conscious sedation, or general anesthesia was administered, removal to a hospital or emergency center that is the normal or expected treatment for the underlying dental condition is not required to be reported. Reports must be submitted to the Board on forms approved by the Board, with copies sent to the Dental Hygiene Board of California if an RDH was involved in the treatment (California Dental Practice Act, 2020e). The report, in cases in which the patient received anesthesia, must contain at least the following information: ● Procedure date. ● Patient’s age in years and months, as well as weight and sex. ● Patient’s American Society of Anesthesiologists (ASA) physical status. ● Patient’s primary diagnosis. ● Any other diagnoses. ● Procedures performed. ● Setting in which sedation was performed. ● Medications employed. ● Monitoring equipment employed. ● Category of provider responsible for supervising sedation. ● Category of provider delivering sedation. ● Category of provider monitoring patient during sedation ● Whether the person supervising sedation performed any of the procedures. ● What airway management was planned. ● What depth of sedation was planned. ● Complications. ● Description of unexpected occurrences in airway management. ● Whether the patient was sedated at any time during transportation. ● Category of provider performing resuscitation. Disclosure of individually identifiable patient information must be consistent with applicable law, and the required report cannot be admissible in any action brought by a patient against the licensee. The form must state that the information is not an admission of guilt but is to be used for educational, data, or investigative purposes (California Dental Practice Act, 2020e). It should be noted that the death of a patient must be reported even in cases in which the dentist comes to believe well after the event that it was related to treatment by the dentist or the RDH. Self-Assessment Quiz Question #1 Which detail does not need to be reported within 7 days to the Dental Board of California upon the death of a patient during a dental procedure? a. Procedure(s) performed. b. Patient’s primary diagnosis. c. Name(s) of the dental assistant(s). d. Medications employed. Other permits Special permits also are required to be a full-time professor, an associate professor, or an assistant professor for a California dental college (Dental Board of California, 2021j). Sections 1640 and 1640.3 of the Dental Practice Act set forth the requirements to qualify for, apply for, and renew such a permit, as well as the causes for revocation of this specialty permit. Other special permits include operating a mobile dental clinic, using a fictitious business name, or having an additional dental office. ● Resuscitation equipment employed. (California Dental Practice Act, 2020e)
dentist needs to submit evidence that he or she has (1) satisfactorily completed a postgraduate program in oral and maxillofacial surgery or pediatric dentistry approved by the Commission on Dental Accreditation or a comparable Board-approved organization, (2) satisfactorily completed a periodontics or general practice residency or other advanced education in a Board-approved general dentistry program, and (3) satisfactorily completed a Board-approved program on oral medications and sedation. A dentist who has already been using oral sedation for adult patients should submit documentation of 10 such cases in any three- year period (Dental Board of California, 2023c). Informed consent, complications, and future legislation When the treatment involves general anesthesia or intravenous conscious sedation, the dentist must obtain written informed consent from the patient or from the parent or guardian (California Dental Practice Act, 2020f). In the case of a minor, the written consent must include the wording: The administration and monitoring of deep sedation or general anesthesia may vary depending on the type of procedure, the type of practitioner, the age and health of the patient, and the setting in which anesthesia is provided. Risks may vary with each specific situation. You are encouraged to explore all the options available for your child’s anesthesia for their dental treatment and consult with your dentist, family physician, or pediatrician as needed (California Dental Practice Act, 2020f). In 2015, the death of a six-year-old child named Caleb Sears inspired legislation concerning the administration and monitoring of dental anesthesia and sedation. The first law, AB 2235, requiring the Board to review laws and regulations, was known as Caleb’s Law Part I . The next legislation, Caleb’s Law Part II, was introduced to codify the recommendations in Part I. Yet another piece of legislation, SB 501, on the same subject was introduced at the same time. Governor Brown signed SB 501 into law in 2018 (Senate Bill No. 501, 2018; Dental Board of California, 2022). According to the California Society of Pediatric Dentistry, this law: Scheduled to become effective January 1, 2022, requires significant change to permitting of General Anesthesia, Conscious Sedation, and Oral Conscious Sedation for Minors in the dental setting. These changes include the introduction of a pediatric endorsement and additional patient monitoring requirements when administering general anesthesia or sedation to a minor dental patient, and the creation a new Pediatric Minimal Sedation (PMS) permit. The PMS permit will be required to administer or order the administration of minimal sedation to a patient under 13 years of age. (Niethamer, 2021) However, it is unlikely that the Dental Board of California will be able to complete its rule making by the date the law is to go into effect, and the enactment date may be extended (Niethamer, 2021). The dentist must report within seven days in writing the death of a patient that takes place during any dental or dental hygiene procedure. The dentist must also report any death discovered to be the result of such treatment. Also, unless previously planned, the removal of a patient to a hospital or emergency center for treatment for problems resulting from a dental or dental hygiene procedure must be reported. A report is also necessary in the case of such a removal when the patient has received conscious sedation, oral conscious sedation, or general anesthesia. With the exception of patients to whom oral conscious sedation,
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