of all Californians, help eliminate barriers to care, and enable dentists to better serve their patients and the public (California Dental Association, 2021). 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 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, 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 successful completion of 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 dentist needs to submit evidence that he or she has (a) 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, (b) satisfactorily completed a periodontics or general practice residency or other advanced education in a Board-approved general dentistry program, and (c) 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 (California Dental Practice Act, 2006). 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). 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, 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.
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