. Deep sedation or general anesthesia:
         1. Pre-operative preparation:
            1. a written and oral medical history shall be obtained;
            2. consultation with the patient’s physician, as appropriate, for patients ASA III (a patient with severe systemic disease, according to the American Society of Anesthesiologists [ASA] patient physical status classification system) or greater;
            3. preoperative instructions shall be given to the patient, parent, escort, guardian or caregiver;
            4. preoperative dietary restrictions shall be considered based on the anesthetic/ sedative technique planned;
            5. the patient, parent, guardian or care giver shall be advised regarding the procedure associated with the delivery of any sedative or anesthetic agents and informed consent for the proposed anesthesia/sedation shall be obtained;
            6. a focused physical evaluation shall be performed as deemed appropriate;
            7. baseline vital signs shall be obtained unless the patient’s behavior prohibits such determination and in any such case, this fact shall be noted in the time-oriented anesthesia record;
            8. determination of adequate oxygen supply and equipment necessary to deliver oxygen under positive pressure shall be completed; and
            9. an intravenous line, which is secured throughout the procedure, shall be established. If, due to lack of patient cooperation, the intravenous line cannot be maintained throughout the procedure, the inability to maintain such shall be documented in the anesthesia record.
         2. Monitoring:
            1. oxygenation:
               1. color of mucosa, skin or blood shall be continually evaluated; and
               2. oxygen saturation shall be evaluated continuously by pulse oximetry.
            2. Ventilation:
               1. intubated patient: end-tidal CO2 shall be continuously monitored and evaluated;
               2. non-intubated patient: breath sounds via auscultation and/or end-tidal CO2 shall be continuously monitored and evaluated;
               3. respiration rate shall be continually monitored and evaluated; and
               4. when agents implicated in precipitating malignant hyperthermia are utilized, end-tidal CO2 shall be continuously monitored and evaluated.
            3. Circulation:
               1. the dentist shall continuously evaluate heart rate and rhythm via ECG throughout the procedure, as well as pulse rate via pulse oximetry; and
               2. the dentist shall continually evaluate blood pressure.
            4. Temperature:
               1. a device capable of measuring body temperature shall be readily available during the administration of deep sedation or general anesthesia; and
               2. when agents implicated in precipitating malignant hyperthermia are utilized, continuous monitoring of body temperature shall be performed.
      2. Conscious (moderate) sedation:
         1. Pre-operative preparation:
            1. a written and oral medical history shall be obtained;
            2. consultation with the patient’s physician, as appropriate, for patients ASA III (a patient with severe systemic disease, according to the American Society of Anesthesiologists [ASA] patient physical status classification system) or greater;
            3. preoperative instructions shall be given to the patient, parent, escort, guardian or caregiver;
            4. preoperative dietary restrictions shall be considered based on the anesthetic/sedative technique planned;
            5. the patient, parent, guardian or care giver shall be advised regarding the procedure associated with the delivery of any sedative or anesthetic agents and informed consent for the proposed anesthesia/sedation shall be obtained;
            6. a focused physical evaluation shall be performed as deemed appropriate;
            7. baseline vital signs shall be obtained unless the patient’s behavior prohibits such determination and in any such case, this fact shall be noted in the time-oriented anesthesia record;
            8. determination of adequate oxygen supply and equipment necessary to deliver oxygen under positive pressure shall be completed; and
            9. an intravenous line, which is secured throughout the procedure, shall be established when parenteral sedation is being administered by way of an intravenous route if, due to lack of patient cooperation, the intravenous line cannot be maintained throughout the procedure, the inability to maintain such shall be documented on the anesthesia record.
         2. Monitoring:
            1. Consciousness:
               1. Level of consciousness (e.g., responsiveness to verbal command) shall be continually assessed.
            2. Oxygenation:
               1. color of mucosa, skin or blood shall be continually evaluated; and
               2. oxygen saturation shall be evaluated continuously by pulse oximetry.
            3. Ventilation:
               1. the dentist shall observe chest excursions continually; and
               2. the dentist shall monitor ventilation by auscultation of breath sounds, monitoring end-tidal CO2 or by verbal communication with the patient.
            4. Circulation:
               1. the dentist shall continually evaluate blood pressure and heart rate (unless the patient is unable to tolerate the monitoring and this is noted in the time-oriented anesthesia record);
               2. during the administration of dental conscious (moderate) enteral sedation, continuous evaluation of ECG shall be done when there is a finding of cardiovascular disease that warrants such monitoring; and
               3. during the administration of dental conscious (moderate) parenteral sedation, the dentist shall continuously evaluate heart rate and rhythm via ECG throughout the procedure, as well as pulse rate via pulse oximetry.
   5. The recovery and discharge of the patient is the responsibility of any of the following: the licensed dentist providing the anesthesia/sedation management for that patient, another licensed dentist with a anesthesia/sedation certificate permitting him or her to provide the same level of anesthesia/sedation administered to the patient treated or a licensed physician with the appropriate anesthesia training. Prior to discharge, the patient shall meet the following discharge criteria, which shall be documented in the patient’s chart:
      1. alert and responsive;
      2. patient can maintain and support his or her airway without intervention;
      3. vital signs, including oxygenation on room air, are within acceptable limits;
      4. patient is ambulatory with assistance;
      5. responsible adult escort is present to escort the patient from the office;
      6. written and verbal instructions are given to patient and responsible adult escort. These instructions shall include a way for the patient/guardian to communicate with the anesthesia provider or provider of dental care in case of an emergency or adverse reaction; and
      7. prior to discharge, evaluation of the patient’s pain and post-operative nausea and vomiting (PONV) shall be done. The results of these assessments and management shall be documented in the patient’s chart.
   6. Every facility at which conscious (moderate) sedation (enteral or parenteral route with or without inhalation agents) or deep sedation or general anesthesia is employed in the practice of dentistry shall be equipped and staffed in a manner appropriate for the administration and monitoring of anesthetic drugs or agents and for the treatment of emergencies which may arise. Each facility shall be constructed to permit ready access by emergency equipment. A protocol for handling emergencies, including transport to an emergency facility, shall be posted in each treatment and recovery area. All dental facilities shall have an automatic external defibrillator (AED) or other defibrillator at the facility.
