DE 11.01 Authority and purpose.
DE 11.025 Permit to administer anesthesia.
DE 11.03 Requirements for nitrous oxide in combination with sedative agent.
DE 11.035 Board approved education program content.
DE 11.075 Continuing education.
DE 11.085 Auxiliary Personnel.
DE 11.09 Standards of care.
DE 11.10 Reporting of adverse occurrences related to sedation or anesthesia administration.
DE 11.01
DE 11.01
Authority and purpose. The rules in this chapter are adopted under authority in ss.
15.08 (5) (b),
227.11 (2) (a) and
447.02 (2) (b), Stats., for the purpose of defining standards for the administration of anesthesia by dentists. The standards specified in this chapter shall apply equally to general anesthesia and sedation, regardless of the route of administration.
DE 11.01 History
History: Cr.
Register, August, 1985, No. 356, eff. 9-1-85; am.
Register, October, 1988, No. 394, eff. 11-1-88; am.
Register, August, 1991, No. 428, eff. 9-1-91.
DE 11.02
DE 11.02
Definitions. In this chapter,
DE 11.02(1g)
(1g) “
ASA” means American Society of Anesthesiologists.
DE 11.02(1s)
(1s) “Class I permit" means a sedation permit issued prior to September 1, 2020. This permit is no longer valid.
DE 11.02(1t)
(1t) “Class II permit - enteral" means a sedation permit enabling a dentist to administer, by enteral route, moderate sedation.
DE 11.02(1tm)
(1tm) “
Class II permit – parenteral” means a sedation permit enabling a dentist to administer, by parenteral route, moderate sedation.
DE 11.02(1u)
(1u) “Class III permit" means a sedation permit enabling a dentist to administer moderate or deep sedation, or general anesthesia.
DE 11.02(2g)
(2g) “
Continual” means repeated regularly and frequently in a steady succession.
DE 11.02(2r)
(2r) “
Continuous” means prolonged without any interruption at any time.
DE 11.02(3)
(3) “Deep sedation" means a drug-induced depression of consciousness during which a patient cannot be easily aroused but responds purposefully following repeated or painful stimulation. The ability to independently maintain ventilatory function may be impaired. A patient may require assistance in maintaining a patent airway, and spontaneous ventilation may be inadequate. Cardiovascular function is usually maintained.
DE 11.02(3m)
(3m) “
Enteral” means administration by which the agent is absorbed through the gastrointestinal tract or through oral, rectal, or sublingual mucosa.
DE 11.02(4)
(4) “General anesthesia" means drug-induced loss of consciousness during which a patient is not arousable, even by painful stimulation. The ability to independently maintain ventilatory function is often impaired. A patient often requires assistance in maintaining a patent airway, and positive pressure ventilation may be required because of depressed spontaneous ventilation or drug-induced depression of neuromuscular function. Cardiovascular function may be impaired.
DE 11.02(4e)
(4e) “
Immediately available” means physically located in the dental office or facility and ready for immediate use or response.
DE 11.02(4m)
(4m) “
Minimal sedation” means a minimally depressed level of consciousness, produced by a pharmacological method that retains the patient's ability to independently and continuously maintain an airway and respond normally to tactile stimulation and verbal command. Although cognitive function and coordination may be modestly impaired, ventilatory and cardiovascular functions are unaffected.
DE 11.02(4s)
(4s) “
Moderate sedation” means a drug-induced depression of consciousness during which patients respond purposefully to verbal commands, either alone or accompanied by light tactile stimulation. No interventions are required to maintain a patent airway, and spontaneous ventilation is adequate. Cardiovascular function is usually maintained. If more than one enteral drug is administered or if an enteral drug is administered at a dosage that exceeds the maximum recommended dose during a single appointment, such administration is considered moderate sedation.
DE 11.02(6)
(6) “Nitrous oxide" means a combination of nitrous oxide and oxygen.
DE 11.02(6g)
(6g) “
Parenteral” means administration by which the drug bypasses the gastrointestinal tract through intramuscular, intravenous, intranasal, submucosal, subcutaneous, or intraosseous methods.
DE 11.02(6r)
(6r) “
Pediatric patient” means a patient who is 12 years old and under.
DE 11.02(10)
(10) “Time-oriented anesthesia record" means documentation at appropriate intervals of drugs, doses and physiologic data obtained during patient monitoring.
DE 11.02 History
History: Cr.
Register, August, 1985, No. 356, eff. 9-1-85; r. and recr.
