03/28/2024

IMPORTANT: New Ohio Dental Board Rules take effect on April 1, 2024

For a printable version (PDF) of this email click here:  Anesthesia Rules 4 1 2024

You will have an opportunity to learn more about these new rules during the OSOMS Business Meeting Luncheon at the Annual Meeting on Saturday, April 13  

Dear Dental Anesthesia Permit Holders and Applicants,

The Ohio State Dental Board, with participation and input from Ohio’s professional societies, dentists, and interested citizens, has adopted new Rules governing:

• Permits for moderate sedation (formerly conscious sedation) (OAC 4715-5-07), for

• patients age 13 and older,
• patients under age 13, or,
• both age groups;

• Permits for general anesthesia (including deep sedation) (OAC 4715-5-05), for all patient
ages; and

• Definitions of terms related to anesthesia/sedation (OAC 4715-3-01)

The new Rules reflect current national guidelines, scientific advances, and safety practices. This email is to inform you that the new Rules will take effect on April 1, 2024. You are very strongly encouraged to read the new Rules in their entirety. As always, familiarity with all dental laws and rules is required. While similar to the existing rules in many ways, the new Rules contain both modifications and some entirely new responsibilities for dental anesthesia providers. A few of the most important changes are referenced in this email and the Highlights document which follows, but dentists must be familiar with the complete Rules, including details not mentioned here.

Thank you for your attention to this important matter. The new Rules are available on the Ohio State Dental Board website and can also be accessed by the above hyperlinks. Please familiarize yourself with the new rules, including the following highlights applicable to your current permit. On behalf of the Ohio State Dental Board, thank you for your continued professionalism and service to the people of Ohio and beyond.

Sincerely,
Dr. Gregory M. Ness, DDS, FACS
Anesthesia Consultant, Ohio State Dental Board

IF YOU ARE PRACTICING UNDER PROVISIONAL PRIVILEGES

Provisional Privileges: The former and new rules permit a period of up to one year to complete an office evaluation and obtain a renewable permit. Since the COVID pandemic and recovery, the Board has been generous in approving extensions, but this practice will now end. If you have provisional privileges, please complete your office evaluation as soon as possible, before your provisional privileges expire. In unusual circumstances the Board may consider an extension, but an extension request must be made at least 90 days before provisional privileges expire or the request may not be considered.

FOR ALL PERMIT TYPES

New, Separate Permit Reapplication Process: Beginning with the next licensure renewal cycle, anesthesia permits will no longer be renewed as part of dental license renewal but will be a separate process on the Ohio eLicense website. Further details will be forthcoming from the Board.

Basic Life Support for Healthcare Professionals (BLS-HCP): The Board will continue to accept current certification in Advanced Cardiac Life Support (ACLS) or Pediatric Advanced Life Support (PALS) as evidence of BLS skills for the relevant patient age group. Those skills are prerequisite to completing certification in the advanced courses, so separate certification is not necessary. Providers and staff who must have BLS but who are not certified in ACLS or PALS must obtain BLS certification in the Healthcare Professional track (BLS-HCP), not CPR certification intended for the lay public.

MODERATE SEDATION HIGHLIGHTS

Next Renewal of Current Sedation Permits is NOT Automatic: To renew, current sedation permit holders who were not trained in sedation as part of an accredited predoctoral or residency program will be required to attest to continued experience and submit evidence of at least 20 successful cases in each intended patient age range, whether:

(1) patients age thirteen and over.
(2) patients age twelve years or younger.
(3) both (forty cases total).

Attestation and supporting evidence (case logs) will be due before April 1, 2025. Logged cases may be from up to THREE years before the date of attestation. Further details on this process will follow later this spring.

Simulated Emergency Drills: Anesthesia providers must perform and log anesthesia team participation in emergency drills at least quarterly. Over the course of each year, these drills must include all emergency scenarios listed in the rule. For offices where anesthesia is used infrequently, particularly those which use the services of a mobile anesthesia provider, this requirement may be met by performing emergency drills for all the specific scenarios immediately before beginning anesthesia for an actual patient.

GENERAL ANESTHESIA HIGHLIGHTS

Simulated Emergency Drills: Anesthesia providers must perform and log anesthesia team participation in emergency drills at least quarterly. Over the course of each year, these drills must include all emergency scenarios listed in the rule.

Anesthesia Team: For patients age 8 and over, the required team of 3 persons is similar to previous rules. For patients under age 8, the anesthesia provider may not be involved in performing the dental procedure. Exception: the anesthesia provider may also perform the dental procedure if he or she possesses a log of providing deep sedation or general anesthesia for patients under age 8 for a minimum of 20 cases in the previous year, or 40 cases in the previous two years.

