64B5-14.003. Training, Education, Certification, and Requirements for Issuance of Permits  


Effective on Monday, November 13, 2017
  • 1(1) General Anesthesia Permit.

    5(a) A permit shall be issued to an actively licensed dentist authorizing the use of general anesthesia or deep sedation at a specified practice location or locations on an outpatient basis for dental patients provided the dentist:

    421. Has completed a minimum of a two year residency program accredited by the Commission on Dental Accreditation in dental anesthesiology or has completed an oral and maxillofacial surgical residency program accredited by the Commission on Dental Accreditation beyond the undergraduate dental school level, or

    872. Is a diplomate of the American Board of Oral and Maxillofacial Surgery, or

    1013. Is eligible for examination by the American Board of Oral and Maxillofacial Surgery, or

    1164. Is a member of the American Association of Oral and Maxillofacial Surgeons.

    129(b) A dentist employing or using general anesthesia or deep sedation shall maintain a properly equipped facility for the administration of general anesthesia, staffed with supervised assistant/dental hygienist personnel, capable of reasonably handling procedures, problems and emergencies incident thereto. The facility must have the equipment capability of delivering positive pressure oxygen ventilation. Administration of general anesthesia or deep sedation requires at least three individuals, each appropriately trained: the operating dentist, a person responsible for monitoring the patient, and a person to assist the operating dentist.

    214(c) A dentist employing or using general anesthesia or deep sedation and all assistant/dental hygienist personnel shall be certified in an American Heart Association or American Red Cross or equivalent Agency sponsored cardiopulmonary resuscitation course at the basic life support level to include one person CPR, two person CPR, infant resuscitation and obstructed airway, with a periodic update not to exceed two years. Starting with the licensure biennium commencing on March of 2000, a dentist and all assistant/dental hygienist personnel shall also be trained in the use of either an Automated External Defibrillator or a defibrillator and electrocardiograph as part of their cardiopulmonary resuscitation course at the basic life support level. In addition to CPR certification, a dentist utilizing general anesthesia or deep sedation must be currently trained in ACLS (Advanced Cardiac Life Support) or ATLS (Advanced Trauma Life Support).

    354(d) A dentist permitted to administer general anesthesia or deep sedation under this rule may administer moderate sedation and nitrous-oxide inhalation moderate sedation.

    377(e) A dentist employing or using deep sedation shall maintain an active and current permit to perform general anesthesia.

    396(2) Moderate Sedation Permit.

    400(a) A permit shall be issued to a dentist authorizing the use of moderate sedation at a specified practice location or locations on an outpatient basis for dental patients provided such dentist:

    4321. Has received formal training in the use of moderate sedation; and,

    4442. Is certified by the institution where the training was received to be competent in the administration of moderate sedation; and,

    4653. Is competent to handle all emergencies relating to moderate sedation.

    476(b) Such certification shall specify the type, the number of hours, the number of patients treated and the length of training. The minimum number of didactic hours shall be sixty, which must include four (4) hours of airway management. Airway management must include emergency airway management protocols. Clinical training shall include personal administration for at least twenty patients including supervised training, clinical experience and demonstrated competence in airway management of the compromised airway. The program must certify that a total of three (3) hours of clinical training was dedicated to hands-on simulated competence in airway management of the compromised airway.

    576(c) 577Personal Administration of Moderate Sedation: The board shall award credit towards the required 20 dental patients, if and only if, the applicant is responsible for and remains with the patient from pre-anesthetic evaluation through discharge. The evaluation and responsibilities include the following: pre-anesthetic evaluation, induction, maintenance, emergence, recovery, and approval for discharge. The board will not award credit for dental anesthetic procedures performed that are greater than or less than the administration of moderate sedation.

    652(d) This formal training program shall be offered through an accredited dental school or program; or through an accredited, teaching hospital.

    673(e) A dentist utilizing moderate sedation shall maintain a properly equipped facility for the administration of moderate sedation, staffed with supervised assistant/dental hygienist personnel, capable of reasonably handling procedures, problems, and emergencies incident thereto. The facility must have the equipment capability of delivering positive pressure oxygen ventilation. Administration of moderate sedation requires at least two individuals: a dentist, and an auxiliary trained in basic cardiac life support. It shall be incumbent upon the operating dentist to ensure that the patient is appropriately monitored.

