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10.44.12.00.htm 10.44.12.00. Title 10 DEPARTMENT OF HEALTH AND MENTAL HYGIENE Subtitle 44 BOARD OF DENTAL EXAMINERS Chapter 12 Anesthesia and Sedation Authority: Health Occupations Article, §4-205 Annotated Code of Maryland
10.44.12.01.htm 10.44.12.01. 01 Scope.. A. This chapter covers the use of anesthesia and sedation by dentists in Maryland for the practice of dentistry.B. The use of local anesthesia by a dentist is not governed by this chapter.. C. The administration of anesthesia and sedation by dentists in hospitals licensed in Maryland is not governed by this chapter.
10.44.12.02.htm 10.44.12.02. 02 Purpose.. Dentists are increasingly administering anesthesia and sedation on an outpatient basis. It is in the best interests of the public and the dentists of Maryland to require dentists who administer anesthesia and sedation to meet certain minimal training and competency standards. Requiring a dentist to obtain a permit before the dentist may administer anesthesia, sedation, or both is the best method to ensure that such administration is performed by
10.44.12.03.htm 10.44.12.03. 03 Definitions.. A. In this chapter, the following terms have the meanings indicated.. B. Terms Defined.. 1) “Accredited facility” means a facility holding current certification from:. a) The Accreditation Association for Ambulatory Health Care (AAAHC). b) The Joint Commission on Accreditation of Healthcare Organizations (JCAHO). c) The Joint Commission Ambulatory Health Care Accreditation (JCAHCA).
10.44.12.04.htm 10.44.12.04. 04 Anxiolysis.. A. A permit is not required for a dentist to administer anxiolysis.. B. The administering, prescribing, or dispensing of more than one type of sedative, narcotic, class of drug, or medication for the purpose of anesthesia to be taken the evening before a procedure, or the morning of a procedure, is not anxiolysis and shall require the appropriate anesthesia or sedation permit.C. A dentist who intends to administer anxiolysis shall indicate the intent
10.44.12.05.htm 10.44.12.05. 05 Classifications of Permits and Certificates.. A. The following permits shall be issued by the Board:. 1) Class I permit that authorizes a dentist to use a nonparenteral anesthetic technique to attain the level of moderate sedation;2) Class II permit that authorizes a dentist to use:. a) A parenteral anesthetic technique to attain the level of moderate sedation; and. b) Any procedure allowed with a Class I permit;. 3) Class III permit that authorizes a dentist to use:.
10.44.12.06.htm 10.44.12.06. 06 Permit Required.. After January 4, 2010, a dentist may not administer an anesthetic technique in order to attain a level beyond anxiolysis for the practice of dentistry unless the dentist holds an appropriate Class I, II, or III permit issued by the Board.
10.44.12.07.htm 10.44.12.07. 07 Location Requirement.. A. On a form provided by the Board, a dentist shall advise the Board of the name and address of each location where the dentist wishes to administer anesthesia and sedation.B. A dentist may not administer anesthesia and sedation unless the dentist has obtained the appropriate permit for each location.C. On a form provided by the Board, a dentist shall advise the Board of each location at which the dentist has ceased to administer anesthesia and sedation.
10.44.12.08.htm 10.44.12.08. 08 Qualifications for Obtaining a Permit.. A. Because sedation is a continuum, it is not always possible to predict how an individual patient will respond. Therefore, practitioners intending to produce a given level of sedation shall be able to recover patients whose level of sedation becomes deeper than initially intended. Individuals administering moderate enteral sedation or moderate parenteral sedation shall be able to recover patients who enter a state of dee
10.44.12.09.htm 10.44.12.09. 09 Administration Evaluation.. A. Class I Permit. To qualify for a Class I permit, the dentist who will perform the administration shall pass:1) An office inspection evaluation;. 2) A clinical evaluation consistent with the age level of the patients treated by the dentist;. 3) An evaluation of the dentist to safely administer sedation techniques; and. 4) An evaluation of the ability of the dentist to effectively respond to sedation related emergencies.B. The clinical evaluatio
10.44.12.10.htm 10.44.12.10. 10 Facility Evaluation.. In addition to the requirements outlined in Regulation .09 of this chapter, for a dentist to obtain a Class I, Class II, or Class III permit, each facility in which the dentist wishes to administer an anesthesia technique shall pass a facility evaluation in order to attain:A. A level beyond anxiolysis;. B. Moderate enteral sedation;. C. Moderate parenteral sedation; or. D. Deep sedation and general anesthesia..