Highlights of Ohio’s New Dental Anesthesia and Sedation Rules
Dr. Gregory M. Ness, DDS, FACS
Anesthesia Consultant, Ohio State Dental Board

On April 1, 2024, newly revised Anesthesia and Sedation Rules will go into effect in the Ohio Administrative Code (OAC) as part of Ohio’s Dental Practice Act. These changes were adopted by the Ohio State Dental Board (Board) after receiving input from Ohio’s professional societies, dentists, and interested citizens. The new rules reflect current national guidelines, scientific advances, and improved safety practices. Additionally, these rules reflect a shift from a focus on the route of administration of anesthesia to a recognition that there is an anesthesia continuum which represents a spectrum encompassing analgesia, local anesthesia, sedation, and general anesthesia. The location on the continuum defines the level of anesthesia administered.

These updated rules govern:
 Use of General Anesthesia and Deep Sedation – OAC 4715-5-05
 Use of Moderate Sedation – OAC 4715-5-07
 Definitions – OAC 4715-3-01 (specifically related to Anesthesia/Sedation terms)

Additionally, OAC 4715-5-06, the rule pertaining to Reports of Adverse Occurrences, has also been amended as part of this package of rules which were reviewed by the Ohio General Assembly’s Joint Committee on Agency Rule Review (JCARR).

(Please note - the hyperlinks for the rules provided in this article go to copies of the rules as they will be on the effective date. These new rules can also be found on the Laws & Rules page of the Board’s website (https://dental.ohio.gov/about/laws-and-rules). The Ohio Administrative Code maintained online by the Ohio Legislative Service Commission reflects the current rules and will not be updated to reflect the new rules until April 1, 2024. As always, familiarity with all dental laws and rules is required. This informational bulletin highlights most of the important changes, but dentists with or seeking permits must be familiar with the complete rules, including details that may not be mentioned here.)

Highlights of Permit Changes

• Conscious Sedation Permits will now be known as Moderate Sedation Permits.
  
  
• Two Versions of Moderate Sedation Permits will be available – one applicable for
  sedating patients aged thirteen (13) and over (MS), and another one with a pediatric
  endorsement (MSP) for sedating patients under the age of thirteen (13). Dentists can
  apply for and receive either or both types of Moderate Sedation Permits. As always, a
  holder of a General Anesthesia Permit (GA) may administer moderate sedation without
  a Moderate Sedation Permit.
  
  
• Current certification in PALS (Pediatric Advanced Life Support) will now be required for
  anesthesia providers when treating very young patients – under eight (8) years of age –
  with deep sedation or general anesthesia. For all MSP holders, obtaining and
  maintaining PALS will be required.
  
  
• The rule for Moderate Sedation expands acceptable continuing education providers to
  now include those approved by either the American Dental Association Commission for
  Continuing Education Provider Recognition (ADA CCEPR) or the Academy of General
  Dentistry Program Approval for Continuing Education Council (AGD PACE).
  
  
• Current Conscious Sedation Permit holders who did not complete a comprehensive
  predoctoral or advanced dental education program and who desire to continue to use
  sedation and receive a Moderate Sedation Permit (MS) and/or a Moderate Sedation
  Permit with a pediatric endorsement (MSP) shall submit to the Board by April 1, 2025, an
  attestation along with evidence of successfully administering sedation to a minimum
  number of age-appropriate patients within the preceding three (3) years. The Board’s
  licensing staff will contact each Conscious Sedation Permit holder via email with
  regards to submitting materials for this review process. More details about the review
  process will be shared at a later date.
  
  
• Quarterly Emergency Drills will now be required for all anesthesia and sedation permit
  holders to renew the permits each biennium. Certain simulated emergency scenarios
  will need to be conducted annually and documented as part of these drills.

eLicense Changes

In the coming year, along with ongoing changes to the state’s licensing system (eLicense) and to accommodate the new rules, existing anesthesia and sedation permits will be given new identifiers with prefixes to reflect whether the permit is a GA, MS, or MSP type. The anesthesia and sedation permits will still be required to renew biennially at the same renewal time as the Dentist’s license. While there still will be no cost for renewing an anesthesia or sedation permit, the online renewal will be separate from the renewal of the Dental license. As such, the renewal process will now mimic how the Teledentistry and Oral Health Access Supervision Permits are handled.

To accommodate the changes in the eLicense system, no new initial applications for anesthesia and sedation permits will be able to be filed between April 1st and April 18th. On April 18th, first-time applicants will be able to file applications online through eLicense for new General Anesthesia Permits (GA), Moderate Sedation Permits (MS), and Moderate Sedation Permits – Pediatric (MSP). Dentists seeking to apply for any of the anesthesia and sedation permits will find the applications listed online in eLicense akin to the other licenses and permits offered by the Ohio State Dental Board.

The initial application fee for each permit will remain $127. However, the accompanying fee for the onsite evaluation for Moderate Sedation Permit applicants, MS and MSP, will increase from $200 to $400 to be on par with the current fee for those applying for General Anesthesia Permits. Evaluation fees are passed along to the Dentist evaluators who serve the Board as qualified consultants.