Missouri Code of State Regulations › Title 20 - DEPARTMENT OF COMMERCE AND INSURANCE › Division 2110 - Missouri Dental Board › Chapter 4 - Sedation › Section 20 CSR 2110-4.020 - Moderate Sedation

Current through Register Vol. 49, No. 14, July 15, 2024
PURPOSE: This proposed change simplifies the process
				  for renewing a moderate sedation permit.
(1) Because sedation and general anesthesia
				are a continuum, it is not always possible to predict how an individual patient
				will respond. Hence, practitioners intending to produce a given level of
				sedation should be able to diagnose and manage the physiologic consequences
				(rescue) for patients whose level of sedation becomes deeper than initially
				intended. For all levels of sedation, the practitioner must have the training,
				skills, drugs, and equipment to identify and manage such an occurrence until
				either assistance arrives (emergency medical service) or the patient returns to
				the intended level of sedation without airway or cardiovascular
				complication.
(2) No dentist shall
				administer enteral and/or parenteral moderate sedation unless the dentist
				possesses a moderate sedation permit issued by the Missouri Dental Board. (A
				dentist is not required to possess a permit for the prescription or
				administration of drugs prescribed for minimal sedation and/or pain control.)
				This permit shall be renewed by June 1 every five (5) years from the year of
				issuance.
(3) No dentist shall
				prescribe sedative agents for enteral moderate sedation unless the dentist
				possesses an enteral or parenteral moderate sedation permit issued by the
				Missouri Dental Board. No dentist shall prescribe parenteral moderate sedation
				agents unless the dentist possesses a parenteral moderate sedation permit
				issued by the Missouri Dental Board.
(4) No dentist shall administer moderate
				sedation to a pediatric patient, as defined in
				20 CSR
				2110-4.010, unless the dentist possesses a pediatric
				moderate sedation permit. A dentist possessing a pediatric moderate sedation
				permit may administer moderate sedation using either enteral or parenteral
				techniques; however, techniques utilizing intravenous administration are
				restricted to qualified deep sedation/general anesthesia providers as defined
				in 20 CSR
				2110-4.040. Moderate sedation services provided to
				pediatric patients shall be done in accordance with current American Academy of
				Pediatric Dentistry Guidelines for Monitoring and Management of Pediatric
				Patients Before, During, and After Sedation for Diagnostic and Therapeutic
				Procedures.
(5) No dental office
				shall be the site for the administration of enteral, parenteral, or pediatric
				moderate sedation without being issued a moderate sedation site certificate by
				the Missouri Dental Board. This site certificate shall be renewed by June 1
				every five (5) years from the year of issuance. The dentist-in-charge is
				responsible for submitting the application and maintaining the documentation as
				required in sections (12) and (14) of this rule.
(6) If the primary administrator of enteral,
				parenteral, or pediatric moderate sedation in a dental office is a certified
				registered nurse anesthetist, the operating dentist must possess the
				appropriate moderate sedation permit for the service being provided.
(7) If the primary administrator of enteral,
				parenteral, or pediatric moderate sedation in a dental office is an
				anesthesiologist or a certified registered nurse anesthetist, the operating
				dentist must order the anesthesia services and is responsible for the readiness
				of the dental office, preoperative patient evaluation and appropriate medical
				consultations, the coordination of and emergency preparedness of the sedation
				team, and the maintenance of appropriate records. The dentist must evaluate the
				patient prior to the procedure, remain in the dental office, and evaluate the
				patient prior to discharge.
(8) To
				qualify for a permit to administer enteral moderate sedation, a dentist shall-
(A) Document satisfactory completion of-
1. An enteral moderate sedation training
				course consistent with the American Dental Association Guidelines for Teaching
				Pain Control and Sedation to Dentists and Dental Students; or
2. An ADA-accredited post-doctoral training
				program that affords training necessary to administer enteral moderate
				sedation; or
3. An enteral moderate
				sedation course approved by the Missouri Dental Board;