20:43:09:04. Moderate sedation permit requirements. The board may issue a permit to a licensed dentist to administer moderate sedation to dental patients 12 years and older on an outpatient basis if the dentist:
(1) Has successfully completed a moderate sedation course approved by the board pursuant to § 20:43:09:04.03. If the course was completed more than 12 months before application, the applicant shall also:
(A) Hold a permit to administer moderate sedation, or an equivalent permit, in another state and have completed a minimum of 12 moderate sedation cases in the 12 months before application; or
(B) Undergo a review by the board of the applicant’s recent training and experience and complete supplemental training, education, evaluation, or remediation required by the board. The applicant shall pay all costs of the training, education, evaluation, remediation, and associated proceedings;
(2) Has met the requirements outlined in §§ 20:43:09:12 and 20:43:09:13; and
(3) Is certified in administering Advanced Cardiovascular Life Support by the American Heart Association or an equivalent program approved by the board.
A dentist with a moderate sedation permit may not administer moderate sedation without the presence and assistance of at least one individual who holds a permit to monitor patients under general anesthesia, deep sedation, or moderate sedation, or is otherwise authorized by law to monitor patients under general anesthesia, deep sedation, or moderate sedation.
A dentist administering moderate sedation may not use general anesthetics; shall be proficient in airway management and advanced cardiac life support; shall be capable of providing intravenous access; shall continuously evaluate the patient’s blood pressure, pulse, respiratory function, and cardiac activity; and shall apply the current standard of care.
A dentist that meets the requirements of this section may only be authorized by the board to administer moderate sedation to a child under 12 years if the dentist has successfully completed an accredited advanced dental education residency program that provides comprehensive and appropriate training necessary to administer and manage pediatric moderate sedation and is certified in Pediatric Advanced Life Support by the American Heart Association or an equivalent program approved by the board. A dentist that does not meet these requirements by June 30, 2022, may not administer moderate sedation to a child under 12 years.
A dentist who administers moderate sedation shall maintain a margin of safety and a level of consciousness in the patient that does not approach general anesthesia or deep sedation and shall be able to rescue a patient whose level of sedation becomes deeper than initially intended.
If moderate sedation results in a general anesthetic state, the requirements outlined in § 20:43:09:03 for general anesthesia and deep sedation apply.
A moderate permit incorporates the authority granted in a nitrous oxide sedation and analgesia permit and host permit. A dentist that holds a moderate sedation permit and utilizes a licensed anesthesia provider to administer general anesthesia, deep sedation, or moderate sedation to a patient under 12 years shall also be certified in Pediatric Advanced Life Support by the American Heart Association or an equivalent program approved by the board.
Source: 9 SDR 49, effective October 25, 1982; 12 SDR 151, 12 SDR 155, effective July 1, 1986; transferred from § 20:43:04:11, 19 SDR 32, effective September 6, 1992; 37 SDR 131, effective January 6, 2011; 42 SDR 83, effective December 3, 2015; 48 SDR 62, effective December 13, 2021.
General Authority: SDCL 36-6A-14(20).
Law Implemented: SDCL 36-6A-14(1)(3)(13)(14)(22).
