Oregon Bulletin
June 1, 2011
Rule
Caption: Amends Oregon Board of Dentistry
Administrative Rules regarding Anesthesia and Specialty Licensing.
Adm.
Order No.: OBD 2-2011(Temp)
Filed with Sec. of
State: 5-9-2011
Certified to be
Effective: 6-1-11 thru 11-27-11
Notice Publication
Date:
Rules Amended: 818-021-0017, 818-026-0060, 818-026-0065, 818-026-0070
Subject: The Board is amending 818-021-0017 Application to
Practice as a Specialist to allow any Board approved examination to qualify for
a Specialty License.
The Board is
amending to 818-026-0060 Moderate Sedation Permit to allow for an additional
course to meet the life support requirements.
The Board is
amending 818-026-0065 Deep Sedation to require that an electrocardiograph
monitor (ECG) be required when Deep Sedation is administered and the patient’s
heart rhythm shall be recorded.
The Board is
amending 818-026-0070 General Anesthesia Permit to require an
electrocardiograph monitor (ECG) and continuous monitoring of a patient’s heart
rhythm when General Anesthesia is administered.
Rules Coordinator: Sharon Ingram—(971) 673-3200
818-021-0017
Application to Practice as a
Specialist
(1) A dentist who wishes to practice as a specialist in
Oregon, who does not have a current Oregon license, in addition to meeting the
requirements set forth in ORS 679.060 and 679.065, shall submit to the Board
satisfactory evidence of:
(a) Having graduated from a school of dentistry
accredited by the Commission on Dental Accreditation of the American Dental
Association and active licensure as a general dentist in another state.
Licensure as a general dentist must have been obtained as a result of the
passage of any clinical Board examination administered by any state or regional
testing agency;
(b) Certification of having passed the dental
examination administered by the Joint Commission on National Dental
Examinations or Canadian National Dental Examining Board Examination; and
(c) Proof of satisfactory completion of a post-graduate
specialty program accredited by the Commission on Dental Accreditation of the
American Dental Association.
(2) A dentist who graduated from a dental school
located outside the United States or Canada who wishes to practice as a
specialist in Oregon, who does not have a current Oregon license, in addition
to meeting the requirements set forth in ORS 679.060 and 679.065, shall submit
to the Board satisfactory evidence of:
(a) Completion of a post-graduate specialty program of
not less than two years at a dental school accredited by the Commission on
Dental Accreditation of the American Dental Association, proficiency in the
English language, and evidence of active licensure as a general dentist in
another state obtained as a result of the passage of any clinical Board examination
administered by any state or regional testing agency; or
(b) Completion of a post-graduate specialty program of
not less than two years at a dental school accredited by the Commission on
Dental Accreditation of the American Dental Association, proficiency in the
English language and certification of having successfully passed the clinical
examination administered by any state or regional testing agency within the
five years immediately preceding application; and
(c) Certification of having passed the dental
examination administered by the Joint Commission on National Dental
Examinations or Canadian National Dental Examining Board Examination; and
(3) An applicant who meets the above requirements shall
be issued a specialty license upon:
(a) Passing a specialty examination approved by the
Board.
(b) Passing the Board's jurisprudence examination.
(4) Any applicant who does not pass the first
examination for a specialty license may apply for a second and third regularly
scheduled specialty examination. The applicable fee and application for the
reexamination shall be submitted to the Board at least 45 days before the
scheduled examination. If the applicant fails to pass the third examination for
the practice of a recognized specialty, the applicant will not be permitted to
retake the particular specialty examination until he/she has attended and
successfully passed a remedial program prescribed by a dental school accredited
by the Commission on Dental Accreditation of the American Dental Association
and approved by the Board.
Stat. Auth.: ORS 679
Stats. Implemented: ORS 679.140,
679.060, 679.065, 679.070, 679.080 679.090
Hist.: DE 4-1997, f. & cert.
ef. 12-31-97; OBD 2-1999(Temp), f. 3-10-99, cert. ef. 3-15-99 thru 9-10-99; OBD
5-1999, f. 6-25-99, cert. ef. 7-1-99; OBD 11-2001, f. & cert. ef. 1-8-01;
OBD 3-2005, f. 10-26-05, cert. ef. 11-1-05; OBD 1-2008, f. 11-10-08, cert. ef.
