Florida Dental Practice Act

Definitions

Anesthesia The loss of feeling or sensation, especially loss of the sensation of pain.

General anesthesia A controlled state of unconsciousness, produced by a pharmacologic agent, accompanied by a partial or complete loss of protective reflexes, including inability to independency maintain an airway and respond purposefully to physical stimulation or verbal command. This modality includes administration of medications via parenteral routes; that is: intravenous, intramuscular, subcutaneous, submucosal, or inhalation.

Deep Sedation A controlled state of depressed consciousness accompanied by partial loss of protective reflexes, including either or both the inability to continually maintain an airway independently or to respond appropriately to physical stimulation or verbal command, produced by pharmacologic or non-pharmacologic method or combination thereof. Deep sedation includes administration of medications via parenteral routes; that is intravenous, intramuscular, subcutaneous, submucosal, or inhalation.

Parenteral conscious sedation A depressed level of consciousness produced by the parenteral administration of pharmacologic substances, chat retains the patient's ability to independently and continuously maintain an air vary and respond appropriately to physical stimulation or verbal command. This modality includes administration of medications via all parenteral routes: that is, intravenous, intramuscular, subcutaneous, submucosal, or inhalation.

Pediatric Conscious Sedation A depressed level of consciousness produced by the administration of pharmacologic substances, that retains a child patient's ability to independently and continuously maintain an airway and respond appropriately to physical stimulation or verbal command. This modality includes administration of medication via all parenteral routes; that is intravenous, intramuscular, subcutaneous, submucosal, or inhalation, and all enteral routes; that is oral, rectal, or transmucosal. The drugs, doses, and techniques used should carry a margin of safety wide enough to render unintended loss of consciousness unlikely.

Nitrous-oxide inhalation analgesia The administration by inhalation of a combination of nitrous-oxide and oxygen producing an altered level of consciousness that retains the patient's ability to independently and continuously maintain an
airway and respond appropriately to physical stimulation or verbal command.

Local anesthesia The loss of sensation of pain in a specific area of the body, generally produced by a topically applied agent or injected agent without causing the loss of consciousness.

Analgesia Absence of sensibility of pain, designating particularly the relief of pain without loss of consciousness.

Office team approach A methodology employed by a dentist in the administration of general anesthesia, deep sedation parenteral conscious sedation, and pediatric sedation whereby the dentist uses one or more qualified assistants/dental hygienists who, working under the direct supervision of the dentist, assist the dentist, and assist in emergency care of the patient. §64BS-14.001

A dentist may not administer general anesthesia, deep sedation, parenteral conscious sedation or pediatric conscious sedation without a permit. §64B5-14.002

Reporting Adverse Occurrences

Any dentist practicing in the State of Florida must notify the Board in writing by registered mail, postmarked within 48 hours of any mortality or other incident occurring in the dentist's outpatient facilities. A complete written report shall be filed with the Board within 30 days of the mortality or other incident. Incidents which shall be reported are those which result in temporary or permanent physical or mental injury requiring hospital emergency room treatment and/or hospitalization of a patient during, or as a direct result of the use of general anesthesia, deep sedation, parenteral conscious sedation, pediatric conscious sedation, oral sedation, nitrous oxide, or local anesthesia during or related to a dental procedure. The report shall include at minimum, responses to the following:

(a) Description of dental procedure.

(b) Description o f preoperative physical condition of the patient l

(c) List of drugs and dosage administered.

(d) Description in detail, of techniques utilized in administering the drugs utilized.

(e) Description of adverse occurrence.

(f) Describe the patient's condition on termination of any procedure undertaken.

Inspection of Facilities

The Board by majority vote shall appoint consultants who are Florida licensed dentists to inspect facilities where general anesthesia, deep sedation, parenteral conscious sedation, or pediatric conscious sedation is performed.

Any dentist who has applied for or received a general anesthesia permit parenteral conscious sedation permit or pediatric conscious sedation permit shall be subject to announced or unannounced on-site inspection and evaluation by an inspection consultant This inspection and evaluation shall be required prior to issuance of an anesthesia permit However, if the Agency cannot complete the required inspection prior to licensure such inspection shall be waived until such time that it can be completed following licensure.

Requirements for General Anesthesia or Deep Sedation

General Anesthesia Permit applicants and permit holders shall comply with the following requirements at each location where anesthesia procedures are performed. The requirements shall be met and equipment permanently maintained and available at each location.

The operatory where anesthesia is to be administered must.

(a) Be of adequate size and design to permit physical access of emergency equipment and personnel and to permit effective emergency management

(b) Be equipped with a chair or table adequate for emergency treatment, including a chair or cardiopulmonary resuscitation (CPR) board suitable for CPR.

If a recovery room is present it shall be equipped with suction equipment, positive pressure oxygen and sufficient light to provide emergency treatment The recovery room shall also be of adequate size and design to allow emergency access and management.

 

The following equipment must be readily available to the operatory and recovery room and maintained in good working order

 

(a) A positive pressure oxygen delivery system including full face mask for adults and for pediatric patients, if pediatric patients are treated

 

(b) Oral and nasal airways of various sizes;

 

(c) Blood pressure cuff and stethoscope, and

(d) Cardioscope — electrocardiograph (EKG) machine and pulse oximeter to provide continuous monitoring of heart rhythm and rate of oxygen saturation of the blood. This equipment shall be used for each procedure, and

 

(e) Defibrillator equipment.

