● 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. Dental auxiliaries There are different categories of dental assistants and dental hygienists, each with specific requirements regarding training and skills. Laws specifically define the duties that each category of auxiliary is allowed to perform, the level of dentist supervision required, and the settings in which the duties may be performed (Cal. Code Regs., 2002). It is a criminal offense to perform illegal functions, as well as grounds for license discipline of both the person performing the illegal function and any person who aids or abets such illegal activity. A dental assistant is an individual who, without a license, may perform basic supportive dental procedures, as authorized by law and by regulations adopted by the Board, under the supervision of a licensed dentist. “Basic supportive dental procedures” are defined in Section 1750 of the Dental Practice Act as procedures that have technically elementary characteristics, are completely reversible, and are unlikely to precipitate potentially hazardous conditions for the patient being treated. Since January 1, 2010, the scope of practice for dental assistants has included new and expanded duties and two new “add- on” specialty permits in orthodontics and dental sedation. All categories of dental assistants are eligible to obtain these specialty permits after completing the required instruction. In addition, licensure and license renewal requirements have changed for RDAs and RDAEFs. The Dental Board of California publishes a duty table available at https://www.dbc.ca.gov/ formspubs/pub_permitted_duties.pdf, and it is shown in Appendix B. Levels of supervision For all categories of dental assistants, dentists retain the Dental assistants Scope of practice authority to determine which new duties their staff members can perform and on which patients these procedures are performed. The level of required supervision is determined by statute for the dental assistant and the RDAEF. For RDAs, the supervising dentist determines on an individual basis which allowable procedures may be completed under general supervision, and which must be completed under direct supervision. In addition to documenting the permitted and prohibited duties of all licensed dental auxiliaries and dental assistants, the table shown in Appendix B designates four basic levels of supervision, using the letters D , C , G , and DD : ● Direct supervision, designated in Appendix B by the letter D , refers to supervision of dental procedures based on instructions given by a licensed dentist who must be
● Resuscitation equipment employed. (California Dental Practice Act, 2020e) 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. 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. According to the Dental Practice Act, Section 1684.5(d): “A dentist shall not concurrently supervise more than a total of five registered dental assistants in extended functions, registered dental hygienists, or registered dental hygienists in alternative practice providing services pursuant to Sections 1753.55, 1910.5, and 1926.05.” (California Dental Practice Act, 2015) physically present in the treatment facility during the performance of those procedures. ● Another type of supervision (C) allows the assistant to perform in a designated setting under the supervision of a dentist, RDH, or registered dental hygienist in alternate practice (RDHAP). ● General supervision, designated by the letter G , means that a duty is permitted based on instructions given by a licensed dentist, but does not require the physical presence of the supervising dentist during its performance. ● Finally, in the category designated DD , the dentist determines whether each procedure can be performed under general supervision, or whether direct supervision of the RDA is required. Exceptions to this category are found in Section 1777 of the Dental Practice Act, which states that direct supervision by the dentist or an RDH or RDHAP is necessary for an RDA or RDAEF engaging in (a) coronal polishing, (b) the application of topical fluoride, or (c) the application of sealants (after having completed a Board-approved course on the procedure) (California Dental Practice Act, 2009c). There is another level of supervision that is not defined but is specified in the description of the actual duty by statute. In those cases, the patient must be seen by the supervising dentist after the duty is performed and before the patient is dismissed. Proof of that compliance requires that the supervising dentist sign off the chart note made by the dental auxiliary. It is a requirement that all supervising dentists be familiar with the permitted and prohibited duties of dental auxiliaries. Therefore, it is essential that supervising dentists review the dental duty tables. Section 1753.7 of the Dental Practice Act also stipulates that a dentist may not simultaneously supervise more than three extended function dental assistants or extended function dental hygienists. Unlicensed dental assistants Although the dental assistant is an unlicensed dental professional, the employer of a dental assistant is responsible for ensuring that any dental assistant hired and in continuous
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