    756(f) A dentist utilizing moderate sedation and his assistant/dental hygienist personnel shall be certified in an American Heart Association or American Red Cross or equivalent agency sponsored cardiopulmonary resuscitation course at the basic life support level to include one person CPR, two person CPR, infant resuscitation, and obstructed airway with a periodic update not to exceed two years. Starting with the licensure biennium commencing on March of 2000, a dentist and all assistant/dental hygienist personnel shall also be trained in the use of either an Automated External Defibrillator or a defibrillator and electrocardiograph as part of their cardiopulmonary resuscitation course at the basic life support level. In addition to CPR certification, a dentist utilizing moderate sedation must be currently trained in ACLS (Advanced Cardiac Life Support) or ATLS (Advanced Trauma Life Support).

    888(g) Dentists permitted to administer moderate sedation may administer nitrous-oxide inhalation moderate sedation.

    901(h) Dentists permitted to administer moderate sedation may administer pediatric moderate sedation in compliance with Rule 91764B5-14.010, 918F.A.C.

    919(3) Pediatric Moderate Sedation Permit.

    924(a) A permit shall be issued to a dentist authorizing the use of pediatric moderate sedation at a specified practice location or locations on an outpatient basis for dental patients provided such dentist:

    9571. Has received formal training in the use of pediatric moderate sedation. This formal training program shall be offered through an accredited dental school or program; or through an accredited teaching program; and,

    9902. Is certified by the institution where the training was received to be competent in the administration of pediatric moderate sedation. This certification shall specify the type, the number of hours, the number of patients treated and the length of training. The minimum number of didactic hours shall be sixty, which must include four (4) hours of airway management. Clinical training shall include personal administration for at least twenty patients including supervised training, management of sedation, clinical experience and demonstrated competence in airway management of the compromised airway. The program must certify that three (3) hours of clinical training was dedicated to hands-on simulated competence in airway management of the compromised airway; and,

    11033. 1104Personal Administration of Pediatric Moderate Sedation: The board shall award credit towards the required 20 dental patients, if and only if, the applicant is responsible for and remains with the patient from pre-anesthetic evaluation through discharge. The evaluation and responsibilities include the following: pre-anesthetic evaluation, induction, maintenance, emergency, recovery, and approval for discharge. The board will not award credit for dental anesthetic procedures performed that are greater than or less than the administration of pediatric moderate sedation, or

    11824. The applicant demonstrates that the applicant graduated, within 24 months prior to application for the permit, from an accredited post-doctoral pediatric residency. The pediatric residency anesthesia requirements must meet the minimum number of sedation cases as required in subsection (2).

    12235. Is competent to handle all emergencies relating to pediatric moderate sedation. A dentist utilizing pediatric moderate sedation shall maintain a properly equipped facility for the administration of pediatric moderate sedation, staffed with supervised assistant/dental hygienist personnel, capable of reasonably handling procedures, problems, and emergencies incidental thereto. The facility must have the equipment capability of delivering positive pressure oxygen ventilation. Administration of pediatric moderate sedation requires at least two individuals: a dentist, and an auxiliary trained in basic cardiac life support. It shall be incumbent upon the operating dentist to ensure that the patient is appropriately monitored.

    1320(b) A dentist utilizing pediatric moderate sedation and his assistant/dental hygienist personnel shall be certified in an American Heart Association or American Red Cross or equivalent agency sponsored cardiopulmonary resuscitation course at the basic life support level to include one person CPR, two person CPR, infant resuscitation, and obstructed airway with a periodic update not to exceed two years. Starting with the licensure biennium commencing on March of 2000, a dentist and all assistant/dental hygienist personnel shall also be trained in the use of either an Automated External Defibrillator or a defibrillator and electrocardiograph as part of their cardiopulmonary resuscitation course at the basic life support level. In addition to CPR certification, a dentist utilizing pediatric moderate sedation must be currently trained in ACLS (Advanced Cardiac Life Support), PALS (Pediatric Advanced Life Support), or a course providing similar instruction which has been approved by the Board. An entity seeking approval of such a course shall appear before the Board and demonstrate that the content of such course and the hours of instruction are substantially equivalent to those in an ACLS or PALS course.

    1503(c) Dentists permitted to administer pediatric moderate sedation may administer nitrous-oxide inhalation moderate sedation.

    1517(d) Dentists permitted to administer moderate sedation may administer pediatric moderate sedation.

    1529(4) Nitrous-Oxide Inhalation Analgesia.