   7. Personnel requirements.
      1. During the administration of deep sedation or general anesthesia, a minimum of three individuals shall be present in the operatory. Such individuals shall include a licensed dentist or licensed physician qualified to administer the deep sedation or general anesthesia, who shall be in charge of the administration of the anesthesia care; and two additional individuals, who have current documentation that they have successfully completed a course in basic life support (BLS), or its equivalent as determined by the department.
      2. During the administration of conscious (moderate) sedation using the enteral or parenteral route with or without inhalation agents, a minimum of two individuals shall be present in the operatory. Such individuals shall include a licensed dentist or licensed physician qualified to administer the conscious (moderate) sedation, who shall be in charge of the administration of the anesthesia care; and one additional individual, who has current documentation that he or she has successfully completed a course in basic life support (BLS) or its equivalent as determined by the department.
   8. Recordkeeping. Licensed dentists who hold certification pursuant to this section shall maintain the records prescribed in this paragraph, which shall be available for review by the department, upon request.
      1. The licensed dentist shall maintain records on the administration of conscious (moderate) sedation (enteral or parenteral route with or without inhalation agents), deep sedation, or general anesthesia, in accordance with the requirements of section 29.2(a)(3) of this Title, which shall include but not be limited to:
         1. a medical history of the patient and appropriate informed consent for administration of conscious (moderate) sedation (enteral or parenteral route with or without inhalation agents), deep sedation, or general anesthesia, prior to the performance of any procedure;
         2. written or documented verbal consultations with licensed physicians that are obtained prior to, during, or 24 hours following the administration of conscious (moderate) sedation, deep sedation or general anesthesia;
         3. time-oriented anesthesia records, based on the level of anesthesia administered, that indicate:
            1. date of treatment;
            2. demographic information:
               1. patient’s name;
               2. age, height, and weight;
               3. nothing by mouth (NPO) status;
               4. medical conditions;
               5. allergies;
               6. medications;
               7. diagnosis; and
               8. treatment proposed/performed.
            3. pre-treatment evaluation/examination:
               1. results of a focused examination and airway evaluation; and
               2. ASA (American Society of Anesthesiologists [ASA] patient physical status classification system) status.
            4. clinical care:
               1. all enteral, parenteral and inhalation agents administered;
               2. dosage of these drugs according to the time administered preoperatively, intraoperatively and during the in-office recovery phase;
               3. type and placement of intravenous access;
               4. type and total amount of intravenous fluids administered;
               5. type of advanced airway management used;
               6. all types of monitoring used;
               7. the physiologic findings of pre-operative (base-line findings), intra-operative, and pre-discharge monitoring including but not limited to:
                  1. blood pressure;
                  2. heart rate;
                  3. respiratory rate;
                  4. end tidal CO2 (ETCO2);
                  5. temperature and ECG rhythm if monitored;
                  6. oxygen saturation, except that records of oxygen saturation and blood pressure shall not be required when conscious (moderate) sedation using an enteral route, with or without inhalation agents, is employed and the patient's conduct prohibits the monitoring of oxygen saturation and blood pressure, in which case the record shall document this fact; and
                  7. if a physiologic parameter cannot be monitored, the reason should be reflected on the anesthesia record;
               8. the time of placement and removal of a throat pack or throat drape when used;
               9. persons present in the treatment room who are providing care or assisting during the procedure;
               10. name of the individual holding an anesthesia certificate responsible for recovery and discharge; and
               11. any irreversible morbidity that occurs during the treatment and in-office recovery period.
      2. The licensed dentist shall maintain current documentation of successful course completion in pediatric advanced life support (PALS) or advanced cardiac life support (ACLS), or their equivalent, as required for the anesthesia certificate held, and current documentation of course completion in basic life support (BLS), or its equivalent, required to be held by individuals present in the operatory during the administration of anesthesia pursuant to the requirements of paragraph (7) of this subdivision, for six years from the date of completion of the coursework. In addition, a licensed dentist who completes 12 clock hours of education in anesthesia/sedation techniques for the renewal of a certification to administer conscious (moderate) enteral sedation, conscious (moderate) parenteral sedation, deep sedation or general anesthesia shall be required to maintain records documenting completion of such course work for six years from the completion of the coursework. The records shall include the number of clock hours completed, the sponsor's name and any identifying number, and the date and location of the program. If any of the coursework is being used by the licensed dentist to meet his or her continuing education requirement, as prescribed in section 61.15 of this Part, such records shall be maintained in accordance with the requirements of section 61.15(f) of this Part.
   9. The dentist administering conscious (moderate) sedation, deep sedation or general anesthesia is responsible for anesthetic/sedative management, adequacy of the facility and staff, diagnosis and treatment of emergencies related to the administration of conscious (moderate) sedation, deep sedation or general anesthesia and provision of the equipment, drugs and protocols for patient rescue.
   10. Mortality or irreversible morbidity occurring during or within 48 hours following, or otherwise related to, the administration of conscious (moderate) sedation or deep sedation or general anesthesia administered pursuant to this section shall be reported, in writing, by the certificate holder to the department within 30 days of the occurrence. This report shall include, but not be limited to the following: the name and license number of the dentist with the anesthesia certificate, as well as that of the operating dentist, if he or she was not providing the anesthesia; the names and titles of office staff present on the date of the incident; name and date of birth of the patient; if the patient is a minor, the name of the parent or guardian must also be included; date of the incident; type of anesthesia administered; and the facts and circumstances surrounding the incident.

1. As used in this section, acceptable accrediting agency shall mean an organization accepted by the department as a reliable authority for the purpose of accreditation at the postsecondary level, applying its criteria for granting accreditation in a fair, consistent and nondiscriminatory manner, such as an agency recognized for these purposes by the United States Department of Education.
2. To meet the professional education requirement for licensure as a registered dental assistant in this State, the applicant shall present satisfactory evidence of:
   1. graduation from high school, or its equivalent; and
   2. completion of a program in registered dental assisting that is either registered by the department pursuant to Part 52 of this Title, or accredited by an acceptable accrediting agency, or determined by the department to be the equivalent of such a registered or accredited program.

1. Each candidate for licensure as a registered dental assistant shall pass an examination that the department has determined measures the applicant's knowledge of curricular areas attained in a program prescribed in section 52.26 of this Title and other matters of law, ethics, or practice deemed appropriate by the department.