10.44.12.11.htm 10.44.12.11. 11 Facility Evaluation Criteria.. A. Except as otherwise provided in this regulation, to qualify for a permit, the facility and the applicant shall pass an evaluation of facility equipment, medications, and clinical records to include at least the following:1) Oxygen and gas delivery system, backup system fail-safe;. 2) Gas storage facility;. 3) Safety indexed gas system;. 4) Suction and backup system;. 5) Auxiliary lighting system;. 6) Suitability of operating room:. b) Lighting;.
10.44.12.12.htm 10.44.12.12. 12 Evaluation Results.. A. A Board evaluator shall hold a permit at the same or higher level as the permit sought by the applicant being evaluated.B. To the extent practicable, a Board evaluator shall provide the results of the evaluation to the Board in writing within 7 days of an applicant’s evaluation.C. Either the Board or the Board’s Anesthesia Committee shall:. 1) Review the results of the evaluation; and. 2) Notify the applicant of the results in a timely manner..
10.44.12.13.htm 10.44.12.13. 13 Exceptions.. A. A dentist who has passed an administration and facility evaluation for a Class I, Class II, or Class III permit may receive a like permit for another facility or facilities if:1) The dentist holds an active Class I, Class II, or Class III permit for which the dentist has passed an administration and facility evaluation; and2) Each facility for which the dentist seeks another permit has at least one dentist who has passed an administration and fac
10.44.12.14.htm 10.44.12.14. 14 Inducing a Level of Sedation for a Patient.. A. Administration of moderate enteral sedation, moderate parenteral sedation, deep sedation, or general anesthesia to a patient requires at least the following appropriately trained individuals:1) The treating dentist;. 2) An individual trained and competent in basic life support or its equivalent to assist the treating dentist; and3) Another individual trained and competent in basic life support or its equivalent in close proximi
10.44.12.15.htm 10.44.12.15. 15 General Anesthesia and Parenteral Sedation Administration Permits in Existence on January 4, 2010.A. A dentist who held a current general anesthesia administration permit on January 4, 2010, may continue to administer anesthesia and sedation under the general anesthesia administration permit until the expiration of the permit only as provided in this regulation.B. A dentist who held a current parenteral sedation administration permit on January 4, 2010, may co
10.44.12.16.htm 10.44.12.16. 16 General Anesthesia and Parenteral Sedation Facility Permits in Existence on January 4, 2010.. A. General anesthesia facility permits and parenteral sedation facility permits in existence on January 4, 2010, shall expire as provided in this regulation.B. A general anesthesia facility permit issued to a dentist who does not hold a general anesthesia administration permit shall expire on January 4, 2010.C. A parenteral sedation facility permit issued to a dentist who does not h
10.44.12.17.htm 10.44.12.17. 17 Conversion of General Anesthesia and Parenteral Sedation Administration Permits in Existence on January 4, 2010.A. At least 120 days before the expiration of a general anesthesia administration permit the Board shall mail an application to each individual who holds a general anesthesia administration permit to convert the general anesthesia administration permit to a Class III permit.B. At least 120 days before the expiration of a parenteral sedation adminis
10.44.12.18.htm 10.44.12.18. 18 Compliance for Dentists with General Anesthesia and Parenteral Sedation Administration Permits in Existence on January 4, 2010.A dentist with a general anesthesia administration permit or a parenteral sedation administration permit in existence on January 4, 2010, shall comply with Regulations .14, .26, .27, .30, .31, .32, and .34 of this chapter.
10.44.12.19.htm 10.44.12.19. 19 Issuance and Expiration of Class I, Class II, and Class III Permits.. A. To apply to obtain a permit, an applicant shall:. 1) Submit to the Board an application on a form provided by the Board;. 2) Pay the fee set by the Board in COMAR 10.44.20; and. 3) Provide evidence satisfactory to the Board that the applicant meets the qualifications for a Class I, Class II, or Class III permit.B. The Board may issue a Class I, Class II, or Class III permit to an appli
10.44.12.20.htm 10.44.12.20. 20 Renewal of Class I and Class II Permits.. A. The Board shall mail a renewal application to each individual holding a Class I or Class II permit at least 180 days before the expiration of the permit.B. Before a Class I or Class II permit expires, an applicant may apply to renew the permit for an additional 5-year term if the applicant:1) Submits to the Board at least 90 days before the expiration of the permit:. a) A renewal application on a form provided by the Board;.