    1533(a) A dentist may employ or use nitrous-oxide inhalation analgesia on an outpatient basis for dental patients provided such dentist:

    15531. Has completed no less than a two-day course of training as described in the American Dental Association’s “Guidelines for Teaching and Comprehensive Control of Pain and Anxiety in Dentistry” or its equivalent, or

    15872. Has training equivalent to that described above while a student in an accredited school of dentistry; and,

    16053. Has adequate equipment with fail-safe features and a 25% minimum oxygen flow.

    1618(b) A dentist utilizing nitrous-oxide inhalation analgesia and such dentist’s assistant/dental hygienist personnel shall be certified in an American Heart Association or American Red Cross or equivalent Agency sponsored cardiopulmonary resuscitation course at the basic life support level to include one man CPR, two man CPR, infant resuscitation and obstructed airway with a periodic update not to exceed two years. Starting with the licensure biennium commencing on March of 2000, a dentist and all assistant/dental hygienist personnel shall also be trained in the use of either an Automated External Defibrillator or a defibrillator and electrocardiograph as part of their cardiopulmonary resuscitation course at the basic life support level. In addition to CPR certification, a dentist utilizing pediatric moderate sedation must be currently trained in ACLS (Advanced Cardiac Life Support), ATLS (Advanced Trauma Life Support), or PALS (Pediatric Advanced Life Support).

    1758(c) A dentist who regularly and routinely utilized nitrous-oxide inhalation analgesia on an outpatient basis in a competent and efficient manner for the three-year period preceding January 1, 1986, but has not had the benefit of formal training outlined in subparagraphs 1. and 2., of paragraph (4)(a), above, may continue such use provided the dentist fulfills the provisions set forth in paragraph 3., of paragraph (4)(a), and the provisions of paragraph (b), above.

    1831(d) Nitrous oxide may be used in combination with a single dose enteral sedative or a single dose narcotic analgesic to achieve a minimally depressed level of consciousness so long as the manufacturer’s maximum recommended dosage of the enteral agent is not exceeded. Nitrous oxide may not be used in combination with more than one (1) enteral agent, or by dosing a single enteral agent in excess of the manufacturer’s maximum recommended dosage unless the administering dentist holds a moderate sedation permit issued in accordance with subsection 191864B5-14.003(2), 1919F.A.C., or a pediatric moderate sedation permit issued in accordance with Rule 193164B5-14.010, 1932F.A.C.

    1933(5) Local Anesthesia Certificate or Permit: A permit or certificate to administer local anesthesia under the direct supervision of a Florida licensed dentist to non-sedated patients eighteen (18) years of age or older shall be issued by the Department of Health to a Florida licensed dental hygienist who has completed the appropriate didactic and clinical education and experience as required by Section 1995466.017(5), F.S., 1997and who has been certified by the Board as having met all the requirements of Section 2013466.017, F.S.

    2015(a) A registered dental hygienist who is seeking a permit or certificate for administering local anesthesia must apply to the department on form DH-MQA 1261 (May 2012), Application for Dental Hygiene Certification Administration of Local Anesthesia, herein incorporated by reference and available at 2058http://www.flrules.org/Gateway/reference.asp?No=Ref-01469, 2060or available on the Florida Board of Dentistry website at http://www.doh.state.fl.us/mqa/dentistry.

    2071(b) An applicant shall submit the following with the application:

    20811. A thirty-five dollar ($35) non refundable certificate or permit fee,

    20922. A certified copy of the applicant’s transcripts that reflect the required didactic and clinical education and experience,

    21103. A certified copy of the diploma or certificate issued by the applicant’s institution, program, or school; and,

    21284. Proof of acceptable certification in Cardiopulmonary Resuscitation for health professionals or Advanced Cardiac Life Support as defined in Section 2148466.017, F.S.

    2150Rulemaking Authority 2152466.004(4), 2153466.017(3), 2154(6) FS. Law Implemented 2158466.017(3), 2159(4), (5), (6) FS. History–New 1-31-80, Amended 4-20-81, 2-13-86, Formerly 21G-14.03, Amended 12-31-86, 11-8-90, 2-1-93, Formerly 21G-14.003, Amended 12-20-93, Formerly 61F5-14.003, Amended 8-8-96, 10-1-96, Formerly 59Q-14.003, Amended 2-17-98, 12-20-98, 5-31-00, 6-7-01, 11-4-03, 6-23-04, 6-11-07, 2-8-12, 8-16-12 (1)(a)-(f), 8-16-12 (5), 8-19-13, 12-16-13, 3-9-14, 7-14-16, 11-13-17.

     

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