2. Passing standard. The passing standard for each examination shall be determined by the State Board for Dentistry.

1. The practice of registered dental assisting shall be that practice defined in section 6808 of the Education Law. In accordance with section 6608 of the Education Law, the practice of registered dental assisting must be supportive services to a licensed dentist in the dentist's performance of dental services and must be performed under the direct personal supervision of a licensed dentist. For purposes of this section, under the direct personal supervision of a licensed dentist shall mean supervision of dental procedures based on instructions given by a licensed dentist in the course of a procedure who remains in the dental office where the supportive services are being performed, personally diagnoses the condition to be treated, personally authorizes the procedures, and before dismissal of the patient, who remains the responsibility of the licensed dentist, evaluates the services performed by the registered dental assistant. Such practice shall include the dental supportive service prescribed in subdivision (b) of this section and shall exclude the dental supportive services prescribed in subdivision (c) of this section.
2. The practice of registered dental assisting shall include the following supportive services to a licensed dentist while under the direct personal supervision of the licensed dentist:
   1. providing patient education;
   2. taking preliminary medical histories and vital signs to be reviewed by the dentist;
   3. placing and removing rubber dams;
   4. selecting and prefitting provisional crowns;
   5. selecting and prefitting orthodontic bands;
   6. removing orthodondic arch wires and ligature ties;
   7. placing and removing matrix bands;
   8. taking impressions for study casts or diagnostic casts;
   9. removing periodontal dressings;
   10. removal of sutures placed by a licensed dentist;
   11. taking impressions for space maintainers, orthodontic appliances, and occlusal guards;
   12. removing temporary cement;
   13. applying topical anticariogenic agents to the teeth;
   14. applying desensitizing agents to the teeth;
   15. placing and removing temporary separating devices;
   16. placing orthodontic ligatures;
   17. placing and removing temporary restorations;
   18. taking x-rays in accordance with the requirements of section 3515(4)(c) of the Public Health Law; and
   19. other dental supportive services authorized by the licensed dentist while the registered dental assistant is under the direct personal supervision of the licensed dentist, provided that such other dental supportive services are not excluded in subdivision (c) of this section.
3. Excluded dental supportive services. The practice of registered dental assisting shall not include the following dental supportive services:
   1. diagnosing;
   2. performing surgical procedures;
   3. performing irreversible procedures;
   4. performing procedures that would alter the hard or soft tissue of the oral and maxillofacial area;
   5. dental supportive services prescribed in section 61.9 of this Part which are services that a dental hygienist may perform, unless such services are expressly permitted as dental supportive services in paragraphs (b)(1) through (17) of this section; and
   6. such dental supportive services that a registered dental assistant would not reasonably be qualified to perform based upon meeting the requirements for certification as a registered dental assistant in section 6608-b of the Education Law, and/or obtaining additional legally authorized experience in the practice of registered dental assisting.
4. In accordance with section 29.1(b)(9) and (10) of this Title, a registered dental assistant is not permitted to provide dental supportive services that the registered dental assistant knows or has reason to know that he or she is not competent to perform, and a licensed dentist is not permitted to delegate to a registered dental assistant dental supportive services the licensed dentist knows or has reason to know that the registered dental assistant is not qualified by training, experience or by licensure to perform.

1. As used in this section, direct personal supervision shall mean supervision by a licensed dentist of dental procedures based on instructions given by a licensed dentist in the course of a procedure who remains in the dental office where the supportive services are being performed, personally diagnoses the condition to be treated, personally authorizes the procedures, and before dismissal of the patient, evaluates the services performed by the limited permittee.
2. In accordance with section 6608-d of the Education Law, permits limited as to eligibility, practice, and duration shall be issued by the department to eligible applicants as follows:
   1. A person who meets all requirements for admission to the licensure examination for registered dental assisting shall be eligible for a limited permit as a registered dental assistant.
   2. A registered dental assistant permittee shall be authorized to practice only under the direct personal supervision of a licensed dentist.
   3. An application for a limited permit in registered dental assisting shall be submitted on a form provided by the department and shall be accompanied by the statutory fee.
   4. Limited permits in registered dental assisting shall expire one year from the date granted, except that such permits may be renewed for one additional one-year period.

1. As used in this section, acceptable accrediting agency shall mean an organization accepted by the department as a reliable authority for the purpose of accreditation at the postsecondary level, applying its criteria for granting accreditation in a fair, consistent and nondiscriminatory manner, such as an agency recognized for this purpose by the United States Department of Education.
2. Applicability of requirement.
   1. Each licensed dentist, required under article 130 of the Education Law to register with the department to practice in New York State, shall comply with the mandatory continuing education requirements as prescribed in subdivision (c) of this section, except those licensees exempt from the requirement or who obtain an adjustment to the requirement pursuant to paragraph (2) of this subdivision.
   2. Exemptions and adjustments to the requirement.
      1. Exemptions. The following licensees shall be exempt from the continuing education requirements, as prescribed in subdivision (c) of this section:
         1. licensees for the triennial registration period during which they are first licensed to practice dentistry in New York State, exclusive of those first licensed to practice dentistry in New York State pursuant to an endorsement of a license of another jurisdiction; and
         2. licensees who are not engaged in the practice of dentistry, as evidenced by not being registered to practice in New York State, except as otherwise provided in paragraph (c)(2) of this section to meet the education requirements for the resumption of practice after a lapse in practice for a licensee who has not lawfully practiced continuously in another jurisdiction throughout such lapse period.
      2. Adjustments to the requirement. An adjustment to the continuing education requirement, as prescribed in subdivision (c) of this section, shall be made by the department, provided that the licensee documents good cause that prevents compliance, which shall include, but not be limited to, any of the following reasons: poor health certified by a physician; or a specific physical or mental disability certified by an appropriate health care professional; or extended active duty with the Armed Forces of the United States; or extreme hardship which in the judgment of the department make it impossible for the licensee to comply with the continuing education requirements in a timely manner.
3. Mandatory continuing education requirement.
   1. Basic requirements.
      1. During each triennial registration period, meaning a registration period of three years' duration, which ends prior to July 1, 2008, an applicant for registration shall complete at least 45 hours of formal continuing education acceptable to the department, as defined in paragraph (4) of this subdivision, provided that no more than 15 hours of such continuing education shall consist of self-study courses.
      2. Any licensed dentist whose registration period begins prior to July 1, 2008 and continues after July 1, 2008, shall complete continuing education hours on a prorated basis at the rate of one and one-quarter hours of acceptable formal continuing education per month for each month from the beginning of that registration period through June 30, 2008 and at the rate of one and two-thirds hours of acceptable formal continuing education per month for each month of that registration period from July 1, 2008 through the end of that registration period.
