Missouri Code of State Regulations › Title 20 - DEPARTMENT OF COMMERCE AND INSURANCE › Division 2110 - Missouri Dental Board › Chapter 4 - Sedation › Section 20 CSR 2110-4.040 - Deep Sedation/General Anesthesia

Current through Register Vol. 49, No. 14, July 15, 2024
PUBLISHER'S NOTE: The secretary of state has
				  determined that the publication of the entire text of the material which is
				  incorporated by reference as a portion of this rule would be unduly cumbersome
				  or expensive. This material as incorporated by reference in this rule shall be
				  maintained by the agency at its headquarters and shall be made available to the
				  public for inspection and copying at no more than the actual cost of
				  reproduction. This note applies only to the reference material. The entire text
				  of the rule is printed here.
PURPOSE: This rule provides for the regulation of the
				  administration of deep sedation/general anesthesia.
(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 deep sedation/general anesthesia unless the dentist possesses a
				permit issued by the Missouri Dental Board. This permit shall be renewed by
				June 1 every five (5) years from the year of issuance.
(3) No dental office shall be the site for
				the administration of deep sedation/general anesthesia without being issued a
				site certificate issued by the Missouri Dental Board. The 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 (7) and (9) of this rule.
(4) No dentist shall prescribe deep
				sedation/general anesthesia agents unless the dentist possesses a deep
				sedation/general anesthesia permit.
(5) If the primary administrator of deep
				sedation/general anesthesia in a dental office is a certified registered nurse
				anesthetist, the operating dentist must possess a deep sedation/general
				anesthesia permit.
(6) If the
				primary administrator of deep sedation/general anesthesia in a dental office is
				an anesthesiologist or a certified registered nurse anesthetist, the operating
				dentist must order the anesthesia services, is responsible for the readiness of
				the dental office, preoperative patient evaluation and appropriate medical
				consultations, the coordination of and emergency preparedness of the anesthesia
				team, and the maintenance of appropriate records. The operating dentist must
				evaluate the patient prior to the procedure, remain in the dental office, and
				evaluate the patient prior to discharge.
(7) To qualify for a permit to administer
				deep sedation/general anesthesia, a dentist shall-
(A) Document satisfactory completion of-
1. An advanced educational program accredited
				by the Americandental Association (ADA) Commission on Dental Accreditation that
				affords comprehensive and appropriate training necessary to administer and
				manage deep sedation or general anesthesia, commensurate with Part IV. C of
				these guidelines. For all levels of sedation and anesthesia, dentists, who are
				currently providing sedation and anesthesia in compliance with their state
				rules and/or regulations prior to adoption of this document, are not subject to
				these additional requirements; or
2. An ADA-accredited post-doctoral training
				program in oral and maxillofacial surgery; or
3. An anesthesia training program that is
				approved and accredited to teach postgraduate medical education by the
				Accreditation Council for Graduate Medical Education of the American Medical
				Association (AMA), or the Education Committee of the American Osteopathic
				Association (AOA); or
4. A
				Diplomate of the Americandental Board of Anesthesiology;