10.44.12.21.htm 10.44.12.21. 21 Renewal of Class III Permits.. A. The Board shall mail a renewal application to each individual holding a Class III permit at least 180 days before the expiration of the permit.B. Before a permit expires, an applicant may apply to renew the permit for an additional 5-year term if the applicant:1) Submits to the Board, at least 90 days before the expiration of the permit, a renewal application on a form provided by the Board;
10.44.12.22.htm 10.44.12.22. 22 Class III Dental School Facility Permit.. A. After January 4, 2010, a dentist may not administer anesthesia or sedation for the practice of dentistry in a dental school recognized by the Commission on Dental Accreditation or its successor organization unless the dental school holds a Class III dental school facility permit.B. A dental school that applies for a Class III dental school facility permit shall pass an on-site facility evaluation by the Board or its designee a
10.44.12.23.htm 10.44.12.23. 23 Issuance and Expiration of Class III Dental School Facility Permits.. A. To obtain a dental school Class III facility permit a dental school recognized by the Commission on Dental Accreditation or its successor organization shall:1) Submit to the Board an application on a form provided by the Board;. 2) Pay the fee set by the Board in COMAR 10.44.20; and. 3) Provide evidence satisfactory to the Board that the dental school meets the qualifications for a Class III dental school f
10.44.12.24.htm 10.44.12.24. 24 Renewal of Class III Dental School Facility Permits.. A. The Board shall mail a renewal application to each dental school holding a Class III dental school facility permit at least 180 days before the expiration of the permit.B. Before a Class III dental school facility permit expires, the dental school may renew the permit for an additional 5-year term if the dental school:1) Submits to the Board, at least 90 days before the expiration of the permit, a renewal application
10.44.12.25.htm 10.44.12.25. 25 Dental School's Required Notice to Board.. A. A dental school that holds a Class III Dental School Facility Permit shall advise the Board of any additional locations it has opened since the issuance or the renewal of its original permit.B. The notice required under §A of this regulation shall be provided to the Board in writing not later than 30 days before the opening of the additional location.C. A dentist may not administer anesthesia or sedation for the practice of
10.44.12.26.htm 10.44.12.26. 26 Facility Records.. All facilities including a dental school that holds a Class III dental school facility permit shall maintain for 5 years for inspection by the Board:A. The name of each dentist who has administered anesthesia or sedation; and. B. The license number of each dentist who has administered anesthesia or sedation..
10.44.12.27.htm 10.44.12.27. 27 Unannounced Inspection Visits.. A. During reasonable business hours, the Board or its designee may conduct unannounced inspection visits of any dental office or facility if the Board has:1) Received a complaint or has initiated a complaint; and. 2) Reason to believe that anesthesia or sedation has been administered:. a) Without an appropriate permit; or. b) In violation of this chapter.. B. Dentists and all associated personnel shall cooperate with the inspector
10.44.12.28.htm 10.44.12.28. 28 Facility Owner or Operator.. A. The owner or operator of a facility may not permit an individual to administer anesthesia or sedation unless the individual is qualified to do so under this chapter.B. The owner or operator of a facility shall ensure that the facility:. 1) Remains properly equipped in accordance with Regulation .11A of this chapter; and. 2) Remains properly staffed in accordance with Regulation .14 of this chapter.. C. In addition to the req
10.44.12.29.htm 10.44.12.29. 29 Continuing Education Requirements for Renewal of a Permit.. A. Renewal of a Class I, Class II, or Class III Permit. Beginning in 2016 and thereafter, an applicant who seeks renewal of a Class I, Class II, or Class III permit shall:1) Complete not less than 24 hours of clinical continuing education related to sedation or anesthesia in a classroom setting during the 5-year term of the permit; and
10.44.12.30.htm 10.44.12.30. 30 Transfer of Permits Prohibited.. A Class I, Class II, or Class III permit may not be transferred to another person or location..