      3. During each triennial registration period, meaning a registration period of three years' duration, beginning on or after July 1, 2008, an applicant for registration shall complete at least 60 hours of formal continuing education acceptable to the department, as defined in paragraph (4) of this subdivision, provided that no more than 18 hours of such continuing education shall consist of self-study courses.
      4. Beginning with the first registration period for a licensed dentist that occurs on or after January 1, 2002 in which completion of acceptable formal continuing education is required, and before the occurrence of the succeeding registration renewal period following that date, a licensed dentist shall be required to have completed on a one-time basis, as part of the formal continuing education required in this paragraph, no fewer than two hours of formal continuing education acceptable to the department, as defined in paragraph (4) of this subdivision, regarding the chemical and related effects and usage of tobacco and tobacco products and the recognition, diagnosis, and treatment of the oral health effects, including but not limited to cancers and other diseases, caused by tobacco and tobacco products. A licensee returning to the practice of dentistry after a lapse in practice, as prescribed in paragraph (2) of this subdivision, shall be subject to the requirements of this subparagraph and shall complete such formal continuing education in the registration period prescribed in this subparagraph. A licensed dentist shall be deemed to have met the requirements of this subparagraph if the licensee provides to the department satisfactory documentation that the licensee has completed on or after January 1, 1997 and prior to the registration period prescribed in this subparagraph in which such formal continuing education is required to be completed, formal continuing education acceptable to the department, as defined in paragraph (4) of this subdivision, of not less than two hours in the same or substantially similar subject matter as that prescribed in this subparagraph.
      5. No later than the end of the first registration period for a licensed dentist beginning on or after January 1, 2008 in which completion of acceptable formal continuing education is required, a licensed dentist shall be required to have completed on a one-time basis, as part of the mandatory hours of acceptable continuing education required in this paragraph, no fewer than three hours in a course approved by the department in dental jurisprudence and ethics, which shall include the laws, rules, regulations and ethical principles relating to the practice of dentistry in New York State.
         1. As used in this section, jurisprudence shall mean the application of the principles of law and justice as they relate to the practice of dentistry. A dental mandatory continuing education course in jurisprudence shall be based upon the laws of New York State.
         2. As used in this section, ethics shall mean the principles of conduct relating to dental practice. A dental mandatory continuing education course in ethics shall be based upon ethical principles, such as those of the New York State Dental Association as established pursuant to section 5 of chapter 987 of the Laws of 1971, or of another dental association approved by the department, or the substantial equivalent thereof, as determined by the department.
         3. Standards for approval of coursework or training. Coursework or training shall include, but need not be limited to, the core elements specified in a syllabus prepared and provided by either a non-profit dental education entity, which has been incorporated or chartered by the New York State Board of Regents for the purpose of providing dental education, or by the New York State Dental Association, which syllabus has been approved by the department. Such non-profit entity shall have knowledge and expertise in New York State Dental Association ethics or the substantial equivalent, as determined by the department.
         4. A postgraduate dental student enrolled in a New York State dental residency program in accordance with section 61.18 of this Part may satisfy the requirements of this subparagraph by taking an approved dental jurisprudence and ethics course during the period of his or her dental residency prior to initial licensure.
   2. Requirement for lapse in practice. A licensee returning to the practice of dentistry after a lapse in practice, as evidenced by not being registered to practice in New York State shall submit an application for renewal of registration on a form prescribed by the commissioner and evidence of acceptable continuing education as defined in paragraph (4) of this subdivision and in accordance with subparagraph (i) or (ii) of this paragraph as applicable:
      1. such licensee who has been lawfully practicing in another jurisdiction and submits such application, shall submit satisfactory evidence of three years of acceptable continuing education completed within the three years immediately preceding the submission of such application. Such continuing education shall be completed at a rate of one and one-quarter hours for each month of such three year period prior to July 1, 2008 and one and two-thirds hours for each month on or after July 1, 2008; or
      2. such licensee who has not been practicing in another jurisdiction and submits such application, shall submit satisfactory evidence of three years of acceptable continuing education completed within the 12 months immediately preceding the submission of such application. Such continuing education shall be completed at a rate of one and one-quarter hours for each month of such three year period prior to July 1, 2008 and one and two-thirds hours for each month on or after July 1, 2008.
   3. Proration. If a registration period is less than three years in duration, a licensed dentist shall complete acceptable formal continuing education at the rate of one and one-quarter hours of continuing education per month for any part of such registration period on or before June 30, 2008 and at the rate of one and two-thirds hours of continuing education per month for any part of such registration period from July 1, 2008 through the end of such registration period.
   4. To be acceptable to the department, formal continuing education shall be formal courses of learning which contribute to professional practice in dentistry:
      1. in any one or more of the following curricular areas: basic and clinical dental sciences; or behavioral science; or pharmacology of new and developing drugs; or drug interactions; or public health issues; or infection control; or sterile procedures; or legal and regulatory issues; or patient counseling; or other topics which contribute to the professional practice in dentistry as such practice is defined in section 6601 of the Education Law; or other matters of health care, law, and ethics which contribute to the health and welfare of the public; and
      2. obtained from a sponsor approved by the department pursuant to subdivision (h) of this section, provided that for courses taken on or after January 1, 2000, a sponsor that is deemed approved pursuant to paragraph (h)(2) of this section shall have at least one full-time employee of any kind, meaning an employee who works at least 30 hours per week, which fact shall be verified by the licensee prior to taking the course and attested to in his or her records as prescribed in subdivision (f) of this section.
4. Renewal of registration. At each reregistration, licensed dentists shall certify to the department that they have either complied with the continuing education requirements, as prescribed in subdivision (c) of this section; or are subject to an exemption or adjustment to such continuing education requirements, as prescribed in subdivision (b) of this section.
5. Conditional registration.
   1. The department shall issue a conditional registration to a licensee who attests to or admits to noncompliance with the continuing education requirements of this section, provided that such licensee meets the following requirements:
      1. the licensee agrees to remedy such deficiency within the conditional registration period;
      2. the licensee agrees to complete the continuing education requirement for any months of the conditional registration period prior to July 1, 2008 at the rate of one and one-quarter hours of acceptable formal continuing education per month and at the rate of one and two-thirds hours per month for the period beginning July 1, 2008 through the end of such conditional registration period; and
      3. the licensee agrees to complete additional continuing education during such conditional registration period, which the department may require to ensure the licensee's proper delivery of dental care consistent with the licensee's practice of dentistry.