Register, October, 1988, No. 394, eff. 11-1-88; r. (4), renum. (1) to (3) to be (2) to (4) and am., cr. (1) and (5),
Register, August, 1991, No. 428, eff. 9-1-91;
CR 04-095: am. (1) to (4), cr. (1m) and (6) to (10), r. (5)
Register August 2006 No. 608, eff. 1-1-07;
CR 13-061: cr. (1s) to (1u)
Register June 2014 No. 702, eff. 7-1-14;
CR 19-132: r. (1), cr. (1g), r. (1m), am. (1s), (1t), cr. (1tm), am. (1u), r. (2), cr. (2g), (2r), am. (3), cr. (3m), am. (4), cr. (4e), (4m), (4s), am. (6), cr. (6g), (6r), r. (7) to (9)
Register August 2020 No. 776, eff. 9-1-20; correction in (3) made under s.
35.17, Stats.,
Register August 2020 No. 776;
CR 22-055: am. (3m), (6g)
Register June 2023 No. 810, eff. 7-1-23.
DE 11.025
DE 11.025
Permit to administer anesthesia. DE 11.025(2)
(2) The board may issue an anesthesia permit at the following levels:
DE 11.025(2)(a)
(a) Class II – enteral is for the administration of moderate sedation by enteral route.
DE 11.025(2)(b)
(b) Class II – parenteral is for the administration of moderate sedation by either enteral or parenteral route,
DE 11.025(2)(c)
(c) Class III is for the administration of moderate or deep sedation, or general anesthesia.
DE 11.025(3)
(3) A dentist may apply to the board for an anesthesia permit by submitting all of the following:
DE 11.025(3)(b)
(b) Verification of any permit or credential authorizing anesthesia or sedation held by the dentist.
DE 11.025(3)(c)
(c) Disclosure of any previous anesthesia or sedation-related incident, morbidity, or mortality or any board investigation or discipline relating to the delivery of anesthesia or sedation.
DE 11.025(3)(d)
(d) Evidence of current licensure to practice dentistry in the state of Wisconsin.
DE 11.025(3)(e)
(e) Evidence of current certification in Advanced Cardiovascular Life Support or Pediatric Advanced Life Support through a course that is certified by the American Heart Association. Pediatric Advanced Life Support is required if treating pediatric patients and is a sufficient certification by itself if the licensee is treating both pediatric and adult patients.
DE 11.025(3)(f)
(f) Affidavit indicating the dentist has the required equipment and medications.
DE 11.025(3)(g)
(g) If applying for a class II permit - enteral, evidence of one of the following:
DE 11.025(3)(g)1.
1. Current board certification or a candidate for board certification by the American Board of Oral and Maxillofacial Surgery.
DE 11.025(3)(g)2.
2. Completion of an accredited oral and maxillofacial surgery residency.
DE 11.025(3)(g)3.
3. Diplomate or candidate of the American Dental Board of Anesthesiology.
DE 11.025(3)(g)4.
4. Successful completion of a board approved education program that provides comprehensive training meeting the requirements in s.
DE 11.035.
DE 11.025(3)(h)
(h) If applying for a class II permit- parenteral, evidence of one of the following:
DE 11.025(3)(h)1.
1. Current board certification or a candidate for board certification by the American Board of Oral and Maxillofacial Surgery.
DE 11.025(3)(h)2.
2. Completion of an accredited oral and maxillofacial surgery residency.
DE 11.025(3)(h)3.
3. Diplomate or candidate of the American Dental Board of Anesthesiology.
DE 11.025(3)(h)4.
4. Successful completion of a board approved education program that provides comprehensive training meeting the requirements in s.
DE 11.035.
DE 11.025(3)(i)
(i) If applying for a class III permit, evidence of one of the following:
DE 11.025(3)(i)1.
1. Current board certification or a candidate for board certification by the American Board of Oral and Maxillofacial Surgery.
DE 11.025(3)(i)2.
2. Completion of an accredited oral and maxillofacial surgery residency.
DE 11.025(3)(i)3.
3. Diplomate or candidate of the American Dental Board of Anesthesiology.
DE 11.025(3)(i)4.
4. Completion of a postdoctoral residency in an accredited dental program in dental anesthesiology.
DE 11.025(3)(j)
(j) Notwithstanding par.
(g) or
(h),
a dentist holding a class I permit on August 31, 2020, shall be granted a class II permit - enteral upon evidence of 20 cases within the last 5 years of providing moderate sedation.
DE 11.025 Note
Note: As of September 1, 2020, a class I permit is no longer valid and moderate sedation requires either a class II permit - enteral or class II permit – parenteral.
