Section 1220.520  Deep Sedation and General Anesthesia in the Dental Office Setting

Deep sedation and general anesthesia must be administered by an individual qualified under this Section. (See Appendix D for characteristics of levels of anesthesia.)

a)         A licensed dentist seeking a permit to administer deep sedation or general anesthesia shall make application to the Division, on forms provided by the Division, that shall include:

1)         Certification of meeting one or more of the following:

A)        Completion of a minimum of 2 years of advanced training in anesthesiology beyond the pre-doctoral level, in a training program approved by the American Dental Association, Commission on Dental Education, as outlined in Guidelines for Teaching Pain Control and Sedation to Dentists and Dental Students, published by the American Dental Association, Commission on Dental Education (October 2012).

B)        Be a diplomate of the American Board of Oral and Maxillofacial Surgery.

C)        Have an active, approved application with the American Board of Oral and Maxillofacial Surgery to obtain diplomat status.

D)        Have a specialty license in oral and maxillofacial surgery issued by the Division;

2)         A signed affidavit certifying that:

A)        the dentist will practice in a facility properly equipped in accordance with subsection (d) for the administration of deep sedation and general anesthesia;

B)        the facility will be staffed with an anesthesia team, supervised by the applicant, that will remain in the treatment room during the procedure on the patient. For each patient, the anesthesia team will consist of at least:

i)          the dentist who holds the permit B;

ii)         one dental hygienist or dental assistant who has completed the training prescribed in Section 1220.240(f) or 1220.245(c)(2) and is capable of assisting with procedures, problems and emergencies incident to the administration of the sedation; and

iii)        one additional hygienist or dental assistant;

C)         the dentist permit holder will remain immediately available to the patient after being treated under deep sedation or general anesthesia. A dental hygienist or dental assistant trained to monitor a patient under deep sedation or general anesthesia will remain with the sedated patient until the patient is no longer sedated;

D)        all members of the anesthesia team are capable of assisting with procedures, problems and emergencies incident to the administration of sedation and will maintain current certification in BLS or its equivalent; and

E)        for the dentist permit holder, the BLS certification is in addition to the required 9 sedation technique CE hours (see subsection (h)) required per renewal cycle;

3)         Proof of current ACLS or PALS certification; and

4)         The required fee set forth in Section 1220.415.

b)         In accordance with the standards set forth in this Section, the Division will issue a deep sedation or general anesthesia permit (Permit B).

c)         If the accuracy, relevance or sufficiency of any submitted documentation is questioned by the Division or the Board because of discrepancies or conflicts in information needing further clarification, and/or missing information, additional documentation may be required and/or an on-site evaluation of the facilities, equipment and personnel may be conducted by the Division or a member of the Board's Anesthesia Review Panel.

d)         A properly equipped facility for the administration of deep sedation or general anesthesia shall include, at a minimum:

1)         Sphygmomanometer and stethoscope;

2)         An oxygen delivery system with full face masks and connectors appropriate to the patient population being served that is capable of delivering oxygen to the patient under positive pressure, with an emergency backup system;

3)         Emergency drugs and equipment appropriate to the medications administered;

4)         Suction equipment, including an emergency backup suction system;

5)         An emergency backup lighting system that will permit the completion of any operation underway;

6)         Laryngoscope complete with selection of blades and spare batteries and bulbs in sizes appropriate to the patient population being served;

7)         Endotracheal tubes and connectors in sizes appropriate for the patient population being served;

8)         Tonsillar or pharyngeal suction tips adaptable to all office outlets;

9)         Nasal and oral airways in sizes appropriate to the patient population being served;

10)         Device for monitoring temperature (e.g., temperature strips, thermometer);

11)         Electrocardioscope and defibrillator (an automated external defibrillator is an acceptable defibrillator);

12)         Pulse oximeter;

13)         Equipment for the establishment of an intravenous infusion;

14)         An operating table or an operating chair that permits appropriate access to the patient and provides a firm platform for the management of cardiopulmonary resuscitation; and

15)         A recovery area that has available oxygen, lighting, suction and electrical outlets.  The Permit B holder shall remain with the patient until the patient retains the ability to independently and consciously maintain an airway and respond appropriately to physical stimulation and oral commands.  The recovery area may be the operating theatre.

e)         The following records shall be kept when administering deep sedation and general anesthesia:

1)         Medical history and patient evaluation prior to the performance of any procedure;