   2. The duration of such conditional registration shall not exceed one year and shall not be renewed or extended.
6. Licensee records. Each licensee subject to this section shall maintain, or ensure access by the department to, a record of completed continuing education, which includes: the title of the program; the number of hours completed; the sponsor's name and any identifying number; attendance verification; the date and location of the program; and a statement attesting to the fact that for courses taken on or after January 1, 2000 from a sponsor that is deemed approved pursuant to paragraph (h)(2) of this section, the licensee, prior to taking the course, has verified that the sponsor has at least one full-time employee of any kind, meaning an employee who works at least 30 hours per week, and indicating the reasonable basis for this determination. Such records shall be retained for at least six years from the date of completion of the program and shall be available for review by the department in the administration of the requirements of this section.
7. Measurement of continuing education study. Continuing education credit shall be granted only for formal programs of learning that meet the requirements set forth in subdivision (c) of this section. A minimum of 50 minutes of study shall equal one hour of continuing education credit. For credit-bearing university or college courses, each semester-hour of credit shall equal 15 hours of continuing education credit, and each quarter-hour of credit shall equal 10 hours of continuing education credit.
8. Sponsor approval.
   1. To be approved by the department, sponsors of continuing education to licensed dentists shall meet the requirements of either paragraph (2) or (3) of this subdivision.
   2. The department shall deem approved as a sponsor of continuing education to licensed dentists:
      1. a sponsor of continuing education that is approved by the American Dental Association Continuing Education Recognition Program, or the Dental Society of the State of New York, or an equivalent organization determined by the State Board for Dentistry to have equivalent standards for approving sponsors of continuing education for professionals regulated by title VIII of the Education Law, including a standard that is equivalent to the standard prescribed in clause (3)(ii)(f) of this subdivision, provided that such sponsor shall also meet the requirements of clause (3)(ii)(g) of this subdivision as verified by the licensee in accordance with the requirements of subparagraph (c)(4)(ii) of this section; or
      2. a postsecondary institution for courses in programs that are registered pursuant to Part 52 of this Title or in equivalent programs that are accredited by an acceptable accrediting agency, which registration standards include a standard that is equivalent to the standard prescribed in clause (3)(ii)(f) of this subdivision, provided that such sponsor shall also meet the requirements of clause (3)(ii)(g) of this subdivision as verified by the licensee in accordance with the requirements of subparagraph (c)(4)(ii) of this section.
   3. Department review of sponsors.
      1. The department shall conduct a review of sponsors that apply for approval to offer continuing education to licensed dentists and that are not deemed approved pursuant to the requirements of paragraph (2) of this subdivision.
      2. Organizations desiring to offer continuing education based upon a department review under this paragraph shall submit, with the fee as set forth in subdivision (i) of this section, an application for advance approval as a sponsor at least 90 days prior to the date for the commencement of such continuing education that documents that the organization:
         1. will offer courses of study in any one or more of the following curricular areas: basic and clinical dental sciences; or behavioral science; or pharmacology of new and developing drugs; or drug interactions; or public health issues; or infection control; or sterile procedures; or legal and regulatory issues; or patient counseling; or other topics which contribute to the professional practice of dentistry as such practice is defined in section 6601 of the Education Law; or other matters of health care, law, and ethics which contribute to the health and welfare of the public;
         2. is an organized educational entity, including but not limited to, a college of dentistry accredited by an acceptable accrediting agency; or a national, State, or local dental association; or a hospital or health maintenance organization;
         3. provides course instructors who are qualified to teach the courses which will be offered, including but not limited to, faculty of a college of dentistry accredited by an acceptable accrediting agency; or instructors who are authorities in the health sciences specially qualified, in the opinion of the State Board for Dentistry, to conduct such courses;
         4. has a method of assessing the learning of participants, and describes such method;
         5. will maintain records for at least six years from the date of completion of course- work, which shall include, but shall not be limited to, the name and curriculum vitae of the faculty, a record of attendance of licensed dentists in such coursework, an outline of the course of instruction, date and location of the coursework, and the number of hours for completion of the coursework. In the event an approved sponsor discontinues operation, the governing body of such sponsor shall notify the department and shall transfer all records as directed by the department;
         6. for an organization initially approved or reapproved by the department as a sponsor on or after September 3, 1999, has the facilities, equipment and financial and physical resources to provide continuing education courses, meaning facilities shall be appropriate to accomplish the educational method being used and the stated educational objectives, equipment shall be adequate and in such condition that instruction can proceed effectively, and financial and physical resources shall be sufficient to fund and support the services necessary to manage the continuing education programs; and
         7. for an organization initially approved or reapproved by the department as a sponsor on or after September 3, 1999, has at least one full-time employee of any kind, meaning an employee who works at least 30 hours per week.
      3. Sponsors that are approved by the department pursuant to the requirements of this paragraph shall be approved for a three-year term.
      4. The department may conduct site visits of or request information from a sponsor approved pursuant to the requirements of this paragraph to ensure compliance with such requirements, and a sponsor shall cooperate with the department in permitting such site visits and in providing such information.
      5. A determination by the department that a sponsor approved pursuant to the requirements of this paragraph is not meeting the standards set forth in this paragraph shall result in the denial or termination of the approved status of the sponsor.
9. Fees.
   1. At the beginning of each registration period, a mandatory continuing education fee of $45 shall be collected from licensees engaged in the practice of dentistry in New York State, except for those exempt from the requirement pursuant to subparagraph (b)(2)(i) of this section. This fee shall be in addition to the registration fee required by section 6604 of the Education Law.
   2. Licensees applying for a conditional registration, pursuant to the requirements of subdivision (e) of this section, shall pay a fee that is the same as and in addition to, the fee for the triennial registration required by section 6604 of the Education Law. In addition, such licensees shall pay the $45 mandatory continuing education fee.
   3. Organizations desiring to offer continuing education to licensed dentists based upon a department review, pursuant to paragraph (h)(3) of this section, shall submit an application fee of $900 with its application for the issuance of a permit from the department to become an approved sponsor of a formal continuing education program. Application for a three-year renewal of the permit shall be accompanied by a fee of $900.

