DE 11.025 NoteNote: As of September 1, 2020, a class I permit is no longer valid and moderate sedation requires either a class II permit - enteral or class II permit – parenteral.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 11.03DE 11.03Requirements 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 11.035DE 11.035Board 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.
DE 11.035(1)(q)5.5. Applicant shall observe the administration of medicines.
DE 11.035(1)(q)6.6. Patient and any anesthesia monitors shall be in full view of the applicant.
DE 11.035(2)(2) A board approved education program that provides comprehensive training for a class II permit - parenteral shall consist of a minimum of 60 hours in administration and management of moderate sedation, including all of the following course content:
DE 11.035(2)(a)(a) Historical, philosophical and psychological aspects of anxiety and pain control.
DE 11.035(2)(b)(b) Patient evaluation and selection through review of medical history taking, physical diagnosis and psychological profiling.
DE 11.035(2)(c)(c) Use of patient history and examination for ASA classification, risk assessment and pre-procedure fasting instruction.
DE 11.035(2)(d)(d) Definitions and descriptions of physiological and psychological aspects of anxiety and pain.
DE 11.035(2)(e)(e) Description of the sedation anesthesia continuum, with special emphasis on the distinction between the conscious and the unconscious state.
DE 11.035(2)(f)(f) Review of adult respiratory and circulatory physiology and related anatomy.
DE 11.035(2)(g)(g) Pharmacology of local anesthetics and agents used in moderate sedation, including drug interactions and contraindications.
DE 11.035(2)(h)(h) Indications and contraindications for use of moderate sedation.
DE 11.035(2)(i)(i) Review of dental procedures possible under moderate sedation.
DE 11.035(2)(j)(j) Patient monitoring using observation, monitoring equipment, with particular attention to vital signs, ventilation, breathing and reflexes related to consciousness.
DE 11.035(2)(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(2)(L)(L) Prevention, recognition and management of complications and emergencies.
DE 11.035(2)(m)(m) Description, maintenance and use of moderate sedation monitors and equipment.
DE 11.035(2)(o)(o) Intravenous access anatomy, equipment and technique.
DE 11.035(2)(p)(p) Prevention, recognition and management of complications of venipuncture and other parenteral techniques.
DE 11.035(2)(q)(q) Description and rationale for the technique to be employed.
DE 11.035(2)(r)(r) 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(2)(s)(s) Twenty individually managed cases that each meet the all of following requirements:
DE 11.035(2)(s)2.2. Include full review of patient medical history, including pertinent lab values.
DE 11.035(2)(s)3.3. Applicant shall be in the room for the duration of the case;
DE 11.035(2)(s)4.4. Applicant shall supervise recovery and discharge of the patient.
DE 11.035(2)(s)5.5. Applicant shall have full view of the patient and access to the patient’s airway.
DE 11.035(2)(s)6.6. Anesthesia monitors shall be in full view of the applicant.
DE 11.035 HistoryHistory:CR 19-132: cr. Register August 2020 No. 776, eff. 9-1-20; correction in (1) (intro.), (2) (intro.) made under s. 35.17, Stats., Register August 2020 No. 776, eff. 9-1-20; EmR2216: renum. (1) (q) to (1) (q) (intro.) and am., cr. (1) (q) 1. to 5., renum. (2) (s) to (2) (s) (intro.) and am., cr. (2) (q) 1. to 6., eff. 11-28-22; CR 22-086: renum. (1) (q) to (1) (q) (intro.) and am., cr. (1) (q) 1. to 6., renum. (2) (s) to (2) (s) (intro.) and am., cr. (2) (q) 1. to 6. Register October 2023 No. 814, eff. 11-1-23; correction in (1) (q) (intro.), (2) (s) (intro.), 1. to 5. made under s. 35.17, Stats., Register October 2023 No. 814.
DE 11.075DE 11.075Continuing education.A dentist with a sedation permit shall complete 2 hours of continuing education on the topic of sedation and anesthesia each biennium. The continuing education completed under this section shall count toward the continuing education requirement under s. DE 13.03.
DE 11.085(1)(1)Auxiliary personnel shall be certified in basic life support for the health care provider.
DE 11.085(2)(2) A dentist administering sedation shall have one additional individual present during the procedure and another individual on the premises and available to respond to a patient emergency.
DE 11.085(3)(3) A dentist administering general anesthesia or deep sedation shall have 2 additional individuals present during the procedure.
DE 11.085(4)(4) If a dentist is both performing the dental procedure and administering moderate or deep sedation, or general anesthesia, one auxiliary personnel must be designated to only monitor the patient. The designated auxiliary personnel may be one of the additional individuals required in sub. (2) or (3).
DE 11.09(1)(1)General.A dentist administering anesthesia or sedation shall be in the room to continuously monitor the patient until the patient meets the criteria for transfer to recovery and may not leave the dental office or facility until the patient meets the criteria for discharge and is discharged from the dental office or facility.
DE 11.09(2)(2) Preoperative preparation. Preoperative preparation for the administration of anesthesia or sedation shall include all of the following steps:
DE 11.09(2)(a)(a) Determine the adequacy of the oxygen supply and equipment necessary to deliver oxygen under positive pressure.
DE 11.09(2)(b)(b) Take and record the patient’s baseline vital signs, including blood pressure, respiratory rate and heart rate. For the administration of general anesthesia and deep and moderate sedation, baseline vital signs include weight, height, blood pressure, heart rate, respiratory rate, blood oxygen saturation by pulse oximetry, and body temperature when appropriate. The inability to take vital signs due to the patient’s behavior or condition shall be documented in the patient record.
DE 11.09(2)(c)(c) Complete medical history and a focused physical evaluation.
DE 11.09(2)(d)(d) Instruct the patient on specific dietary limitations based upon the sedative and anesthetic technique to be used and patient’s physical status.
DE 11.09(2)(e)(e) Provide preoperative instructions to the patient or, as appropriate, to the patient’s parent or legal guardian.
DE 11.09(2)(f)(f) Notify and require a patient to arrive and leave with a vested escort.
DE 11.09(2)(g)(g) Establish and secure, where clinically indicated, an intravenous line throughout the procedure, except as provided for pediatric or special needs patients.
DE 11.09(2)(h)(h) Advise the patient of fasting requirements.
DE 11.09(3)(3)Monitoring and evaluation of general anesthesia, deep sedation or moderate sedation.A dentist administering general anesthesia, deep sedation, or moderate sedation shall continuously monitor and evaluate all of the following:
DE 11.09(3)(j)(j) Body temperature whenever triggering agents associated with malignant hyperthermia are administered.
DE 11.09(4)(4)Monitoring and evaluation of minimal sedation.A dentist administering minimal sedation shall continuously monitor and evaluate all of the following:
Published under s. 35.93, Stats. Updated on the first day of each month. Entire code is always current. The Register date on each page is the date the chapter was last published.