12-1-08; OBD 1-2010, f. 6-22-10, cert. ef. 7-1-10; OBD 2-2011(Temp), f. 5-9-11,
cert. ef. 6-1-11 thru
1-27-11
818-026-0060
Moderate Sedation Permit
Moderate sedation, minimal sedation, and nitrous oxide
sedation.
(1) The Board shall issue or renew a Moderate Sedation
Permit to an applicant who:
(a) Is a licensed dentist in Oregon;
(b) Either holds a current Advanced Cardiac Life
Support (ACLS) or Pediatric Advanced Life Support (PALS) certificate, whichever
is appropriate for the patient being sedated, or successfully completes the
American Dental Association’s course “Recognition and Management of
Complications during Minimal and Moderate Sedation” at least every two
years; and
(c) Satisfies one of the following criteria:
(A) Completion of a comprehensive training program in
enteral and/or parenteral sedation that satisfies the requirements described in
Part III of the ADA Guidelines for Teaching Pain Control and Sedation to
Dentists and Dental Students (2007) at the time training was commenced.
(i) Enteral Moderate Sedation requires a minimum of 24
hours of instruction plus management of at least 10 dental patient experiences
by the enteral and/or enteral-nitrous oxide/oxygen route.
(ii) Parenteral Moderate Sedation requires a minimum of
60 hours of instruction plus management of at least 20 dental patients by the
intravenous route.
(B) Completion of an ADA accredited postdoctoral
training program (e.g., general practice residency) which affords comprehensive
and appropriate training necessary to administer and manage parenteral
sedation, commensurate with these Guidelines.
(C) In lieu of these requirements, the Board may accept
equivalent training or experience in moderate sedation anesthesia.
(2) The following facilities, equipment and drugs shall
be on site and available for immediate use during the procedures and during
recovery:
(a) An operating room large enough to adequately
accommodate the patient on an operating table or in an operating chair and to
allow an operating team of at least two individuals to freely move about the
patient;
(b) An operating table or chair which permits the
patient to be positioned so the operating team can maintain the patient's
airway, quickly alter the patient's position in an emergency, and provide a
firm platform for the administration of basic life support;
(c) A lighting system which permits evaluation of the
patient's skin and mucosal color and a backup lighting system of sufficient
intensity to permit completion of any operation underway in the event of a
general power failure;
(d) Suction equipment which permits aspiration of the
oral and pharyngeal cavities and a backup suction device which will function in
the event of a general power failure;
(e) An oxygen delivery system with adequate full face
mask and appropriate connectors that is capable of delivering high flow oxygen
to the patient under positive pressure, together with an adequate backup
system;
(f) A nitrous oxide delivery system with a fail-safe
mechanism that will insure appropriate continuous oxygen delivery and a
scavenger system;
(g) A recovery area that has available oxygen, adequate
lighting, suction and electrical outlets. The recovery area can be the
operating room;
(h) Sphygmomanometer, precordial/pretracheal
stethoscope or capnograph, pulse oximeter, oral and nasopharyngeal airways,
larynageal mask airways, intravenous fluid administration equipment, automated
external defibrillator (AED); and
(i) Emergency drugs including, but not limited to:
pharmacologic antagonists appropriate to the drugs used, vasopressors,
corticosteroids, bronchodilators, antihistamines, antihypertensives and
anticonvulsants.
(3) No permit holder shall have more than one person
under moderate sedation, minimal sedation, or nitrous oxide sedation at the
same time.
(4) During the administration of moderate sedation, and
at all times while the patient is under moderate sedation, an anesthesia
monitor, and one other person holding a Health Care Provider BLS/CPR level
certificate or its equivalent, shall be present in the operatory, in addition
to the dentist performing the dental procedures.
(5) Before inducing moderate sedation, a dentist who
induces moderate sedation shall:
(a) Evaluate the patient and document, using the
American Society of Anesthesiologists Patient Physical Status
Classifications, that the patient is an appropriate candidate for moderate
sedation;
(b) Give written preoperative and postoperative
instructions to the patient or, when appropriate due to age or psychological
status of the patient, the patient's guardian; and
(c) Obtain written informed consent from the patient or
patient's guardian for the anesthesia.