2)         Preoperative, intraoperative, and pre-discharge monitoring of blood pressure, pulse, respiration and oxygen saturation. A time based record shall be entered into the patient's chart;

3)         EKG monitoring during the entire procedure;

4)         Drugs and dosages of agents used during the operative procedure, including nitrous oxide and oxygen, and including identification of the person administering drugs and times of their administration over the course of the procedure. Documentation of the anesthetic encounter will be consistent with currently accepted standards of anesthetic practice.

f)         The dentist who holds the Permit B shall report adverse occurrences to the Division and the Board as required by Section 1220.405.

g)         A licensed dentist shall hold a Permit B in order to perform dentistry while a licensed certified nurse anesthetist administers deep sedation or general anesthesia.  A nurse anesthetist for purposes of this Section is a licensed certified nurse anesthetist who holds a license as an advanced practice nurse under the Nurse Practice Act.  The dentist shall enter into a written collaborative agreement with the nurse anesthetist in accordance with the following:

1)         A certified registered nurse anesthetist who provides anesthesia services in a dental office shall enter into a written collaborative agreement with the operating dentist performing the procedure.  The agreement shall describe the working relationship of the nurse anesthetist and the operating dentist and shall authorize the categories of care, treatment, or procedures to be performed by the nurse anesthetist.  In a collaborating dentist office, the nurse anesthetist may only provide those services that the operating dentist with the appropriate permit is authorized to provide as found in 68 Ill. Adm. Code 1220.510 and 1220.520. 

2)         For anesthesia services, the operating dentist shall approve the anesthesia plan prepared by the nurse anesthetist and shall remain physically present and be available on the premises during the delivery of anesthesia services for diagnosis, consultation, and treatment of emergency medical conditions.  The nurse anesthetist may select, order, and administer medications, including controlled substances, and apply appropriate medical devices for delivery of anesthesia services under the anesthesia plan agreed with by the operating dentist.  

h)         Proof of 9 hours of continuing education per renewal cycle in sedation techniques, including medications and recognition and management of complications and emergencies, is required for renewal of Permit B.

i)          A treating dentist does not need to hold Permit B to perform dentistry when another dentist, who holds Permit B, or a physician or dental anesthesiologist assists the treating dentist by administering deep sedation or general anesthesia.  Physician for purposes of this Section means a physician who is licensed to practice medicine in all of its branches under the Medical Practice Act of 1987 and is authorized to provide anesthesia services in a licensed hospital or licensed ambulatory surgical treatment center or is a Board-certified anesthesiologist. 

1)         The treating dentist shall be prepared to provide affidavits attesting to the following if requested by the Division:

A)        That the facility used is equipped as specified in subsection (d);

B)        That the dentist shall staff the facility with a team, supervised by the Permit B holder or physician, that includes a minimum of 3 individuals per patient.  The team shall be composed of either:

i)          One dental hygienist or dental assistant who has completed the training prescribed in Section 1220.240(f) or 1220.245(c)(2) capable of assisting with procedures, problems and emergencies incident to the administration of the sedation; the treating dentist; and the dentist who holds a Permit B providing the anesthesia services;

ii)         One dental hygienist or dental assistant; the treating dentist; and a physician providing the anesthesia services; or

iii)        One dental hygienist or dental assistant; the treating dentist; and a dental anesthesiologist providing the anesthesia services.

C)        That the Permit B holder will remain with the patient until the patient retains the ability to independently and consciously maintain an airway and respond appropriately to physical stimulation and oral commands.  The recovery area may be the operating theatre.

2)         All members of the anesthesia team, including the treating dentist (non-Permit B holder) must maintain certification in BLS or its equivalent. 

3)         In addition, the dentist shall report severe adverse occurrences to the Division as set forth in Section 1220.405 and accept the responsibility for verifying certification and licensure of any licensed provider present during the deep sedation or general anesthesia of a patient receiving dental care.

j)          A dentist holding a Permit B shall maintain current ACLS or PALS certification.  ACLS or PALS certification shall be in addition to the required 9 hours of anesthesia CE per renewal cycle.

k)         A dentist holding a Permit B shall maintain a logbook indicating the sedation cases performed.  The log shall include the patient name, date, route of sedation administration, drug name and dosage, and the names of anesthesia team members assisting.  This information shall be supplied to the Division upon request.

l)          A dentist holding a Permit B must also hold an active Illinois Controlled Substances License and current federal Drug Enforcement Administration registration.

(Source:  Amended at 47 Ill. Reg. 1672, effective January 23, 2023)