STATE OF WISCONSIN
DENTISTRY EXAMINING BOARD
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IN THE MATTER OF RULE-MAKING : ORDER OF THE
PROCEEDINGS BEFORE THE : DENTISTRY EXAMINING BOARD
DENTISTRY EXAMINING BOARD : ADOPTING RULES
: (CLEARINGHOUSE RULE 19-132)
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ORDER
An order of the Dentistry Examining Board to repeal DE 11.02(1), (1m), (2), (7), (8), and (9), 11.04, 11.05, 11.06, 11.07, 11.08 and 11.10 (intro.); to renumber DE 11.10 (1), (2), (3), (4), (5), (6), and (7); to amend DE 9.015 (2), 11.02 (1s), (1t), and (1u), 11.02 (3), 11.02 (4), 11.02 (6) and 11.10 (title); to repeal and recreate DE 9.02, 11.025, 11.03 and 11.09; and to create DE 11.02 (1g), (2g), (2r), (3m), (43), (4m), (4s), (6g) and (6r), 11.035, 11.075, 11.085 and 11.10 (1), (2) and (3)(intro.) relating to laboratory work authorizations, sedation and anesthesia.
Analysis prepared by the Department of Safety and Professional Services.
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ANALYSIS
Explanation of agency authority:
Each Examining Board shall promulgate rules for its own guidance and for the guidance of the profession to which it pertains, and define and enforce professional conduct and unethical practices not inconsistent with the law relating to the particular profession. [ s. 15.08 (5) (b), Stats.] The Examining Board shall promulgate rules specifying the standards, conditions and any educational requirements that are in addition to the requirements specified in s. 447.04 (1) that must be met by a dentist to be permitted to induce general anesthesia or conscious sedation in connection with the practice of dentistry. [ s. 447.02 (2) (b), Stats.] Related statute or rule: N/A
Plain language analysis:
Section 1 simplifies the definition to just an official, signed request from a dentist to a laboratory.
Section 2 eliminates the prescribed format for the dental laboratory work authorization and simplifies the requirements to include the patient’s name or id number, the dentist’s name and the prescription information.
Sections 3, 5, 9, and 17 repeal definitions no longer utilized in the chapter.
Section 4 defines ASA as the American Society of Anesthesiologists.
Sections 6, 7, and 8 amends the definitions for Class 1, Class 2 and Class 3 permits. Currently the permits are issued based upon method of sedation and this proposed rule bases the permits on level of sedation which is in line with the American Dental Association’s guidelines. A Class 1 is no longer being issued or valid as minimal sedation is being considered as part of the scope of dentistry that does not require a sedation permit. A Class 2 - Enteral permit allows the dentist to do moderate sedation by enteral route and a Class 2 – Parenteral permit allows the dentist to do moderate sedation by parenteral route. A Class 3 permit allows a dentist to do deep sedation or general anesthesia.
Section 10 defines continual to mean repeated regularly and frequently in a stead succession and continual to mean prolonged without interruption.
Section 11 redefines deep sedation as a drug induced depression of consciousness. A patient cannot be easily aroused but respond to repeated painful stimulation. A patient may require assistance in maintaining an airway and spontaneous ventilation may be inadequate. Cardiovascular function usually is maintained.
Section 12 creates a definition for enteral for agents which are absorbed through the gastrointestinal tract or through the oral, rectal or nasal mucous membranes.
Section 13 redefines general anesthesia as a drug-induced loss of consciousness. The patient is not arousable. The patient often requires assistance to maintain an airway and ventilation is required. Cardiovascular function may be impaired.
Section 14 defines immediately available as the person is actually in the dental office or facility and can immediately available to respond.
Minimal sedation is defined as a depressed level of consciousness allowing the patient to maintain an airway and respond to stimulation or command. Ventilatory and cardiovascular functions are unaffected.
Moderate sedation is defined as a drug-induced depression of consciousness which the patient can respond to oral commands either alone or with a light stimulation. No interventions are necessary to maintain airway or ventilation. Cardiovascular function is maintained. If more than one enteral drug is administered or it is administered at a dosage that exceeds the maximum recommended dose during one appointment, it is considered moderate sedation instead of minimal.
Section 15 revises the term being defined to “nitrous oxide” and defines it as a combination of nitrous oxide and oxygen in a patient.
Section 16 creates a definition for parenteral which means the administration of a drug which bypasses the gastrointestinal tract. It is administered into a muscle, vein, nasal structurers, areolar connective tissue lying beneath a mucous membrane, interocular, or under the skin.
The definition of a pediatric patient is a patient who is 12 years or younger.
Section 18 indicates a permit is not required for minimal sedation. A Class 2 – Enteral or Class 2 - Parenteral is required for moderate sedation and a Class 3 is required for moderate or deep sedation or general anesthesia. A person applies for a permit by submitting the following: an application; fee; verification of any permit or credential for anesthesia or sedation held by the application; disclosure of any previous adverse incident involving anesthesia or sedation; evidence of current Wisconsin dentistry licensure; evidence of certification in advanced cardiovascular life support or pediatric advanced life support; affidavit indicating the dentist has required equipment and medications for sedation; and approved education. Class 2 – Enteral or Class 2 - Parenteral permit requires one of the following: board certification or a candidate for board certification by the American Board of Oral and Maxillofacial Surgery; completion of an accredited fellowship in oral and maxillofacial surgery; diplomate or candidate of the American Dental Board of Anesthesiology; or successful completion of a Board approved education program. Class 3 permit requires one of the following: board certification or a candidate for board certification by the American Board of Oral and Maxillofacial Surgery; diplomate or candidate of the American Dental Board of Anesthesiology; or postdoctoral residency in an accredited dental program in dental anesthesiology. This section also provides for a grandfathering for those currently holding a Class I permit or a Class 2 permit to show evidence of 20 moderate sedation cases in the previous 5 years in lieu of meeting the education requirements to receive a Class II – enteral or Class II – parenteral respectively.