20:43:09:04.01. Employing or contracting with licensed anesthesia provider that provides general anesthesia, deep sedation, or moderate sedation in dental office. A dentist that holds a general anesthesia and deep sedation, moderate sedation, or host permit and utilizes a licensed anesthesia provider to administer general anesthesia, deep sedation, or moderate sedation in a dental office or facility on an outpatient basis to a dental patient on whom the dentist is performing a dental procedure shall:
(1) Have a written contract or written agreement with the licensed anesthesia provider that outlines the appropriate roles and responsibilities of the dentist, licensed anesthesia provider, and clinical staff, for the administration of sedation or anesthesia, that shall include requirements that the licensed anesthesia provider:
(A) Collaborate with the dentist on patient selection based on clearly defined patient selection criteria;
(B) Be continuously present during the administration of the anesthetic;
(C) Remain with the patient until the patient is communicating effectively;
(D) Transfer care of the patient to an individual who holds a permit to monitor patients under general anesthesia, deep sedation, or moderate sedation, or is otherwise authorized by law to monitor patients under general anesthesia, deep sedation, or moderate sedation; and
(E) Remain on the premises of the facility where the anesthesia was administered until the anesthetized patient is fully recovered and discharged from the facility to a responsible adult;
(2) Notify the board of the location of any dental office or facility where general anesthesia, deep sedation, or moderate sedation services will be provided;
(3) Ensure the availability of auxiliary personnel that are certified in administering basic life support by the American Heart Association for the Healthcare Provider, the American Red Cross for the Professional Rescuer, or an equivalent program approved by the board;
(4) Verify that the requirements for the level of anesthesia or sedation being provided, as required in § 20:43:09:13 or 20:43:09:13.01, are satisfied;
(5) Hold a general anesthesia and deep sedation, moderate sedation, or host permit and have completed the inspection, as required in § 20:43:09:12;
(6) Ensure that the licensed anesthesia provider holds a license in good standing in South Dakota;
(7) Ensure that the licensed anesthesia provider's qualifications and competency to deliver the necessary sedation or anesthesia services have been meaningfully verified; and
(8) Ensure that the licensed anesthesia provider is not administering general anesthesia and deep sedation without the presence and assistance of at least one individual, other than the dentist completing the dental procedure, who holds a permit to monitor patients under general anesthesia, deep sedation, or moderate sedation, or is otherwise authorized by law to monitor patients under general anesthesia and deep sedation.
Source: 37 SDR 131, effective January 6, 2011; 42 SDR 83, effective December 3, 2015; 48 SDR 62, effective December 13, 2021.
General Authority: SDCL 36-6A-14(20).
Law Implemented: SDCL 36-6A-14(1)(13)(14)(22).
20:43:09:04.02. Utilizing licensed anesthesia provider for general anesthesia and deep sedation or moderate sedation in ambulatory surgery center or hospital. No permit is required if a dentist utilizes the services of a licensed anesthesia provider for dental patients in a licensed ambulatory surgery center or hospital.
Source: 37 SDR 131, effective January 6, 2011; 48 SDR 62, effective December 13, 2021.
General Authority: SDCL 36-6A-14(20).
Law Implemented: SDCL 36-6A-14(1)(13)(22).
20:43:09:04.03. Moderate sedation course requirements. The board may approve a moderate sedation training course as referenced in subdivision 20:43:09:04(1) if the course meets the following requirements:
(1) The course satisfies all objectives and content as described in Part 5 of the Guidelines for Teaching Pain Control and Sedation to Dentists and Dental Students;
(2) The course includes a minimum of 60 clock hours of coursework that is provided through didactic instruction;
(3) The course includes the administration of moderate parenteral sedation via the intravenous route to at least 20 individually managed live patients of the appropriate age. The course participant must be listed on the anesthesia record, administer the drugs, and document the administration and physiologic findings on the anesthesia record;
(4) The course includes clinical experience in the management of the compromised airway and establishment of intravenous access;
(5) The course is directed by a dentist or physician qualified by experience and training, including the following:
(A) The course director has not been disciplined for conduct that, in the opinion of the board, would jeopardize the safety of the public or patients;
(B) The course director holds a current permit or license to administer general anesthesia and deep sedation or moderate sedation in at least one state; and
(C) The course director has at least three years of experience administering general anesthesia and deep sedation or moderate sedation, including formal postdoctoral residency training in anxiety and pain control;
(6) The course has a clinical participant-faculty ratio of not more than four-to-one;
(7) The course includes a mechanism for the course participant to evaluate the performance of individuals presenting the course material, a summary of which is maintained and available for review;
(8) The course provides additional clinical experience if the course participant has not achieved competency within the time allotted for the course; and
(9) The course director certifies the competency of a course participant in each moderate sedation technique, including instruction, clinical experience, managing the airway, intravascular or intraosseous access, and reversal drugs, before the course participant is issued documentation verifying successful completion of the course.
