(A) With the exception of nitrous oxide/oxygen inhalation conscious sedation for patients of any age and/or oral conscious sedation or anxiolysis of patients age thirteen or older, no dentist shall administer conscious sedation in the state of Ohio, in accordance with the definition of "conscious sedation," as defined in rule 4715-3-01 of the Administrative Code, unless such dentist possesses a permit of authorization 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 to the Ohio state dental board, submit the fee as established by division (E) of section 4715.13 of the Revised Code, and produce evidence showing that he or she:
(1) Has satisfactorily completed comprehensive pre-doctoral or continuing education conscious sedation training in an accredited educational institution or program, which included a minimum of sixty hours of didactic instruction and twenty cases of clinical experience commensurate with each intended route(s) of administration, whether;
(a) Oral for children twelve years or younger; or
(b) Non-intravenous parenteral; or
Training in intravenous conscious sedation qualifies the permit holder to administer any route of conscious sedation. Didactic and clinical training shall conform to the principles in part one or part three of the American dental association's "Guidelines for Teaching the Comprehensive Control of Anxiety and Pain in Dentistry", with clinical experience commensurate with the intended route of administration; or
(2) Has satisfactorily completed an accredited post-doctoral training program which included conscious sedation training equivalent to paragraph (B)(1) of this rule; or
(3) Has satisfactorily completed the qualifications governing the use of general anesthesia in rule 4715-5-05 of the Administrative Code; and
(4) Has a properly equipped facility(s), whether fixed, mobile, or portable, 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 academy of pediatric dentistry "Guidelines for the Elective Use of Conscious Sedation, Deep Sedation and General Anesthesia in Pediatric Patients"; 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 where he or she conducts business pursuant to his or her Ohio state 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, conscious sedation 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 academy of pediatric dentistry "Guidelines for the Elective Use of Conscious Sedation, Deep Sedation and General Anesthesia in Pediatric Patients". 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 conscious sedation is administered. A written list of all monitors, emergency equipment and other materials which the mobile conscious sedation provider agrees to have available at all times while administering conscious sedation in multiple locations shall be provided to the Ohio state dental board. The applicant shall be responsible for the cost of this evaluation, which will be an amount not to exceed two 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 conscious sedation 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 which may result from the use of conscious sedation. The board shall renew the permit unless the conscious sedation permit holder is informed in writing that a reevaluation as outlined 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-sedation evaluations, sedation 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 two hundred dollars.
(F) The Ohio state dental board may grant a permit authorizing the administration of conscious sedation to those Ohio licensed dentists who do not meet the qualifications outlined in paragraphs (B)(1) and (B)(2) of this rule, but who have provided conscious sedation in a safe, competent, ethical and effective manner, and who have moved to Ohio within the six months preceding his or her application, provided such dentist meets the requirements of paragraphs (B)(4), (B)(5) and (B)(6) of this rule.
(G) A dentist holding a general anesthesia permit under rule 4715-5-05 of the Administrative Code may administer conscious sedation without a conscious sedation permit.
(H) No dentist shall administer or employ any agent(s) which has a narrow margin for maintaining consciousness including, but not limited to, ultra-short acting barbiturates, propofol, parenteral ketamine, and similarly acting drugs, or quantity of agent(s), or technique(s), or any combination thereof that would likely render a patient deeply sedated, generally anesthetized or otherwise not meeting the conditions of the definition of conscious sedation as stated in paragraph (B)(5) of rule 4715-3-01 of the Administrative Code, unless he or she holds a valid general anesthesia permit issued by the Ohio state dental board.
(I) A dentist holding a valid conscious sedation permit may supervise a certified registered nurse anesthetist only for conscious sedation procedures for which the dentist is qualified.
(J) All conscious sedation permit holders shall provide written notification within ten days to the Ohio state dental board if conscious sedation services are to be provided at any new facility(s) other than those already listed with the Ohio state dental board.
(K) No dentist, without personally obtaining a conscious sedation permit, may employ or work in conjunction with a conscious sedation provider in an out-patient dental facility unless that conscious sedation provider is a dentist holding a valid general anesthesia or conscious sedation permit under rule(s) 4715-5-05 and/or 4715-5-07 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 a course in advanced cardiac life support whenever conscious sedation is provided in a dental facility. The conscious sedation provider, whether a dentist or physician, must remain on the premises of the dental facility until any patient given conscious sedation has adequately recovered. The operating dentist shall provide advanced written notification to the Ohio state dental board that conscious sedation services are provided at his or her facility by a physician anesthesiologist. Failure to comply with paragraph (K) of this rule when the conscious sedation provider is a physician may result in disciplinary action against the operating dentist.
(L) Reference materials for paragraphs (B)(1)(c), (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 academy of pediatric dentistry: 211 E. Chicago Avenue Suite 1700, Chicago, Illinois, 60611-2637; telephone -312-337-2169; facsimile - 312-337-6329; internet website address -www.aapd.org.