June 1, 2009
The Colorado State Board of Dental Examiners (SBDE) recently revised its rule on the administration of anesthesia in an attempt to better define and clarify the permit structure. The proposed rule would reduce the four current anesthesia permits to two proposed permits. The new rule is based on an “anesthesia continuum” that ranges from local to general anesthesia, and focuses on the sedation level of the patient rather than on specific drugs or routes of administration. Requirements become more stringent as one progresses to deeper levels of sedation on the continuum.
Under the new rule, licensed dentists could provide local anesthesia, analgesia and anxiolysis without a permit. In most cases a permit would not be required for nitrous oxide applications performed by a dentist.
The Colorado State Board of Dental Examiners (SBDE) recently revised its rule on the administration of anesthesia in an attempt to better define and clarify the permit structure. The proposed rule would reduce the four current anesthesia permits to two proposed permits. The new rule is based on an anesthesia continuum that ranges from local to general anesthesia, and focuses on the sedation level of the patient rather than on specific drugs or routes of administration. Requirements become more stringent as one progresses to deeper levels of sedation on the continuum.
Under the new rule, licensed dentists could provide local anesthesia, analgesia and anxiolysis without a permit. In most cases a permit would not be required for nitrous oxide applications performed by a dentist.
Dentists who intend to provide patients with minimum or moderate sedation must complete 60 hours of coursework within the five years preceding the application and 20 supervised clinical cases to qualify for the Level I Permit. These training and experience requirements were previously associated with parenteral sedation. Under the new rule, dentists who provide enteral conscious sedation that results in minimal or moderate patient sedation would be required to obtain a Level I permit. The SBDE has estimated that this change would impact only a small group of dentists and expressed a willingness to work with the affected group to ease the transition to the new permit system.
Only dentists who have completed a residency program in general anesthesia or a relevant post-doctoral training program, like oral surgery, would be eligible for the Level II Permit, which allows for deep sedation or general anesthesia. These qualifications correspond to the current requirements for deep sedation or general anesthesia.
Anesthesia permits would be renewed every five years and each renewal would include a clinical on-site evaluation.
Under the new rule, the documentation sections have been consolidated and some additional requirements have been added.
The new rule has been structured to allow dentists added flexibility in administering anesthesia to patients. However, some have expressed concern that the structure of the rule is more theoretical than past guidelines and may lead to more subjectivity in interpretation and application.
The Board will hold a public hearing on this proposed rule at its July 9 meeting. Any comments on the rule will be heard at that time. Also, the SBDE has indicated that it will discuss the process that will be used to transition existing permits to the new permit structure at this hearing.
The text of the new rule can be found at http://www.dora.state.co.us/pls/real/SB121_Web.Show_Rule?p_rule_id=3193.
Please take a minute to review the rule and contact Jennifer Goodrum at 303-996-2847 or jennifer@cdaonline.org if you have any comments or concerns.