The board shall conduct a review of moderate sedation courses annually and may only approve courses that have submitted documentation necessary to verify that the course requirements outlined in this section have been met. A course director may be required to participate in an interview as part of the course review before the board approves the course.
Source: 48 SDR 62, effective December 13, 2021.
General Authority: SDCL 36-6A-14(20).
Law Implemented: SDCL 36-6A-14(1)(3)(13)(22).
References: "Guidelines for Teaching Pain Control and Sedation to Dentists and Dental Students," 2016 Edition, American Dental Association. Copies may be obtained from the American Dental Association at www.ada.org free of charge.
20:43:09:04.04. Host permit requirements. The board may issue a permit to a licensed dentist to utilize a licensed anesthesia provider to administer general anesthesia, deep sedation, or moderate sedation, in compliance with § 20:43:09:04.01 on an outpatient basis to a dental patient on whom the dentist is performing a dental procedure, if the dentist:
(1) Has successfully completed a course approved by the board that meets the criteria outlined in § 20:43:09:04.05. If the course was completed more than 12 months before application for a permit, the applicant must also hold a permit equivalent to the host permit in another state;
(2) Has met the requirements outlined in § 20:43:09:12;
(3) Has met the requirements outlined in § 20:43:09:13 or 20:43:09:13.01, based on the highest level of sedation or anesthesia that will be provided to a patient; and
(4) Is certified in administering Advanced Cardiovascular Life Support by the American Heart Association or an equivalent program approved by the board.
A dentist that holds a host permit is authorized to monitor a patient under general anesthesia, deep sedation, or moderate sedation. A dentist that holds a host permit and utilizes a licensed anesthesia provider to provide general anesthesia, deep sedation, or moderate sedation to a patient under 12 years shall also be certified in Pediatric Advanced Life Support by the American Heart Association or an equivalent program approved by the board.
Source: 48 SDR 62, effective December 13, 2021.
General Authority: SDCL 36-6A-14(20).
Law Implemented: SDCL 36-6A-14(1)(13)(14)(22).
20:43:09:04.05. Host course requirements. The board may approve an educational course as referenced in subdivision 20:43:09:04.04(1) if the course meets the following requirements:
(1) The course provides instruction and an assessment of knowledge and skill in the following areas:
(A) Preoperative patient assessment;
(B) Emergency scenarios and rescue;
(C) Respiratory complications;
(D) Patient safety and monitoring;
(E) Airway assessment and management;
(F) Anesthetic drugs; and
(G) Recovery; and
(2) Upon completion, the course participant can:
(A) Identify a high-risk patient;
(B) Differentiate between levels of sedation;
(C) Monitor a patient receiving sedation or anesthesia; and
(D) Rescue a patient from a deeper-than-intended level of sedation.
The board shall conduct a review of courses annually and may only approve courses that have submitted documentation necessary to verify that the course requirements outlined in this section have been met. A course director may be required to participate in an interview as part of the course review before the board approves the course.
Source: 48 SDR 62, effective December 13, 2021.
General Authority: SDCL 36-6A-14(20).
Law Implemented: SDCL 36-6A-14(1)(3)(13)(22).
20:43:09:04.06. Anesthesia or sedation education -- Other. At its discretion, in lieu of the requirement outlined in subdivision 20:43:09:03(1), 20:43:09:04(1), or 20:43:09:04.04(1), the board may consider training or experience accepted in any state or jurisdiction that resulted in an equivalent permit being issued to or maintained by the applicant. The board may deem such training or experience substantially equivalent and issue a permit or may require that the applicant complete supplemental training, education, evaluation, or remediation before a permit may be issued. The applicant shall pay all costs of the training, education, evaluation, remediation, or proceedings.
Source: 48 SDR 62, effective December 13, 2021.
General Authority: SDCL 36-6A-14(20).
Law Implemented: SDCL 36-6A-14(1)(13)(22).
