Special permits Special permits are required for dentists who want to administer general anesthesia or conscious sedation (to be called “moderate sedation” as of January 1, 2022) in the dental office. Offices providing these services are required to maintain specialized equipment and to have such equipment inspected. Dentists must meet certain initial requirements to obtain these permits and other ongoing requirements to renew these permits every two years (Dental Board of California, 2021h). General anesthesia permit A dentist may not administer general anesthesia on an outpatient basis for dental patients unless he or she possesses a current license in good standing and holds a Board-issued valid general anesthesia permit, or possesses a current permit under Section 1638 (a physician or surgeon with a license to practice dentistry in another state) or 1640 (having a pending contract as a professor in a California dental college; having graduated from a Board-approved dental college, or having completed an advanced education program accredited by either the Commission on Dental Accreditation of the American Dental Association [ADA] or a Board-approved national accrediting body; and being a diplomate of a specialty board, or being qualified to take a specialty board examination, or having completed an advanced educational program from a Board-approved dental college) and holds a Board-issued valid general anesthesia permit (California Dental Practice Act, 2019b). To obtain such a permit, the dentist must supply documentation of the successful completion of a residency program in anesthesia—approved by the Board of Directors of the American Dental Society of Anesthesiology for eligibility for fellowship in general anesthesia—of not less than one calendar year, supply documentation of the successful completion of a graduate program in oral and maxillofacial surgery that has been approved by the Commission on Accreditation of the ADA, and have a fellowship in anesthesia approved by the Board of Directors of the American Dental Society of Anesthesiology. In order to renew a general anesthesia permit, the dentist must complete, at least once every two years, 24 hours of approved courses of study related to general anesthesia, and successfully complete an advanced cardiac life support (ACLS) course. Units earned in the ACLS course may be used toward fulfillment of the general anesthesia course requirement (Dental Board of California, 2021f). Conscious sedation permit A dentist who wants to administer or order the administration of conscious (moderate) sedation must hold a conscious sedation permit. To obtain this permit, the dentist must show proof of successful completion of a course of study in conscious sedation consisting of at least 60 hours of instruction and satisfactory completion of at least 20 cases of the administration of conscious sedation for a variety of dental procedures. The course must comply with the requirements of the ADA’s Guidelines for Teaching the Comprehensive Control of Pain and Anxiety in Dentistry. To renew this permit, the dentist must complete at least once every two years a minimum of 15 hours of coursework related to the administration of conscious sedation and to medical emergencies (Dental Board of California, 2021a). Oral conscious sedation for minors Similarly, permits must be obtained in order for a dentist to administer oral conscious sedation for minors younger than the age of 13. Renewal of this permit requires a minimum of seven hours of approved courses of study related to oral conscious sedation of minors (Dental Board of California, 2021i). Along with an application fee and the form, the
California, 2021d). Applicants must have (1) graduated from a Board-approved dental school in good academic standing and with no pending ethical issues, (2) have passed Parts I and II of the National Board Written Examinations, (3) submit a completed portfolio to the Board within 90 days of graduation, and (4) successfully complete the Law and Ethics examination. Dentists with a current valid license in another state may pursue licensure by credential. (See https://dbc.ca.gov/ applicants/licensure_by_credential.shtml.) Section 1635.5 of the Dental Practice Act requires the applicant to show that he or she has either been in active clinical practice or has been a full-time faculty member in an accredited dental education program, and in active clinical practice for a total of at least 5,000 hours in five of the seven consecutive years immediately preceding the date of his or her application. With two years of clinical practice or completion of an accredited residency training program, the remainder of the five-year requirement may be fulfilled with a contract to teach or to practice in certain specified settings. The applicant must submit a letter from WREB to the effect that he or she has not failed the WREB examination within the past five years. The applicant also must not have failed the ADEX examination after November 15, 2019. The applicant must have completed 50 units of continuing education in the past two years, including current mandatory courses (Dental Board of California, 2021d). In 2008, in response to a shortage of dentists the Board implemented a program allowing licensure by residency (Dental Board of California, 2023b). Under this program, individuals are allowed to qualify for dental licensure based on proof of (1) graduation from a CODA-approved (Commission on Dental Accreditation) or Board-approved dental school, (2) the completion of a minimum of 12 months of a general practice residency or advanced education in a CODA-approved general dentistry program, (3) not having failed the WREB examination within the past five years, (4) not having failed the ADEX examination after November 15, 2019, (5) successful completion of the California Law and Ethics examination, and (6) fulfilling the requisite fingerprinting requirements. (See https://dbc. ca.gov/applicants/licensure_by_residency.shtml; Dental Board of California, 2021d). According to the Kaiser Family Foundation and the Health Resources Services Administration, California had 513 dental professional shortage areas (Becker’s Dental Review, 2022). Today, geographic areas throughout California continue to experience shortages of dental health providers (State of California, 2021). This situation is likely to persist because the percentage of dentists who may be nearing retirement age is greater than the percentage of dentists who are newly licensed. California does not have a shortage of dentist as the ratio of dentists is 77.9 per 100,000 persons, which is better than the national average of 60.98 persons per 100,000 (Fix, 2020). Similar to dentist shortage areas in other states, it is the inadequate distribution of dentists that is a major component of this problem. The Board regulates more than 100,000 licensees, including dentists, RDAs, and RDAEFs (Dental Board of California, 2021c). As of January 1, 2023, 38,940,231individuals resided in the State of California (California Department of Finance, 2023). The California Dental Association and the Board continue to seek cooperative dialogue with the dental schools and with one another to implement changes that will advance the oral health of all Californians, help eliminate barriers to care, and enable dentists to better serve their patients and the public (California Dental Association, 2021).
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