DE 11.025(3)(k)
(k) Notwithstanding par.
(h),
a dentist holding a class II permit on August 31, 2020, shall be granted a class II permit - parenteral.
DE 11.025(4)
(4) A dentist may not administer anesthesia or sedation without a permit at the appropriate level of anesthesia or sedation.
DE 11.025 History
History: CR 13-061: cr.
Register June 2014 No. 702, eff. 7-1-14;
CR 19-132: r. and recr.
Register August 2020 No. 776, eff. 9-1-20; correction in (2) (a) to (c), (3) (c), (g) (intro.), (h) (intro.), (i) (intro.), (j), (k) made under s.
35.17, Stats., and correction in (3) (j), (k) made under s.
13.92 (4) (b) 14., Stats.,
Register August 2020 No. 776;
CR 21-086: am. (3) (i) 4.
Register June 2023 No. 810, eff. 7-1-23;
EmR2216: emerg. am. (1) (e), eff. 11-28-22;
CR 22-086: am. (1) (e)
Register October 2023 No. 814, eff. 11-1-23;
CR 23-041: am. (3) (e) Register April 2024 No. 820, eff. 5-1-24. DE 11.03
DE 11.03
Requirements for nitrous oxide in combination with sedative agent. Nitrous oxide when used in combination with sedative agent may produce minimal, moderate or deep sedation. During the administration of moderate or nitrous-oxide oxygen sedation, if a patient enters a deeper level of sedation than the dentist is authorized by permit to provide, then the dentist shall stop the sedation and dental procedures until the patient returns to the intended level of sedation.
DE 11.035
DE 11.035
Board approved education program content. DE 11.035(1)(1)
A board approved education program that provides comprehensive training for a class II permit - enteral shall consist of a minimum of 18 hours in administration and management of moderate sedation, including all of the following course content:
DE 11.035(1)(a)
(a) Historical, philosophical and psychological aspects of anxiety and pain control.
DE 11.035(1)(b)
(b) Patient evaluation and selection through review of medical history taking, physical diagnosis and psychological profiling.
DE 11.035(1)(c)
(c) Use of patient history and examination for ASA classification, risk assessment and pre-procedure fasting instruction.
DE 11.035(1)(d)
(d) Definitions and descriptions of physiological and psychological aspects of anxiety and pain.
DE 11.035(1)(e)
(e) Description of the sedation anesthesia continuum, with special emphasis on the distinction between the conscious and the unconscious state.
DE 11.035(1)(f)
(f) Review of adult respiratory and circulatory physiology and related anatomy.
DE 11.035(1)(g)
(g) Pharmacology of local anesthetics and agents used in moderate sedation, including drug interactions and contraindications.
DE 11.035(1)(h)
(h) Indications and contraindications for use of moderate sedation.
DE 11.035(1)(i)
(i) Review of dental procedures possible under moderate sedation.
DE 11.035(1)(j)
(j) Patient monitoring using observation, monitoring equipment, with particular attention to vital signs, ventilation, breathing and reflexes related to consciousness.
DE 11.035(1)(k)
(k) Maintaining proper records with accurate chart entries recording medical history, physical examination, informed consent, time-oriented anesthesia record, including the names of all drugs administered, doses and monitored physiological parameters.
DE 11.035(1)(L)
(L) Prevention, recognition and management of complications and emergencies.
DE 11.035(1)(m)
(m) Description, maintenance and use of moderate sedation monitors and equipment.
DE 11.035(1)(o)
(o) Description and rationale for the technique to be employed.
DE 11.035(1)(p)
(p) Prevention, recognition and management of systemic complications of moderate sedation, with particular attention to airway maintenance and support of the respiratory and cardiovascular systems.
DE 11.035(1)(q)
(q) Twenty cases, which may include group observation cases, that each meet all of the following requirements:
DE 11.035(1)(q)1.
1. At least 3 cases must occur in person as live clinical dental experiences. These cases may occur at any time or location permitted by the education program. The remaining cases may include simulations or video presentations.
DE 11.035(1)(q)2.
2. One case must have experience in returning a patient from deep to moderate sedation, which may be done by simulation or video presentation.
DE 11.035(1)(q)3.
3. Include full review of patient medical history, including pertinent lab values.
DE 11.035(1)(q)4.
4. Applicant shall be present and participate for the duration of live clinical dental experience cases up through recovery and discharge of the patient and shall participate in any remaining cases via simulation or video presentation to completion.