(6) A patient under moderate sedation shall be visually
monitored at all times, including the recovery phase. The dentist or anesthesia
monitor shall monitor and record the patient's condition.
(7) The patient shall be monitored as follows:
(a) Patients must have continuous monitoring using
pulse oximetry. The patient's blood pressure, heart rate, and respiration shall
be recorded at regular intervals but at least every 15 minutes, and these
recordings shall be documented in the patient record. The record must also
include documentation of preoperative and postoperative vital signs, all
medications administered with dosages, time intervals and route of
administration. If this information cannot be obtained, the reasons shall be
documented in the patient's record. A patient under moderate sedation shall be
continuously monitored;
(b) During the recovery phase, the patient must be
monitored by an individual trained to monitor patients recovering from moderate
sedation.
(8) A dentist shall not release a patient who has
undergone moderate sedation except to the care of a responsible third party.
(9) The dentist shall assess the patient's
responsiveness using preoperative values as normal guidelines and discharge the
patient only when the following criteria are met:
(a) Vital signs including blood pressure, pulse rate
and respiratory rate are stable;
(b) The patient is alert and oriented to person, place
and time as appropriate to age and preoperative psychological status;
(c) The patient can talk and respond coherently to
verbal questioning;
(d) The patient can sit up unaided;
(e) The patient can ambulate with minimal assistance;
and
(f) The patient does not have uncontrollable nausea or
vomiting and has minimal dizziness.
(10) A discharge entry shall be made by the dentist in
the patient's record indicating the patient's condition upon discharge and the
name of the responsible party to whom the patient was discharged.
(11) After adequate training, an assistant, when
directed by a dentist, may introduce additional anesthetic agents to an
infusion line under the direct visual supervision of a dentist.
(12) Permit renewal. In order to renew a Moderate
Sedation Permit, the permit holder must provide documentation of having current
ACLS or PALS certification or current certification of successful completion of
the American Dental Association’s course “Recognition and Management of
Complications during Minimal and Moderate Sedation” and must complete 14
hours of continuing education in one or more of the following areas every two
years: sedation, physical evaluation, medical emergencies, monitoring and the
use of monitoring equipment, or pharmacology of drugs and agents used in sedation.
Training taken to maintain current ACLS or PALS certification or successful
completion of the American Dental Association’s course “Recognition and
Management of Complications during Minimal and Moderate Sedation” may be
counted toward this requirement. Continuing education hours may be counted
toward fulfilling the continuing education requirement set forth in OAR
818-021-0060.
[Publications: Publications
referenced are available from the agency.]
Stat. Auth.: ORS 679
Stats. Implemented: ORS 679.250(7)
& 679.250(10)
Hist.: OBD 2-1998, f. 7-13-98,
cert. ef. 10-1-98; OBD 1-1999, f. 2-26-99, cert. ef. 3-1-99; OBD 6-1999, f.
6-25-99, cert. ef. 7-1-99; Administrative correction 8-12-99; OBD 2-2000(Temp),
f. 5-22-00, cert. ef. 5-22-00 thru 11-18-00; OBD 2-2001, f. & cert. ef.
1-8-01; OBD 3-2003, f. 9-15-03, cert. ef. 10-1-03; OBD 1-2005, f. 1-28-05,
cert. ef. 2-1-05; OBD 2-2005, f. 1-31-05, cert. ef. 2-1-05; OBD 1-2010, f.
6-22-10, cert. ef. 7-1-10; OBD 2-2011(Temp), f. 5-9-11, cert. ef. 6-1-11 thru
1-27-11
818-026-0065
Deep Sedation
Deep sedation, moderate sedation, minimal sedation, and
nitrous oxide sedation.
(1) The Board shall issue a Deep Sedation Permit to a
licensee who holds a Class 3 Permit on or before July 1, 2010 who:
(a) Is a licensed dentist in Oregon; and
(b) Holds a current Advanced Cardiac Life Support
(ACLS) or Pediatric Advanced Life Support (PALS) certificate, whichever is
appropriate for the patient being sedated.
