Pennsylvania Code › Title 49 - PROFESSIONAL AND VOCATIONAL STANDARDS › Part I - DEPARTMENT OF STATE › Subpart A - PROFESSIONAL AND OCCUPATIONAL AFFAIRS › Chapter 33 - STATE BOARD OF DENTISTRY › Subchapter E - ADMINISTRATION OF GENERAL ANESTHESIA, DEEP SEDATION, CONSCIOUS SEDATION AND NITROUS OXIDE/OXYGEN ANALGESIA › Section 33.344 - Requirement of anesthesia permit for nonparenteral premedication of dental patients-statement of policy

Current through Register Vol. 54, No. 28, July 13, 2024
(a)
Background
. Section
					 11.2 of the act (63 P. S. §
												130c) directs the Board to establish minimal
					 training and education for the issuance of permits to dentists to administer
					 general anesthesia, conscious sedation and analgesia on an outpatient basis.
					 Definitions of these three terms appear in section 2 of the act (63 P. S. §
												121). The definition of conscious sedation as
					 "a minimally depressed level of consciousness . . . produced by a pharmacologic
					 or nonpharmacologic method, or combination thereof" has raised the question of
					 whether nonparenteral premedication of patients constitutes conscious sedation
					 and thus triggers the permit requirement.
(b)
Purpose
. The Board
					 regards section
					 11.2 of the act as expressing the
					 legislative purpose of reducing the risk of death or injury to dental patients
					 who receive anesthetic modalities on an outpatient basis. In view of that
					 purpose, and of the encompassing definition of conscious sedation adopted by
					 the legislature, the Board believes that the protection afforded by the act
					 extends to patients who, owing to a depressed level of consciousness produced
					 by premedication, are at greater risk during the dental procedure and the
					 recovery period thereafter. The Board believes further that such an increase in
					 patient risk as a result of premedication requires the dentist to have training
					 in preventing, recognizing and managing complications and emergencies
					 associated with conscious sedation. It is this training which the conscious
					 sedation permit requirement is designed to ensure.
(c)
Implementation
. The
					 Board recognizes that many variables-such as dosage, time of administration and
					 the patient's physical and medical condition-bear on the effects of
					 premedication during and after the dental procedure and that judgments as to
					 these effects are the professional responsibility of the dentist. It is for the
					 dentist therefore to determine whether premedication produces conscious
					 sedation creating an increased risk of harm to the patient. If so, the dentist
					 shall possess a restricted permit I or an unrestricted permit. In disciplinary
					 proceedings brought against a dentist who has premedicated a patient without a
					 permit, the Board will consider whether the average dentist in this
					 Commonwealth, acting reasonably under the same circumstances, would have
					 concluded, based on this section, the act and this chapter, that a permit was
					 required.
(d)
Guidelines
. The Board cannot provide absolute directives as to
					 when a dentist is required to possess a permit before premedicating patients.
					 The Board offers, however, the following guidelines concerning patients who, in
					 its judgment, are most and least likely to require the protection afforded by
					 the permit requirement:
(1) The Board regards
					 pediatric patients, geriatric patients, patients with handicapping conditions
					 and patients who are medically compromised as principal candidates for
					 nonparenteral premedication as well as the groups most at risk from this
					 modality. Dentists who premedicate patients from these groups are advised to
					 consider most carefully whether the permit requirement applies.
(2) The Board regards persons not in the
					 groups enumerated in paragraph (1), for whom nonparenteral premedications are
					 used solely to reduce mild situational anxiety, or for whom analgesics are
					 prescribed preoperatively to relieve dentally related pain, as generally
					 incurring no increased risk of injury. In the absence of obvious risk,
					 premedication of these patients is not considered conscious sedation for
					 purposes of the permit requirement.