1. As used in this section, acceptable accrediting agency shall mean an organization accepted by the department as a reliable authority for the purpose of accreditation at the postsecondary level, applying its criteria for granting accreditation in a fair, consistent and nondiscriminatory manner, such as an agency recognized for this purpose by the United States Department of Education.
2. Applicability of requirement.
   1. Each licensed dental hygienist required under article 130 of the Education Law to register with the department to practice in New York State, shall comply with the mandatory continuing education requirements as prescribed in subdivision (c) of this section, except those licensees exempt from the requirement or who obtain an adjustment to the requirement pursuant to paragraph (2) of this subdivision.
   2. Exemptions and adjustments to the requirement.
      1. Exemptions. The following licensees shall be exempt from the continuing education requirements, as prescribed in subdivision (c) of this section:
         1. licensees for the triennial registration period during which they are first licensed to practice dental hygiene in New York State, exclusive of those first licensed to practice dental hygiene in New York State pursuant to an endorsement of a license of another jurisdiction;
         2. licensees whose first registration date following January 1, 1997 occurs prior to January 1, 1998, for periods prior to such registration date; and
         3. licensees who are not engaged in the practice of dental hygiene, as evidenced by not being registered to practice in New York State, except as otherwise provided in paragraph (c)(2) of this section to meet the education requirements for the resumption of practice after a lapse in practice for a licensee who has not lawfully practiced continuously in another jurisdiction throughout such lapse period.
      2. Adjustments to the requirement. An adjustment to the continuing education requirement, as prescribed in subdivision (c) of this section, shall be made by the department, provided that the licensee documents good cause that prevents compliance, which shall include but not be limited to, any of the following reasons: poor health certified by a physician; or a specific physical or mental disability certified by an appropriate health care professional; or extended active duty with the Armed Forces of the United States; or extreme hardship which in the judgment of the department makes it impossible for the licensee to comply with the continuing education requirements in a timely manner.
3. Mandatory continuing education requirement.
   1. During each triennial registration period, meaning a registration period of three years' duration, an applicant for registration shall complete at least 24 hours of formal continuing education acceptable to the department, as defined in paragraph (4) of this subdivision, provided that no more than 10 hours of such continuing education shall consist of self-instructional coursework. Any licensed dental hygienist whose first registration date following January 1, 1997 occurs less than three years from that date, but on or after January 1, 1998, shall complete continuing education hours on a prorated basis at the rate of one and one-quarter hours of acceptable formal continuing education per month up to a maximum of 24 hours for the period beginning January 1, 1997 up to the first registration date thereafter. Such continuing education shall be completed during the period beginning January 1, 1997 and ending before the first day of the new registration period or at the option of the licensee during any time in the previous registration period.
   2. Requirement for lapse in practice.
      1. A licensee returning to the practice of dental hygiene after a lapse in practice, as evidenced by not being registered to practice in New York State, whose first registration date after such lapse in practice and following January 1, 1997 occurs less than three years from January 1, 1997, but on or after January 1, 1998, shall be required to complete:
         1. one and one-quarter hours of acceptable formal continuing education for each month beginning with January 1, 1997 until the beginning of the new registration period, up to a maximum of 24 hours, which shall be completed for a licensee who has not lawfully practiced dental hygiene continuously in another jurisdiction throughout such lapse period, in the 12-month period before the beginning of the new registration period; and for a licensee who has lawfully practiced dental hygiene continuously in another jurisdiction throughout such lapse period, in the new registration period or at the option of the licensee in the period beginning 36 months before the commencement of the new registration period and ending at the conclusion of the new registration period; and
         2. for a licensee who has not lawfully practiced dental hygiene continuously in another jurisdiction throughout such lapse period, at least eight hours of acceptable formal continuing education in each successive 12-month period of the new registration period; and for a licensee who has lawfully practiced dental hygiene continuously in another jurisdiction throughout such lapse period, acceptable formal continuing education at the rate of two-thirds of an hour per month during the new registration period.
      2. Except as prescribed in subparagraph (i) of this paragraph for registrations therein specified, the licensee who returns to the practice of dental hygiene after a lapse in practice in which the licensee was not registered to practice in New York State and did not lawfully practice dental hygiene continuously in another jurisdiction throughout the lapse period, shall be required to complete:
         1. the continuing education requirement applicable to the period of time the licensee was registered in the licensee's last registration period;
         2. at least two-thirds of an hour of acceptable formal continuing education for each month of lapsed registration up to a maximum of 24 hours, which shall be completed in the 12 months before the beginning of the new registration period; and
         3. at least eight hours of acceptable formal continuing education in each succeeding 12-month period, after such registration is reissued, until the next registration date.
      3. Except as prescribed in subparagraph (i) of this paragraph for registrations therein specified, the licensee who returns to the practice of dental hygiene after a lapse in practice in which the licensee was not registered to practice in New York State but did lawfully practice dental hygiene continuously in another jurisdiction throughout the lapse period, shall be required to complete:
         1. the continuing education requirement applicable to the period of time the licensee was registered in the licensee's last registration period;
         2. at least two-thirds of an hour of acceptable formal continuing education for each month of lapsed registration up to a maximum of 24 hours, which shall be completed in the new registration period, or at the option of the licensee in the period beginning 36 months before the commencement of the new registration period and ending at the conclusion of the new registration period; and
         3. completion of the regular continuing education requirement at the rate of two- thirds of an hour of acceptable formal continuing education per month during the new registration period.
   3. Proration. Except as otherwise provided in this section, if a registration period is less than three years in duration, a licensed dental hygienist shall complete acceptable formal continuing education at the rate of two-thirds of an hour of continuing education per month for such registration period.
   4. To be acceptable to the department, formal continuing education shall be formal courses of learning which contribute to professional practice in dental hygiene:
      1. in any one or more of the following curricular areas: basic and clinical dental sciences; or behavioral science; or pharmacology of new and developing drugs; or drug interactions; or public health issues; or child abuse reporting instruction; or infection control; or sterile procedures; or legal and regulatory issues; or patient counseling; or other topics which contribute to the professional practice in dental hygiene as such practice is defined in section 6606 of the Education Law; or other matters of health care, law, and ethics which contribute to the health and welfare of the public; and
      2. obtained from a sponsor approved by the department pursuant to subdivision (h) of this section.