(2) The following facilities, equipment and drugs shall
be on site and available for immediate use during the procedures and during
recovery:
(a) An operating room large enough to adequately
accommodate the patient on an operating table or in an operating chair and to
allow an operating team of at least two individuals to freely move about the
patient;
(b) An operating table or chair which permits the
patient to be positioned so the operating team can maintain the patient's
airway, quickly alter the patient's position in an emergency, and provide a
firm platform for the administration of basic life support;
(c) A lighting system which permits evaluation of the
patient's skin and mucosal color and a backup lighting system of sufficient
intensity to permit completion of any operation underway in the event of a
general power failure;
(d) Suction equipment which permits aspiration of the
oral and pharyngeal cavities and a backup suction device which will function in
the event of a general power failure;
(e) An oxygen delivery system with adequate full face
mask and appropriate connectors that is capable of delivering high flow oxygen
to the patient under positive pressure, together with an adequate backup
system;
(f) A nitrous oxide delivery system with a fail-safe
mechanism that will insure appropriate continuous oxygen delivery and a
scavenger system;
(g) A recovery area that has available oxygen, adequate
lighting, suction and electrical outlets. The recovery area can be the
operating room;
(h) Sphygmomanometer, precordial/pretracheal stethoscope
or capnograph, pulse oximeter, electrocardiograph monitor (ECG), automated
external defibrillator (AED), oral and nasopharyngeal airways, laryngeal mask
airways, intravenous fluid administration equipment; and
(i) Emergency drugs including, but not limited to:
pharmacologic antagonists appropriate to the drugs used, vasopressors,
corticosteroids, bronchodilators, antihistamines, antihypertensives and
anticonvulsants.
(3) No permit holder shall have more than one person
under deep sedation or conscious sedation at the same time.
(4) During the administration of deep sedation, and at
all times while the patient is under deep sedation, an anesthesia monitor, and
one other person holding a Health Care Provider BLS/CPR level certificate or
its equivalent, shall be present in the operatory, in addition to the dentist
performing the dental procedures.
(5) Before inducing deep sedation, a dentist who
induces deep sedation shall:
(a) Evaluate the patient and document, using the
American Society of Anesthesiologists Patient Physical Status
Classifications, that the patient is an appropriate candidate for deep
sedation;
(b) Give written preoperative and postoperative
instructions to the patient or, when appropriate due to age or psychological
status of the patient, the patient's guardian; and
(c) Obtain written informed consent from the patient or
patient's guardian for the anesthesia.
(6) A patient under deep sedation shall be visually
monitored at all times, including the recovery phase. The dentist or anesthesia
monitor shall monitor and record the patient's condition.
(7) The patient shall be monitored as follows:
(a) Patients must have continuous monitoring using
pulse oximetry. The patient's blood pressure, heart rate, heart rhythm, and
respiration shall be recorded at regular intervals but at least every 5
minutes, and these recordings shall be documented in the patient record. The
record must also include documentation of preoperative and postoperative vital
signs, all medications administered with dosages, time intervals and route of
administration. If this information cannot be obtained, the reasons shall be
documented in the patient's record. A patient under deep sedation shall be
continuously monitored;
(b) During the recovery phase, the patient must be
monitored by an individual trained to monitor patients recovering from deep
sedation.
(8) A dentist shall not release a patient who has
undergone deep sedation except to the care of a responsible third party.
(9) The dentist shall assess the patient's
responsiveness using preoperative values as normal guidelines and discharge the
patient only when the following criteria are met:
(a) Vital signs including blood pressure, pulse rate
and respiratory rate are stable;
(b) The patient is alert and oriented to person, place
and time as appropriate to age and preoperative psychological status;
(c) The patient can talk and respond coherently to
verbal questioning;
(d) The patient can sit up unaided;
(e) The patient can ambulate with minimal assistance;
and
(f) The patient does not have uncontrollable nausea or
vomiting and has minimal dizziness.
(10) A discharge entry shall be made by the dentist in
the patient's record indicating the patient's condition upon discharge and the
name of the responsible party to whom the patient was discharged.
(11) After adequate training, an assistant, when
directed by a dentist, may introduce additional anesthetic agents to an
infusion line under the direct visual supervision of a dentist.
