The State Board of Dental Examiners (SBDE) proposes new §110.1, relating to Definitions, §110.2, relating to Sedation/Anesthesia Permit, §110.3, relating to Nitrous Oxide/Oxygen Inhalation Sedation, §110.4, relating to Minimal Sedation, §110.5, relating to Moderate Sedation, §110.6, relating to Deep Sedation or General Anesthesia, §110.7, relating to Portability, §110.8, relating to Provisional Anesthesia and Portability Permits, and §110.9, relating to Anesthesia Permit Renewal.

Ms. Sherri Sanders Meek, Executive Director, has determined that for each year of the first five years the new sections are in effect, the public benefit anticipated as a result of enforcing the new sections will be protection of the public through updated sedation and anesthesia rules.

The SBDE's Anesthesia Rules Ad-Hoc Committee was convened to update the agency's sedation and anesthesia rules based on sedation guidelines adopted by the American Dental Association (ADA) House of Delegates in 2007. The committee met on August 27, 2009, November 19, 2009, April 15, 2010, and August 19, 2010. The committee was chaired by Tamela L. Gough, DDS, and its members included William L. Purifoy, DDS; James W. Chancellor, DDS; William Birdwell, DDS; Maxwell Finn, DDS, MD; and Arthur Troilo, JD.

The new sections developed by the committee (new Chapter 110, Sedation and Anesthesia) consolidate sedation and anesthesia rules previously found in §§108.30 - 108.35 and Chapter 110, Enteral Sedation. The most significant change in the revisions is to the levels of anesthesia and sedation permitting. The permitting process emphasizes the level of sedation of the patient rather than the route of administration of the medication. The new sections establish five levels of anesthesia and sedation permits beyond the standard dental license: Nitrous Oxide/Oxygen Inhalation Sedation; Level 1: Minimal Sedation; Level 2: Moderate Sedation (enteral sedation); Level 3: Moderate Sedation (parenteral sedation); and Level 4: Deep Sedation or General Anesthesia.

Most levels of permitting will change in name only. Licensed dentists who lack sedation permits may continue to utilize local anesthetic and prescribe minor tranquilizers for anxiolysis. A licensed dentist who holds an active Nitrous Oxide/Oxygen Inhalation Conscious Sedation permit, Parenteral Sedation permit, or Deep Sedation or General Anesthesia permit on or before the effective date of the new sections will have his or her permit automatically reclassified as a Nitrous Oxide/Oxygen Inhalation Sedation permit, Level 3 permit, and Level 4 permit respectively on the effective date.

A licensed dentist who holds an active Enteral Sedation permit on or before the effective date will have his or her permit automatically reclassified as a Level 1 (Minimal Sedation) permit. Dentists in this category may continue to administer Enteral Sedation as permitted by the current rules until January 1, 2013. A dentist who holds an active Enteral Sedation permit on or before June 1, 2011 who desires to administer Level 2 (Moderate - Enteral) sedation after January 1, 2013 must submit an application for a Level 2 permit prior to January 1, 2013. A Level 1 permit allows a dentist to use a single medication or a single medication in combination with nitrous oxide to achieve sedation. The sedation provided under this permit may only result in a minimally depressed level of consciousness for the patient. A Level 2 permit will be required to utilize two or more medications to achieve sedation or to achieve a moderate level of sedation.

In addition to changes in the permitting process, the new Chapter 110 revises education requirements for future permit holders and revises clinical guidelines and continuing education requirements for current permit holders. The new chapter takes effect on June 1, 2011.

The ADA's Guidelines may be accessed at:

www.ada.org/sections/about/pdfs/anesthesia_guidelines.pdf,

www.ada.org/sections/professionalresources/pdfs/anxiety_guidelines.pdf, and

www.ada.org/sections/about/pdfs/statements_anesthesia.pdf.

Ms. Meek has also determined that for each year of the first five years the new sections are in effect, there will be no fiscal implications for local or state government as a result of enforcing or administering the sections. There is no anticipated economic impact on individuals or small or micro-businesses required to comply with the sections as proposed.

Comments on the proposals may be submitted to Carey A. Olney, staff attorney, State Board of Dental Examiners, 333 Guadalupe Street, Tower 3, Suite 800, Austin, Texas 78701 (by mail), (512) 463-7452 (by fax), or carey.olney@tsbde.state.tx.us (by email). To be considered, comments must be in writing and received by the State Board of Dental Examiners no later than 30 days from the date that the sections are published in the Texas Register.

The new sections are proposed under Texas Occupations Code §254.001, which provides the Board with the authority to adopt and enforce rules necessary for it to perform its duties.

The proposal affects Texas Occupations Code, Title 3, Subtitle D and Texas Administrative Code, Title 22, Part 5.