4. Renewal of registration. At each reregistration, licensed dental hygienists shall certify to the department that they have either complied with the continuing education requirements, as prescribed in subdivision (c) of this section; or are subject to an exemption or adjustment to such continuing education requirements, as prescribed in subdivision (b) of this section.
5. Conditional registration.
   1. The department shall issue a conditional registration to a licensee who attests to or admits to noncompliance with the continuing education requirements of this section, provided that such licensee meets the following requirements:
      1. the licensee agrees to remedy such deficiency within the conditional registration period;
      2. the licensee agrees to complete the regular continuing education requirement at the rate of two-thirds of an hour per month during such conditional registration period; and
      3. the licensee agrees to complete additional continuing education during such conditional registration period, which the department may require to ensure the licensee's proper delivery of dental hygiene care consistent with the licensee's practice of dental hygiene.
   2. The duration of such conditional registration shall not exceed one year and shall not be renewed or extended.
6. Licensee records. Each licensee subject to this section shall maintain, or ensure access by the department to, a record of completed continuing education, which includes: the title of the program, the number of hours completed, the sponsor's name and any identifying number, attendance verification, and the date and location of the program. Such records shall be retained for at least six years from the date of completion of the program and shall be available for review by the department in the administration of the requirements of this section.
7. Measurement of continuing education study. Continuing education credit shall be granted only for formal programs of learning that meet the requirements set forth in subdivision (c) of this section. A minimum of 50 minutes of study shall equal one hour of continuing education credit. For credit-bearing university or college courses, each semester-hour of credit shall equal 15 hours of continuing education credit, and each quarter-hour of credit shall equal 10 hours of continuing education credit.
8. Sponsor approval.
   1. To be approved by the department, sponsors of continuing education to licensed dental hygienists shall meet the requirements of either paragraph (2) or (3) of this subdivision.
   2. The department shall deem approved as a sponsor of continuing education to licensed dental hygienists:
      1. a sponsor of continuing education that is approved by the American Academy of Dental Hygiene, Inc., or the American Dental Association Continuing Education Recognition Program, or the Dental Society of the State of New York, or an equivalent organization determined by the State Board for Dentistry to have equivalent standards for approving sponsors of continuing education for professionals regulated by title VIII of the Education Law; or
      2. a postsecondary institution for courses in programs that are registered pursuant to Part 52 of this Title or in equivalent programs that are accredited by an acceptable accrediting agency.
   3. Department review of sponsors.
      1. The department shall conduct a review of sponsors that apply for approval to offer continuing education to licensed dental hygienists and that are not deemed approved pursuant to the requirements of paragraph (2) of this subdivision.
      2. Organizations desiring to offer continuing education based upon a department review under this paragraph shall submit, with the fee as set forth in subdivision (i) of this section, an application for advance approval as a sponsor at least 90 days prior to the date for the commencement of such continuing education that documents that the organization:
         1. will offer courses of study in any one or more of the following curricular areas: basic and clinical dental sciences; or behavioral science; or pharmacology of new and developing drugs; or drug interactions; or public health issues; or child abuse reporting instruction, or infection control; or sterile procedures; or legal and regulatory issues; or patient counseling; or other topics which contribute to the professional practice of dental hygiene as such practice is defined in section 6606 of the Education Law; or other matters of health care, law, and ethics which contribute to the health and welfare of the public;
         2. is an organized educational entity, including but not limited to, a college accredited by an acceptable agency offering dental hygiene or dentistry professional programs; or a national, State, or local dental association; or a hospital or health maintenance organization;
         3. provides course instructors who are qualified to teach the courses which will be offered, including but not limited to, faculty of a college accredited by an acceptable accrediting agency which offers dental hygiene or dentistry professional programs; or instructors who are authorities in the health sciences specially qualified, in the opinion of the State Board for Dentistry, to conduct such courses;
         4. has a method of assessing the learning of participants, and describes such method; and
         5. will maintain records for at least six years from the date of completion of course- work, which shall include, but shall not be limited to, the name and curriculum vitae of the faculty, a record of attendance of licensed dental hygienists in such coursework, an outline of the course of instruction, date and location of the coursework, and the number of hours for completion of the coursework. In the event an approved sponsor discontinues operation, the governing body of such sponsor shall notify the department and shall transfer all records as directed by the department.
      3. Sponsors that are approved by the department pursuant to the requirements of this paragraph shall be approved for a three-year term.
      4. The department may conduct site visits of or request information from a sponsor approved pursuant to the requirements of this paragraph to ensure compliance with such requirements, and a sponsor shall cooperate with the department in permitting such site visits and in providing such information.
      5. A determination by the department that a sponsor approved pursuant to the requirements of this paragraph is not meeting the standards set forth in this paragraph shall result in the denial or termination of the approved status of the sponsor.
9. Fees.
   1. At the beginning of each registration period, a mandatory continuing education fee of $30 shall be collected from licensees engaged in the practice of dental hygiene in New York State, except for those exempt from the requirement pursuant to subparagraph (b)(2)(i) of this section. This fee shall be in addition to the registration fee required by section 6609 of the Education Law.
   2. Licensees applying for a conditional registration, pursuant to the requirements of subdivision (e) of this section, shall pay a fee that is the same as and in addition to, the fee for the triennial registration required by section 6609 of the Education Law. In addition, such licensees shall pay the $30 mandatory continuing education fee.
   3. organizations desiring to offer continuing education to licensed dental hygienists based upon a department review, pursuant to paragraph (h)(3) of this section, shall submit an application fee of $900 with its application for the issuance of a permit from the department to become an approved sponsor of a formal continuing education program. Application for a three-year renewal of the permit shall be accompanied by a fee of $900.

1. Definitions. As used in this section:
   1. Acceptable accrediting body means an accrediting body which is accepted by the department as a reliable authority for the purpose of accrediting educational programs leading to licensure in dentistry and/or dental hygiene, applying its criteria for granting accreditation in a fair, consistent, and nondiscriminatory manner, and which accredits such programs on a national basis.
   2. Under personal supervision of a licensed dentist means that the supervising licensed dentist remains in the dental office or other location where the local infiltration anesthesia or nitrous oxide analgesia services are being performed by the dental hygienist, personally authorizes and prescribes the use of local infiltration anesthesia or nitrous oxide analgesia for the patient and, before dismissal of the patient, personally examines the condition of the patient after the use of local infiltration anesthesia or nitrous oxide analgesia that is administered by the dental hygienist is completed.