(12) Permit renewal. In order to renew a Deep Sedation
Permit, the permit holder must provide documentation of having current ACLS or
PALS certification and must complete 14 hours of continuing education in one or
more of the following areas every two years: sedation, physical evaluation,
medical emergencies, monitoring and the use of monitoring equipment, or
pharmacology of drugs and agents used in sedation. Training taken to maintain
current ACLS or PALS certification may be counted toward this requirement.
Continuing education hours may be counted toward fulfilling the continuing
education requirement set forth in OAR 818-021-0060.
[Publications: Publications
referenced are available from the agency.]
Stat. Auth.: ORS 679
Stats. Implemented: ORS 679.250(7)
& 679.250(10)
Hist. : OBD 1-2010, f. 6-22-10,
cert. ef. 7-1-10; OBD 2-2011(Temp), f. 5-9-11, cert. ef. 6-1-11 thru 1-27-11
818-026-0070
General Anesthesia Permit
General anesthesia, deep sedation, moderate sedation,
minimal sedation and nitrous oxide sedation.
(1) The Board shall issue a General Anesthesia Permit
to an applicant who:
(a) Is a licensed dentist in Oregon;
(b) Holds a current Advanced Cardiac Life Support
(ACLS) Certificate or Pediatric Advanced Life Support (PALS) Certificate,
whichever is appropriate for the patient being sedated; and
(c) Satisfies one of the following criteria:
(A) Completion of an advanced training program in
anesthesia and related subjects beyond the undergraduate dental curriculum that
satisfies the requirements described in the ADA Guidelines for Teaching Pain
Control and Sedation to Dentists and Dental Students (2007) consisting of a
minimum of 2 years of a postgraduate anesthesia residency at the time training
was commenced.
(B) Completion of any ADA accredited postdoctoral
training program, including but not limited to Oral and Maxillofacial Surgery,
which affords comprehensive and appropriate training necessary to administer
and manage general anesthesia, commensurate with these Guidelines.
(C) In lieu of these requirements, the Board may accept
equivalent training or experience in general anesthesia.
(2) The following facilities, equipment and drugs shall
be on site and available for immediate use during the procedure and during
recovery:
(a) An operating room large enough to adequately
accommodate the patient on an operating table or in an operating chair and to
allow an operating team of at least three individuals to freely move about the
patient;
(b) An operating table or chair which permits the
patient to be positioned so the operating team can maintain the patient's
airway, quickly alter the patient's position in an emergency, and provide a
firm platform for the administration of basic life support;
(c) A lighting system which permits evaluation of the
patient's skin and mucosal color and a backup lighting system of sufficient
intensity to permit completion of any operation underway in the event of a
general power failure;
(d) Suction equipment which permits aspiration of the
oral and pharyngeal cavities and a backup suction device which will function in
the event of a general power failure;
(e) An oxygen delivery system with adequate full face
mask and appropriate connectors that is capable of delivering high flow oxygen
to the patient under positive pressure, together with an adequate backup
system;
(f) A nitrous oxide delivery system with a fail-safe
mechanism that will insure appropriate continuous oxygen delivery and a
scavenger system;
(g) A recovery area that has available oxygen, adequate
lighting, suction and electrical outlets. The recovery area can be the
operating room;
(h) Sphygmomanometer, precordial/pretracheal
stethoscope or capnograph, pulse oximeter, electrocardiograph monitor (ECG),
automated external defibrillator (AED), oral and nasopharyngeal airways,
laryngeal mask airways, intravenous fluid administration equipment; and
(i) Emergency drugs including, but not limited to:
pharmacologic antagonists appropriate to the drugs used, vasopressors,
corticosteroids, bronchodilators, intravenous medications for treatment of
cardiac arrest, narcotic antagonist, antihistaminic, antiarrhythmics,
antihypertensives and anticonvulsants.
(3) No permit holder shall have more than one person
under general anesthesia, deep sedation, moderate sedation, minimal sedation or
nitrous oxide sedation at the same time.
(4) During the administration of deep sedation or
general anesthesia, and at all times while the patient is under deep sedation
or general anesthesia, an anesthesia monitor and one other person holding a
Health Care Provider BLS/CPR level certificate, or its equivalent, shall be
present in the operatory in addition to the dentist performing the dental
procedures.