 

The following emergency equipment must be present

 

(a) Appropriate I.V. set-up, including appropriate hardware and fluids;

 

(b) Laryagoscope with current batteries

(c) Intubation forceps and endotracheal tubes;

 

(d) Tonsillar suction with back up suction

(e) Appropriate syringes;

 

(f) Tourniquet and tape;

 

(g) CPR board or chair suitable for CPR, and

(h) Blood pressure cuff and stethoscope.

 

The following drugs or type of drugs with a current shelf life must be maintained and easily accessible from the operatory and recovery room:

 

(a) Epinephrine;

 

(b) Atropine;

 

(c) Lidocaine;

 

(d) Sodium Bicarbonate;

 

(e) An antihistamine;

 

(f) A vasodilator;

 

(g) A bronchodilator,

(h) An antibypoglycemic agent;

 

(i) A vasopressor,

(j) A corticosteroid;

 

(k) An anticonvulsant;

 

(1) A muscle relaxant;

 

(m) A narcotic and benzodiazepine antagonist;

 

(n) An appropriate antiarrhythmic medication and

 

(o) Nitroglycerine.

 

The applicant or permit holder shall provide written emergency protocols, and shall provide training to familiarize office personnel in the treatment of the following clinical emergencies:

 

(a) Laryngospasm;

 

(b) Bronchospasm;

 

(c) Emesis and aspiration

(d) Airway blockage by foreign body;

 

(e) Angina pectoris

(f) Myocardial infarction;

 

(g) Hypertension/Hypotension;

 

(h) Hypertensive crisis;

 

(i) Allergic and toxicity reactions

(j) Convulsions; and

(k) Hyperventilation/Hypoventilation.

 

Parenteral Conscious Sedation

Parenteral Conscious Sedation Permit applicants or permit holders shall comply with the following requirements at each location where anesthesia procedures are performed. The requirements shall be met and equipment permanently maintained and available at each location

The following equipment must be readily available to the operatory and recovery room and maintained in good working order

(a) A positive pressure oxygen delivery system including full face mask for adults and for pediatric patients, if pediatric patients are treated;

(b) Oral and nasal airways of various sizes

(c) Blood pressure cuff and stethoscope; and

(d) A pulse oximeter which provides continuous monitoring of pulse and rate of oxygen saturation of the blood shall be used during each procedure.

The following emergency equipment must be present

(a) Appropriate intravenous set-up, including appropriate hardware and fluids;

(b) Appropriate syringes;

(c) Tourniquet and tape.

The following drugs or type of drugs with a current shelf life must be maintained and easily accessible from the operatory and recovery room:

(a) Epinephrine;

(b) Atropine;

(c) Lidocaine;

(d) Narcotic (e.g., Naloxone HCI) and benzodiazepine (e.g., Flumazenil) antagonists, if these agents are used;

(e) An antihistamine (e.g., Diphenhydramine MCI);

(f) A corticosteroid (e.g., Hydrocortisone);

(g) Nitroglycerine;

(h) A bronchodilator-(e.g., Albuterol inhaler);

(i) An antihypoglycemic (e.g.,-50% glucose).

The applicant or permit holder shall provide written emergency protocols, and shall provide training to familiarize office personnel in the treatment of the following clinical emergencies:

(a) Laryngospasm;

(b ) Bronchospasm;

(c) Emesis and aspiration;

(d) Airway blockage by foreign body;

(e) Angina pectoris;

(f) Myocardial infarction

(g) Hypertension/Hypotension;

(h) Hypertensive crisis;

(i) Allergic and toxicity reactions;

(j) Convulsions; and

(k) Hyperventilation/Hypoventilation.

Pediatric Conscious Sedation

Pediatric Conscious Sedation Permit applicants or permit holders shall comply with the following requirements at each location where anesthesia procedures are performed.

The following equipment must be readily available to the operatory and recovery room and maintained in good working order

(a) A positive pressure oxygen delivery system including full face mask for pediatric patients;

(b) Airways of appropriate size for the pediatric patient;

(c) Blood pressure cuff and stethoscope;

(d) A pulse oximeter which provides continuous monitoring of pulse and rate of oxygen saturation of the blood shall be used during each procedure; and

(e) A scale for weighing pediatric patients.

The following emergency equipment must be present

(a) Appropriate intravenous set-up, including appropriate hardware and fluids;

(b) Appropriate syringes;

(c) Tourniquet and tape.

The following drugs or type of drugs with a current shelf life must be maintained and easily accessible from the operatory and recovery room:

(a) Epinephrine;

(b) Atropine;

(c) Lidocaine;

(d) Narcotic (e.g., Naloxone HCI) and benzodiazepine (e.g., Flumazenil) antagonists, if these agents are used;

(e) An antihistamine (e.g., Diphenhydramine

(f) A corticosteroid (e.g., Hydrocortisone);

(g) Nitroglycerine;

(h) A bronchodilator (e.g., Albuterol inhaler);

(i) An antihypoglycemic (e.g., 50% glucose).

The applicant or permit holder shall provide written emergency protocols, and shall provide training to familiarize office personnel in the treatment of the following clinical emergencies:

(a) Laryngospasm;

(b) Bronchospasm;

(c) Emesis and aspiration;

(d) Airway blockage by foreign body;

(e) Cardiac arrhythmias;

(f) Hypertension/Hypotension;

(g) Hypertensive crisis;

(h) Allergic and toxicity reactions;

(i) Convulsions; and

(j) Hyperventilation/Hypoventilation.

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