2. General provisions.
   1. A licensed dental hygienist shall not administer or monitor nitrous oxide analgesia or local infiltration anesthesia in the practice of dental hygiene without being issued a dental hygiene restricted local infiltration anesthesia/nitrous oxide analgesia certificate in accordance with the requirements of this section, except that such administration or monitoring of nitrous oxide analgesia or local infiltration anesthesia by a licensed dental hygienist who is certified under this section must be under the personal supervision of a licensed dentist, as defined in subdivision (a) of this section.
   2. The applicant for certification or the renewal of certification must be a licensed dental hygienist or be concurrently licensed as a dental hygienist at the time of initial certification; and shall meet the additional requirements of this section.
   3. The certificate issued pursuant to this section shall be issued for a three-year term and shall be renewable.
3. Requirements for initial certification.
   1. Application requirement. The applicant shall apply for initial certification on forms prescribed by the department and pay the fee prescribed in section 6605-b of the Education Law.
   2. Education and training requirement. For initial certification, the applicant shall complete a program registered pursuant to section 52.9(b) of this Title and offered by an institution which has programs that are registered by the department pursuant to Part 52 of this Title as leading to licensure in dentistry and/or dental hygiene; or equivalent educational preparation offered by an institution that has programs leading to licensure in dentistry and/or dental hygiene that are accredited by an acceptable accrediting body.
4. Requirements for renewal of certification.
   1. Each certificate holder shall renew certification with the department triennially on a schedule determined by the department.
   2. The certificate holder shall renew certification on forms prescribed by the department and pay the fee prescribed in section 6605-b of the Education Law.

1. Definitions. As used in this section:
   1. Acceptable national accrediting body means until December 31, 2006 the Commission on Dental Accreditation of the American Dental Association, and thereafter it means an organization accepted by the department as a reliable authority for the purpose of accreditation of dental residency programs, applying its criteria for granting accreditation in a fair, consistent, and nondiscriminatory manner, such as the Commission on Dental Accreditation of the American Dental Association, its successors, or an equivalent organization as determined by the department.
   2. Competent to practice dentistry means the level of knowledge and skills necessary to perform safely and independently the practice of dentistry consistent with the definition of the practice of dentistry in section 6601 of the Education Law.
2.  Residency program. To be acceptable to the department for purposes of licensure under section 6604 of the Education Law, a residency program shall meet the requirements of this section.
   1. The residency program shall be a postdoctoral dental residency program in either general dentistry, or a specialty of dentistry as defined in paragraph (2) of this subdivision, of at least one year's duration in a hospital or facility accredited for teaching purposes by an acceptable national accrediting body, which is completed successfully by the applicant prior to the submission to the department of the application for licensure.
   2. The accredited residency program in a specialty of dentistry shall be in the specialty of endodontics, oral and maxillofacial surgery, orthodontics and dentofacial orthopedics, pediatric dentistry, periodontics, prosthodontics, oral and maxillofacial pathology, oral and maxillofacial radiology, dental anesthesiology, dental public health, orofacial pain, oral medicine, or another specialty of dentistry, as determined by the department.
   3. The accredited residency program shall include a formal written outcome assessment which is acceptable to the department, which shall include a written statement by the residency program director attesting that the applicant has successfully completed the accredited residency program as defined in this section, and is, in the director's judgment, competent to practice general dentistry or a specialty of dentistry.
3. A residency program that has not met the requirements of this section shall not be acceptable to the department for purposes of licensure under this section. A formal written outcome assessment shall not be acceptable to the department for purposes of licensure under this section if it does not meet the requirements of paragraph (b)(3) of this section.
4. In accordance with subdivision (5) of section 6605 of the Education Law, not later than 60 days after entry into an acceptable residency program, and annually thereafter for the duration of such residency program, the dental resident shall register on a form acceptable to the department and pay to the department a residency registration fee in the amount prescribed for limited permit fees in subdivision (4) of section 6605 of the Education Law.

1. Beginning January 1, 2009, each dentist licensed and registered to practice in New York State shall become certified in cardiopulmonary resuscitation by a provider approved by the department and thereafter shall maintain current certification, except as provided for in subdivision (e) of the section. Coursework leading to obtaining and maintaining such certification shall be included in the mandatory hours of continuing education to the extent provided in subdivision (c) of this section.
2. Cardiopulmonary resuscitation certification providers approved by the department shall include the American Heart Association, the American Red Cross, the National Safety Council and the American Safety and Health Institute. The department may also approve other providers determined by the department to offer substantially similar content to courses offered to professionals by such organizations and to have a similar renewal period. Online courses are not acceptable; all courses taken to meet this requirement shall be taken in person. Provided, however, that the Department, in its discretion, may accept alternative means to meet the in person course requirement of this subdivision if such requirement cannot be met due to the State of Emergency declared by the Governor pursuant to an Executive Order for the COVID-19 crisis. Such coursework shall include, but need not be limited to, content in the following:
   1. scene survey;
   2. patient assessment;
   3. one and two rescuer cardiopulmonary resuscitation;
   4. mouth-to-mouth resuscitation;
   5. mouth-to-mask resuscitation;
   6. conscious choking;
   7. unconscious choking;
   8. bag-valve-mask resuscitation;
   9. recovery position;
   10. automated external defibrillator use;
   11. infection control matters;
   12. recognizing a heart attack; and
   13. cardiopulmonary resuscitation and automated external defibrillator scenarios.
3. For each triennial registration period, a licensee may count up to a maximum of 12 hours of coursework in cardiopulmonary resuscitation, including coursework in advanced cardiac life support and/or pediatric advanced life support.
4. At the time of his or her registration renewal, each dentist shall attest to having met the cardiopulmonary resuscitation requirement or attest to meeting the requirements for exemption as defined in subdivision (e) of this section.
5. A licensee may be granted an exemption to the cardiopulmonary resuscitation requirement if he or she is physically incapable of complying with the requirements of subdivision (a) of this section. Documentation of such incapacity shall include a written statement by a licensed physician describing the licensee's physical incapacity. The licensee shall also submit an application to the department for exemption which verifies that another individual will maintain certification and be present in the dental office while the dentist is treating patients.
6. In accordance with section 61.15(f) of this Part, each licensee shall maintain for review by the department records of compliance with this section, including the licensee's cardiopulmonary resuscitation certification card.