(5) Before inducing deep sedation or general anesthesia
the dentist who induces deep sedation or general anesthesia shall:
(a) Evaluate the patient and document, using the
American Society of Anesthesiologists Patient Physical Status Classifications,
that the patient is an appropriate candidate for general anesthesia or deep
sedation;
(b) Give written preoperative and postoperative
instructions to the patient or, when appropriate due to age or psychological
status of the patient, the patient's guardian; and
(c) Obtain written informed consent from the patient or
patient's guardian for the anesthesia.
(6) A patient under deep sedation or general anesthesia
shall be visually monitored at all times, including recovery phase. A dentist
who induces deep sedation or general anesthesia or anesthesia monitor trained
in monitoring patients under deep sedation or general anesthesia shall monitor
and record the patient's condition on a contemporaneous record.
(7) The patient shall be monitored as follows:
(a) Patients must have continuous monitoring of their
heart rate, heart rhythm, oxygen saturation levels and respiration. The
patient's blood pressure, heart rate and oxygen saturation shall be assessed
every five minutes, and shall be contemporaneously documented in the patient
record. The record must also include documentation of preoperative and
postoperative vital signs, all medications administered with dosages, time
intervals and route of administration. The person administering the anesthesia
and the person monitoring the patient may not leave the patient while the
patient is under deep sedation or general anesthesia;
(b) During the recovery phase, the patient must be
monitored, including the use of pulse oximetry, by an individual trained to
monitor patients recovering from general anesthesia.
(8) A dentist shall not release a patient who has
undergone deep sedation or general anesthesia except to the care of a
responsible third party.
(9) The dentist shall assess the patient's
responsiveness using preoperative values as normal guidelines and discharge the
patient only when the following criteria are met:
(a) Vital signs including blood pressure, pulse rate
and respiratory rate are stable;
(b) The patient is alert and oriented to person, place
and time as appropriate to age and preoperative psychological status;
(c) The patient can talk and respond coherently to
verbal questioning;
(d) The patient can sit up unaided;
(e) The patient can ambulate with minimal assistance;
and
(f) The patient does not have nausea or vomiting and
has minimal dizziness.
(10) A discharge entry shall be made in the patient's
record by the dentist indicating the patient's condition upon discharge and the
name of the responsible party to whom the patient was discharged.
(11) After adequate training, an assistant, when
directed by a dentist, may introduce additional anesthetic agents to an
infusion line under the direct visual supervision of a dentist.
(12) Permit renewal. In order to renew a General
Anesthesia Permit, the permit holder must provide documentation of having
current ACLS or PALS certification and complete 14 hours of continuing
education in one or more of the following areas every two years: deep sedation
and/or general anesthesia, physical evaluation, medical emergencies, monitoring
and the use of monitoring equipment, pharmacology of drugs and agents used in
anesthesia. Training taken to maintain current ACLS or PALS certification may
be counted toward this requirement. Continuing education hours may be counted
toward fulfilling the continuing education requirement set forth in OAR
818-021-0060.
[Publications: Publications
referenced are available from the agency.]
Stat. Auth.: ORS 679
Stats. Implemented: ORS 679.250(7)
& 679.250(10)
Hist.: OBD 2-1998, f. 7-13-98,
cert. ef. 10-1-98; OBD 6-1999, f. 6-25-99, cert. ef. 7-1-99; Administrative
correction 8-12-99; OBD 2-2000(Temp), f. 5-22-00, cert. ef. 5-22-00 thru
11-18-00; Administrative correction 6-21-01; OBD 3-2003, f. 9-15-03, cert. ef.
10-1-03; OBD 1-2005, f. 1-28-05, cert. ef. 2-1-05; OBD 1-2010, f. 6-22-10,
cert. ef. 7-1-10; OBD 2-2011(Temp), f. 5-9-11, cert. ef. 6-1-11 thru 1-27-11
Notes
1.) This online version of the OREGON BULLETIN is provided for convenience of reference and enhanced access. The official, record copy of this publication is contained in the original Administrative Orders and Rulemaking Notices filed with the Secretary of State, Archives Division. Discrepancies, if any, are satisfied in favor of the original versions. Use the OAR Revision Cumulative Index found in the Oregon Bulletin to access a numerical list of rulemaking actions after November 15, 2010.
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