Mississippi State Board of Dental Examiners

Monday, September 15, 2014

Frequently Asked Questions -- >
  Anesthesia Administration

Dentist anesthetizing patient
  • Can I use a drug in a dosage for a purpose that is not on the package insert or Food and Drug Administration (FDA) labeling?
  • Yes. Licensed Mississippi dentists may utilize drugs in accordance with the drug manufacturer's guidelines as set forth in FDA-approved labeling or peer-reviewed scientific literature, including, but not limited to, indications of usage, dosage amounts, and safety requirements for each drug so utilized. Refer to Board Regulation 29.
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  • What is an Enteral Conscious Sedation Permit?
  • This is a permit for conscious sedation that is achieved by administration of pharmacological agents through the alimentary tract either orally or rectally. Refer to Board Regulation 29.
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  • Is Advanced Cardiac Life Support (ACLS) required for an Enteral Conscious Sedation Permit?
  • Yes. An applicant applying for any kind of Mississippi anesthesia permit is required to produce evidence of a current ACLS certificate; however, Pediatric Advanced Life Support (PALS) or a certificate from a Board-approved course also may be used to fulfill the ACLS requirement. Refer to Board Regulation 29.
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  • Is the course offered by the Dental Organization for Conscious Sedation (DOCS) considered as an approved course to fulfill the requirements for an Enteral Conscious Sedation Permit?
  • Yes. All courses, however, must be approved by the Board. For patients patients who are 12 years of age or under, or who are 13 years of age or older AND who are deemed to be patients with special health care needs, the minimum number of didactic hours shall be 50, with a minimum of 25 hours pediatric-specific, and the minimum number of clinical patient cases shall be 10, with a minimum of 5 being pediatric clinical patient cases. For patients who are 13 years of age or older and who are NOT deemed to be patients with special health care needs, the minimum number of didactic hours shall be 22, and the minimum number of clinically oriented experiences shall be 15. The training program must include physical evaluation, enteral conscious sedation, airway management monitoring, and emergency management. The preceding is necessary for recognition of the formal training program, and training programs in enteral conscious sedation that satisfy the requirements described in Parts I and III of the ADA’s "Guidelines for Teaching Pain Control and Sedation to Dentists and Dental Students” at the time training was commenced, shall be deemed by the Board as approved training programs, wherein the hours of didactic training and the number of clinical patient cases shall be credited to the minimum amounts noted above. Refer to Board Regulation 29.
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  • What equipment must I have to administer enteral conscious sedation and pass the required site visit?
  • The Board's Enteral Conscious Sedation Permit Site Visit Form is on the Board's web site in the section entitled "Applications and Forms." Many of the same equipment and drugs are required to administer enteral conscious sedation as are required for general anesthesia and parenteral conscious sedation, and you should thoroughly familiarize yourself with the required equipment, supplies, drugs, and written documentation. Also, feel free to contact the Board's office to have the site visit form faxed or mailed to you. Refer to Board Regulation 29 and the Board's Enteral Conscious Sedation Permit Site Visit Form.
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  • If I prescribe Valium, or another sedative agent, for a patient to take before bed time the night before treatment and before the actual dental appointment, is that considered multiple dosing, thereby requiring an Enteral Conscious Sedation Permit?
  • No. An Enteral Conscious Sedation Permit is required whenever a licensed dentist utilizes inhalation agents and/or multiple doses of oral medications attempting to achieve a level of sedation beyond anxiolysis. Refer to Board Regulation 29.
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  • Does my staff require additional training for me to hold an Enteral Conscious Sedation Permit?
  • Yes. All dental auxiliaries having direct patient care responsibilities are required to be current in CPR at all times. However, dental auxiliaries in offices wherein any anesthesia requiring a permit is administered also must be trained to reasonably assist the dentist with procedures, problems, and emergencies. Refer to Board Regulation 29.
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  • How often do I need to take a refresher course for an Enteral Conscious Sedation Permit?
  • Licensed Mississippi dentists holding Mississippi anesthesia permits must provide proof during their biennial renewal that they are current in ACLS or PALS, or have a certificate from a Board-approved anesthesia review course. There is no specific mandate requiring refresher courses; however, the Board recommends that dentists holding Mississippi anesthesia permits avail themselves of the appropriate continuing education to ensure their patients' safety and welfare. Refer to Board Regulation 29.
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  • Are there any drugs that cannot be used for enteral conscious sedation?