10.44.12.31.htm 10.44.12.31. 31 Administration by Physicians or Dentists at the Site of a Treating Dentist.. A. A treating dentist who wishes to allow a physician or another dentist to administer anesthesia and sedation to a patient at a specific practice location shall receive a certificate from the Board before allowing a physician or another dentist to administer anesthesia and sedation at that location.B. To apply for a certificate to allow a physician or another dentist to administer anesthesia and s
10.44.12.32.htm 10.44.12.32. 32 Certification of a Dentist Providing Treatment Outside the Dentist's Location.. A. A treating dentist who treats a patient at a practice location other than the dentist's own location, at which anesthesia and sedation are administered to the patient, shall receive a certificate from the Board before treating the patient.B. To apply for a certificate to treat a patient at a practice location other than the dentist's own location, at which anesthesia and sedation are ad
10.44.12.33.htm 10.44.12.33. 33 Administration by a Certified Registered Nurse Anesthetist.. A. A treating dentist who wishes to allow a certified registered nurse anesthetist to administer anesthesia and sedation to a patient at a specific practice location shall receive a certificate from the Board before allowing a certified registered nurse anesthetist to administer anesthesia and sedation at that location.B. To apply for a certificate to allow a certified registered nurse anesthetist to administer anesth
10.44.12.34.htm 10.44.12.34. 34 Display and Location of Permit.. A. A dentist who holds a Class I, Class II, or Class III permit shall maintain their wallet certificate in their possession for inspection at the administration site.B. A dentist who holds a general anesthesia facility permit or a parenteral sedation facility permit shall display the permit and any current renewal certificates in the facility.
10.44.12.35.htm 10.44.12.35. 35 Exceptions to Anesthesia and Sedation Permits and Dentist Certification.. A dentist who treats a patient at an accredited facility as defined in Regulation .03 of this chapter where anesthesia or sedation is being administered to the patient by either another dentist, physician, or certified registered nurse anesthetist is not required to hold:A. A Class I, Class II, or Class III permit; or. B. A certification to allow another dentist, physician, or certified regist
10.44.12.36.htm 10.44.12.36. 36 Morbidity and Mortality Reports.. A. A dentist shall report to the Board, in writing, any death caused by or resulting from the dentist's administration of anxiolysis, moderate sedation, deep sedation, or general anesthesia within 7 days after its occurrence.B. A dentist shall report to the Board, in writing, any complication or disabling incident requiring admission to a hospital either for a period greater than 24 hours, or for purposes other than observation, as a result of th
10.44.12.37.htm 10.44.12.37. 37 Violations for Individuals with a Class I, Class II, or Class III Permit.. A. After an opportunity for a hearing, the Board may revoke or suspend a Class I, Class II, or Class III permit or take disciplinary action under Health Occupations Article, §4-315(a) or (b) Annotated Code of Maryland, if the Board finds that:1) The holder of the permit violates any provision of this chapter; or. 2) The facility is inadequate under the provisions of this chapter.. B. Failure to comply with
10.44.12.38.htm 10.44.12.38. 38 Violations for Individuals with General Anesthesia and Parenteral Sedation Permits in Existence as of January 4, 2010.A. After an opportunity for a hearing, the Board may revoke or suspend a general anesthesia administration permit or a parenteral sedation administration permit or take disciplinary action under Health Occupations Article, §4-315(a) or (b) Annotated Code of Maryland, if the Board finds that:1) The holder of the permit violates Regulation .1
10.44.12.39.htm 10.44.12.39. 39 Summary Suspension of a Permit.. A. The Board may order the summary suspension of a permit if the Board:. 1) Finds that the public health, safety, or welfare imperatively requires emergency action; and. 2) Promptly gives the licensee:. a) Written notice of the suspension, the finding, and the reasons that support the finding; and. b) An opportunity to be heard.. B. Service of the notice of the suspension, the finding, the reasons that support the finding, and t
10.44.12.9999.htm 10.44.12.9999. Administrative History Effective date: February 11, 1985 (12:3 Md. 245). Regulation .04 amended effective March 8, 1999 (26:5 Md. R. 392). Regulation .07B, C amended effective September 23, 1996 (23:19 Md. R. 1376). Regulation .09 amended effective February 19, 1990 (17:3 Md. R. 300) March 8, 1999 (26:5 Md. R. 392). Regulation .10C amended effective September 23, 1996 (23:19 Md. R. 1376) March 8, 1999 (26:5 Md. R. 392) ―Regulations .01―13 under General Anesthesia, repea
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