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New Jersey State Board of Dentistry Frequently Asked Questions - Enteral Sedation Permits



  1. What is covered under the new regulation?

    The new rule defines enteral sedation to include the prescription or administration of one or more pharmacological agents, used for the purpose of causing a depressed level of consciousness, but not a loss of consciousness. Pharmacological agents include any nonparenteral agent, but do not include any agent that is introduced by intravenous, intramuscular, subcutaneous, submucosal or inhalation routes, including nitrous oxide inhalation.
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  2. When is the new rule effective?

    The regulation became effective upon its adoption on September 6, 2005. As of July 1, 2006, any New Jersey dentists who wish to administer any pharmacological agent in any dose for the purpose of inhibiting patient response beyond diminishing patient anxiety must possess an enteral sedation permit. The Board will consider applications beginning in the first quarter of 2006.
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  3. I advertise "Sleep Dentistry." May I continue to do so after I get permit?

    No. The use of this term (and those below) is prohibited effective with the adoption of the new rule, unless a dentist holds a General Anesthesia (G.A.) permit. The Board is aware that some dentists have been advertising the provision of "sleep dentistry" services as a way for very apprehensive patients to undergo dental procedures. Patients are sedated and placed in a very "sleep-like" state prior to the start of the dental services and are "awakened," or brought out of this sedated state, once the procedures have been completed. The Board believes that some dentists who advertise or offer "sleep dentistry" services and are placing patients under deep sedation in order to achieve the desired sleep-like state, are doing so without the benefit of a G.A. permit. If a patient is going to be placed under deep sedation, which is necessary if a "sleep-like" state is the desired effect, the Board believes that the dentist must possess a G.A. permit in order to properly handle any untoward reaction the patient may experience during the procedure. The new regulation provides that a dentist who uses or advertises the terms "sleep," "sleep dentistry," or "sleep-like state," or any other similar words, in connection with the provision of dental services, will be considered to be inducing deep sedation. Such a dentist must possess a G.A. permit.
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  4. How does the Board define "deep sedation?"

    The term "deep sedation" is defined to mean the administration of pharmacological and/or nonpharmacological agents, or a combination of the two, to induce a state of depressed consciousness in a patient, which is accompanied by a partial loss of protective reflexes, including the inability of the patient to continually maintain an airway independently and/or to respond purposefully to painful physical stimulation or verbal command. The new rules prohibit a dentist from administering, dispensing or prescribing any pharmacological agent which will cause a patient to lapse into this type of sedation unless the dentist possesses a G.A. permit issued by the Board. The Board believes that the risks associated with this type of sedation are such that only those dentists who are properly trained in the administration of general anesthesia, and have satisfied the requirements necessary to obtain a G.A. permit, should be authorized to employ it in their dental practices.
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  5. Sometimes I prescribe a dose of medication to control anxiety before a patient visit. Am I required to hold a permit?

    No. The new rule only applies to the administration of pharmacological agents with the purpose of inhibiting patient response beyond diminishing patient anxiety.
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  6. What kind of training is required for the issuance of an enteral sedation permit?

    A dentist applying for this new permit must submit certification verifying that the dentist has completed Board-approved postdoctoral course work at an accredited dental school, or in a college or university clinical setting, which has prepared the applicant to administer enteral sedation safely and effectively. The course work must consist of a minimum of 40 hours of didactic training in basic enteral sedation, physical evaluation, recognition and management of complications and emergencies, and patient monitoring. A list of approved courses is posted on the Board's Web site.
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  7. Does the completion of a general practice, pediatric or other residency program qualify a dentist for an enteral sedation permit?

    It depends on when the program was completed. Any dentist who has completed a general practice residency or has graduated from a postdoctoral training program within three years of application will qualify for the issuance of an enteral sedation permit. A dentist completing a general practice residency or a postdoctoral training program more than three years prior to application may qualify for a permit if he or she has completed a Board-approved program of 20 hours of didactic training in enteral sedation within the three years immediately preceding the date of application. The general practice residency or postdoctoral training program must include a minimum of 60 hours of training in anesthesia or conscious sedation. The Board believes that the modifications of the course-work requirement are warranted because the training obtained by dentists who have completed a general practice residency or postdoctoral training program is comprehensive and will adequately prepare them to safely and effectively administer enteral sedation. A list of approved courses is posted at www.njconsumeraffairs.gov/dentistry/esplist.htm.
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  8. Are permits renewable?

    Enteral sedation permits are renewed every two years.
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  9. Are there continuing education requirements to renew the permit?

    Yes. Every holder of an enteral sedation permit is required to complete at least 20 hours of continuing education in every biennial period in physiology, pharmacology, patient evaluation, patient monitoring or medical emergencies. The 20 hours of training must be completed consistent with the requirements imposed by the Board pursuant to its existing continuing education rule for dentists. The Board has determined that completion of the 20 hours of continuing education required for the maintenance of an enteral sedation permit may be counted toward satisfaction of the total number of credits required for a dentist to renew a license.
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  10. Are there exemptions for holders of G.A. and Parenteral Conscious Sedation (P.C.S.) permits?

    Holders of G.A. or P.C.S. permits are not required to hold an enteral sedation permit to administer enteral sedation. The minimum training and standards imposed by the Board for those permits are higher than they would be under an enteral sedation permit and, therefore, the Board is confident that the holders of G.A. and P.C.S. permits are already qualified to administer enteral sedation without an additional permit.
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  11. Are there any special staffing requirements when administering enteral sedation?

    Yes. The enteral sedation permit holder must certify, on the initial application and upon permit renewal, that he or she employs a licensed health care professional who is present in the office and is trained to assist in the monitoring of the patient whenever enteral sedation is employed.
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  12. Are any special supplies or equipment needed in my office?

    Yes. The regulations require the dentist to provide for appropriate monitoring of the patient during the administration of the sedation, to be prepared to manage any reasonably foreseeable complications and to be in attendance in the peratory until the patient's protective reflexes have returned and the patient is determined by the dentist to be stable and ambulatory. Therefore, it is necessary that the dentist possess basic equipment and supplies to address emergency situations. At a minimum, a permit holder's office must contain suction equipment capable of aspirating gastric contents from the mouth and pharynx; a portable oxygen delivery system; a blood pressure cuff and stethoscope; a pulse oximeter; an emergency drug kit; and back-up lighting, suction and pulse oximeter devices that can operate by means of battery or generator power.
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  13. Is there any special patient evaluation or documentation required when administering enteral sedation?

    Prior to the administration of enteral sedation the dentist is required to perform a physical evaluation of the patient and take a complete medical history, which must include the patient's medications, allergies and sensitivities. The patient history must be maintained in the patient record for at least seven years. In addition, N.J.A.C. 13:30-8.4 (l) requires that the patient record contain specific notations on the use of enteral sedation, including the type of agent, dosage, duration of the sedation, the patient's vital signs during the drug administration, and any untoward reactions the patient may have suffered.
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