4715-5-05 Use of general anesthesia and deep sedation.

(A) No dentist shall administer general anesthesia or deep sedation in the state of Ohio unless such dentist possesses a permit of authorization issued by the Ohio state dental board or has made application for such permit and, based on a credentials review, is notified that a formal evaluation as outlined in paragraph (C) of this rule is pending. The dentist holding such permit shall be subject to review and such permit must be renewed biennially.

(B) In order to receive such permit, the dentist must apply on a prescribed application form to the Ohio state dental board, submit the application fee, and produce evidence showing that he or she:

(1) Has completed an approved, accredited post-doctoral training program which affords appropriate training necessary to administer deep sedation and general anesthesia; and/or

(2) Has completed an approved Accreditation council for graduate medical education (ACGME) accredited post-doctoral training program in anesthesiology which affords appropriate training necessary to administer deep sedation and general anesthesia: and/or

(3) Has completed a minimum of one year advanced clinical training in anesthesiology from a Joint commission on accreditation of healthcare organization (JCAHO) accredited institution that meets the objectives set forth in part two of the American dental association's "Guidelines for Teaching the Comprehensive Control of Anxiety and Pain in Dentistry"; and

(4) Has a properly equipped facility(s), whether fixed, mobile, or portable, for the administration of general anesthesia or deep sedation in which the permit holder agrees to have available and utilize adequate monitoring, personnel, emergency equipment and drugs as recommended in the American dental association's "Guidelines for the Use of Conscious Sedation, Deep Sedation and General Anesthesia for Dentists" and/or the American association of oral and maxillofacial surgeon's "Office Anesthesia Evaluation Manual"; and

(5) At the time of application maintains successful completion of an advanced cardiac life support course, or its age appropriate equivalent; and

(6) Maintains a permanent address within the state of Ohio in which he or she conducts business pursuant to his or her Ohio dental license.

(C) Prior to the issuance of such permit, the Ohio state dental board shall require an on-site evaluation of the facility(s), equipment, personnel, anesthetic techniques, and related document(s) to determine if the aforementioned requirements have been met. This evaluation shall be conducted by a qualified consultant appointed by the Ohio state dental board and will follow the American dental association's "Guidelines for the Use of Conscious Sedation, Deep Sedation and General Anesthesia for Dentists" and/or the American association of oral and maxillofacial surgeon's "Office Anesthesia Evaluation Manual". In the case of a mobile or portable facility, one inspection of that facility shall be conducted in the office of an Ohio licensed dentist where deep sedation or general anesthesia is administered. A written list of all monitors, emergency equipment, and other materials which the mobile anesthesia provider agrees to have available at all times while administering conscious sedation, deep sedation, and general anesthesia in multiple locations shall be provided to the Ohio state dental board. The applicant shall be responsible for the cost of this evaluation not to exceed four hundred dollars.

(D) In the event the Ohio state dental board deems the application or evaluation unsatisfactory, a written explanation documenting deficiencies and suggested remedies shall be forwarded to the applicant within fourteen days. The board may issue a permit based on documentation that deficiencies have been corrected; or the board may require a formal re-evaluation; or the applicant may request an appearance before the board to address the documented deficiencies.

(E) The board shall without charge renew the general anesthesia permit biennially at the time of dental licensure renewal, provided the permit holder attests to the Ohio state dental board that he or she has maintained successful completion of a basic life support course, and maintains successful completion of a course in advanced cardiac life support or its age appropriate equivalent, or a minimum of six hours of board approved continuing education devoted specifically to the management and/or prevention of emergencies associated with general anesthesia/deep sedation. The board shall renew the permit unless the permit holder is informed in writing that a reevaluation, as described in paragraph (C) of this rule, of his or her facility(s) and/or methods, is to be required. In determining whether such reevaluation is necessary, the board shall consider such factors as it deems pertinent including, but not limited to, patient complaints, reports of adverse occurrences, and random quality assurance audits. Such quality assurance audit(s), may include, but are not limited to, a review of documentation of pre-anesthetic evaluation(s), anesthetic and recovery records, and documentation of appropriateness for discharge. The permit holder shall be responsible for any costs incurred in a formal reevaluation, not to exceed four hundred dollars.

(F) A dentist holding a general anesthesia permit may supervise a certified registered nurse anesthetist for any anesthetic procedure for which the dentist is qualified.

(G) All permit holders shall provide written notification within ten days to the Ohio state dental board if anesthesia services are provided at any new facility(s) other than those already listed with the Ohio state dental board.

(H) No dentist, without personally obtaining a general anesthesia permit, may employ or work in conjunction with a general anesthesia/deep sedation provider in an out-patient dental facility unless that anesthesia provider is a dentist holding a valid general anesthesia permit under rule 4715-5-05 of the Administrative Code or an Ohio licensed physician who has successfully completed graduate medical education, as defined in section 4731.091 of the Revised Code, in the field of anesthesiology, provided that such physician maintains successful completion of advanced cardiac life support whenever general anesthesia or deep sedation is provided in a dental facility. The general anesthesia/deep sedation provider, whether a dentist or physician, must remain on the premises of the dental facility until any patient given a general anesthetic or deep sedation regains consciousness and has adequately recovered. The operating dentist shall provide advanced written notice to the Ohio state dental board that general anesthesia/deep sedation services are provided at his or her facility by a physician anesthesiologist. Failure to comply with paragraph (H) of this rule when the general anesthesia/deep sedation provider is a physician may result in disciplinary action against the operating dentist.

(I) Reference materials for paragraphs (B)(3), (B)(4), and (C) of this rule may be found at the following addresses:

(1) American dental association: 211 E. Chicago Avenue, Chicago, Illinois, 60611-2678; telephone - 312-440-2500; facsimile - 312-440-2800; internet website address - www.ada.org.

(2) American association of oral and maxillofacial surgeons: 9700 West Bryn Mawr Avenue, Rosemont, Illinois, 60018-5701; telephone - 847-678-6200 or 800-822-6637; facsimile - 847-678-6286; internet website address -www.aaoms.org.

Effective: 04/02/2010
R.C. 119.032 review dates: 12/29/2009 and 01/30/2015
Promulgated Under: 119.03
Statutory Authority: 4715.03
Rule Amplifies: 4715.13
Prior Effective Dates: 8-1-74; 10-1-88; 3-3-95; 4-27-98; 5-15-03; 4-7-05