  • No. All drugs should be label specific or in peer-reviewed literature. Refer to Board Regulation 29.
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  • Are there any drugs that cannot be used in combination with N2O2 for anxiolysis purposes?
  • Yes. As previously noted, all drugs should be label specific or in peer-reviewed literature. Refer to Board Regulation 29.
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  • Can I have a licensed Mississippi dentist currently holding a valid Mississippi anesthesia permit come to my office and sedate my patients for me to treat?
  • Yes. However, the licensed Mississippi dentist administering enteral conscious sedation, parenteral conscious sedation, and/or general anesthesia at a facility other than that dentist's own office or facility must ensure that the proper equipment and personnel are present, e.g., the office must be staffed with a supervised team of auxiliary personnel capable of reasonably assisting the dentist with procedures, problems, and emergencies incident thereto. Refer to Board Regulation 29.
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  • If a licensed Mississippi dentist holding a valid Mississippi anesthesia permit can sedate my patients for me, do I have to hold a similar permit, and/or do I have to pass a site visit from the Board?
  • No. You do not have to hold a valid Mississippi anesthesia permit, and you do not have to first pass a site visit from the Board. However, you must ensure that your office is properly equipped in both equipment, supplies, and personnel, as is required by Board Regulation 29.
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  • If a CRNA or an anesthesiologist sedates my patients for me in my dental office, what kind of training must I have?
  • When anesthesia is administered in a dental facility, a licensed dentist may employ or work in conjunction with a qualified anesthesiologist or CRNA who practices in an accredited hospital, provided that such anesthesiologist or CRNA remains on the premises of the dental facility until any patient given any level of anesthetic requiring a permit regains consciousness and is discharged. Prior to employing or working in conjunction with an anesthesiologist who administers enteral conscious sedation, parenteral conscious sedation, and/or general anesthesia in a dental facility, the operating dentist must possess a currently valid Board-issued anesthesia permit which is commensurate with the level of anesthesia being administered by the anesthesiologist, and which permit has been issued in accordance with the guidelines for anesthesia permits. Prior to applying to the Mississippi Board of Nursing to enter into a Nursing Board-approved collaborative/consultative relationship with a CRNA which includes protocols/practice guidelines for the administration of enteral conscious sedation, parenteral conscious sedation, and/or general anesthesia by a CRNA, the operating dentist must possess a currently valid Board-issued anesthesia permit which is commensurate with the level of anesthesia being administered by the CRNA, and which permit has been issued in accordance with the guidelines for anesthesia permits. Refer to Board Regulation 29.
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  • How has the Board defined Anxiolysis?
  • Anxiolysis (minimal sedation) has been defined as the pharmacological reduction of anxiety through the administration of a minor psychosedative/tranquilizer, which allows for uninterrupted interactive ability in a totally awake patient with no compromise in the ability to maintain a patent airway continuously and without assistance. The total dosage cannot exceed 1.5 MRD (maximum recommended dosage). Dentists administering anxiolysis (minimal sedation) shall prescribe only a single agent to each patient (no multiple drugs or combination drug regimens). When the intent is minimal sedation for adults, the appropriate initial dosing of a single enteral drug is no more than the MRD of a drug that can be prescribed for unmonitored home use. Refer to Board Regulation 29.
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  • Once I have been issued a Mississippi anesthesia permit, will I be subject to periodic site visits from the Board?
  • Yes. All facilities wherein anesthesia requiring permits is administered shall be inspected at least once every five (5) years beginning with the permit issue date, or as designated by the Board, to ensure all equipment is appropriate and in good working order. Refer to Board Regulation 29.
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  • Does the coursework offered by the American Safety & Health Institute (ASHI) fulfill the requirements of Board Regulation 29?
  • Yes. At its 08/19/2011 meeting, the Board approved ASHI's ACLS and PALS coursework as fulfilling the requirements in Board Regulation 29 for the application for and renewal of anesthesia permits. Refer to Board Regulation 29.
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  • Does the substitute Advanced Cardiac Life Support (ACLS) course developed by the American Dental Association (ADA) fulfill the requirements of Board Regulation 29?
  • Yes, but not for all anesthesia permits. At its 11/18/2011 meeting, the Board approved the substitute ACLS course developed by the ADA for use in fulfilling the ACLS requirements for Enteral Conscious Sedation and Parenteral Conscious Sedation Permits as stipulated by Board Regulation 29. This course was NOT approved as a substitute ACLS course for General Anesthesia Permits. Refer to Board Regulation 29.
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