(1) Is a licensed dentist in West Virginia;
(2) Holds valid and current documentation showing successful completion of a Health Care Provider BLS/CPR course, ACLS and/or a PALS course if treating pediatric patients; and
(3) Satisfies one of the following criteria:
(A) Certificate of completion of a comprehensive training program in conscious sedation that satisfies the requirements described in Part III of the ADA Guidelines for Teaching the Comprehensive Control of Pain and Anxiety in Dentistry at the time training was commenced.
(B) Certificate of completion of an ADA accredited postdoctoral training program which affords comprehensive and appropriate training necessary to administer and manage conscious sedation, commensurate with these guidelines.
(C) In lieu of these requirements, the board may accept documented evidence of equivalent training or experience in conscious sedation anesthesia:
(i) Limited (Enteral) Permit (3(a)) must have a board approved course of at least eighteen hours didactic and twenty mentored clinical cases.
(ii) Comprehensive (Parenteral) Permit (3(b)) must have a board approved course of at least sixty hours didactic and twenty mentored clinical cases.
(b) A dentist who induces conscious sedation shall have the following facilities, properly maintained age appropriate equipment and age appropriate medications available during the procedures and during recovery:
(1) An operating room large enough to adequately accommodate the patient on an operating table or in an operating chair and to allow an operating team of at least two individuals to freely move about the patient;
(2) An operating table or chair which permits the patient to be positioned so the operating team can maintain the patient's airway, quickly alter the patient's position in an emergency, and provide a firm platform for the administration of basic life support;
(3) A lighting system which permits evaluation of the patient's skin and mucosal color and a backup lighting system of sufficient intensity to permit completion of any operation underway in the event of a general power failure;
(4) Suction equipment which permits aspiration of the oral and pharyngeal cavities and a backup suction device which will function in the event of a general power failure;
(5) An oxygen delivery system with adequate full face mask and appropriate connectors that is capable of delivering high flow oxygen to the patient under positive pressure, together with an adequate backup system;
(6) A nitrous oxide delivery system with a fail-safe mechanism that will insure appropriate continuous oxygen delivery and a scavenger system;
(7) A recovery area that has available oxygen, adequate lighting, suction and electrical outlets. The recovery area can be the operating room;
(8) Sphygmomanometer, pulse oximeter, oral and nasopharyngeal airways, intravenous fluid administration equipment;
(9) Emergency drugs including, but not limited to: Pharmacologic antagonists appropriate to the drugs used, vasopressors, corticosteroids, bronchodilators, antihistamines, antihypertensives and anticonvulsants; and
(10) A defibrillator device.
(c) Before inducing conscious sedation, a dentist shall:
(1) Evaluate the patient and document, using the American Society of Anesthesiologists Patient Physical Status Classifications, that the patient is an appropriate candidate for conscious sedation;
(2) Give written preoperative and postoperative instructions to the patient or, when appropriate due to age or neurological status of the patient, the patient's guardian; and
(3) Obtain written informed consent from the patient or patient's guardian for the anesthesia.
(d) The dentist shall ensure that the patient's condition is monitored and recorded on a contemporaneous record. The dentist an shall use a Qualified Monitor to monitor and record the patient's condition in addition to the chair side dental assistant. A Qualified Monitor shall be present to monitor the patient at all times.
(e) The patient shall be monitored as follows:
(1) Patients must have continuous monitoring using pulse oximetry. At no time shall the patient be unobserved by a Qualified Monitor until discharge criteria have been met. The Qualified Monitor shall have a current Health Care provider BLS/CPR certification and certification from the American Association of Oral and Maxillofacial Surgeon' certification program for Anesthesia Assistants or an equivalent. The patient's blood pressure, heart rate, and respiration shall be recorded every five minutes, and these recordings shall be documented in the patient record. The record must also include documentation of preoperative and postoperative vital signs, all medications administered with dosages, time intervals and route of administration. If the dentist is unable to obtain this information, the reasons shall be documented in the patient's record.
(2) During the recovery phase, the patient must be monitored by a qualified monitor.
(3) A discharge entry shall be made by the dentist in the patient's record indicating the patient's condition upon discharge and the name of the responsible party to whom the patient was discharged.
(f) A dentist may not release a patient who has undergone conscious sedation except to the care of a responsible adult third party.
(g) The dentist shall assess the patient's responsiveness using preoperative values as normal guidelines and discharge the patient only when the following criteria are met:
(1) Vital signs including blood pressure, pulse rate and respiratory rate are stable;
(2) The patient is alert and oriented to person, place and time as appropriate to age and preoperative neurological status;
(3) The patient can talk and respond coherently to verbal questioning, or to preoperative neurological status;
(4) The patient can sit up unaided, or to preoperative neurological status;
(5) The patient can ambulate with minimal assistance, or to preoperative neurological status; and
(6) The patient does not have uncontrollable nausea or vomiting and has minimal dizziness.
(h) A dentist who induces conscious sedation shall employ the services of a Qualified Monitor and a chair side dental assistant at all times who each shall hold a valid BLS/CPR certification and maintains such certification. Note: WV Code updated with legislation passed through the 2012 1st Special Session
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