Section 1220.510  Moderate Sedation (Conscious Sedation) in the Dental Office Setting

a)         Moderate sedation (conscious sedation) includes the prescription or administration of pharmacologic agents to be used for the purposes of moderate sedation.  Moderate sedation (conscious sedation) must be administered by an individual qualified under this Section. (See Appendix D for characteristics of levels of anesthesia.) The drugs and/or techniques used must carry a margin of safety wide enough to render unintended loss of consciousness unlikely.

b)         A licensed dentist seeking a Permit A for moderate sedation (conscious sedation) administration privileges shall file an application with the Division, on forms provided by the Division, that shall include:

1)         Certification of completion of an anesthesiology training program that meets the following requirements:

A)        Include a minimum of 75 hours of didactic and clinical study that includes training in moderate sedation (conscious sedation), physical evaluation, venipuncture, advanced airway management, technical administration, recognition and management of complications and emergencies, and monitoring with additionally supervised experience in providing moderate sedation to 20 or more patients; and

B)        Be an organized sequence of study operated by one entity and completed in less than one calendar year;

2)         A signed affidavit certifying that:

A)        the dentist will practice in a facility properly equipped in accordance with subsection (g) for the administration of moderate sedation (conscious sedation);

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

i)          the dentist who holds the Permit A;

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 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 moderate sedation.  A dental hygienist or dental assistant trained to monitor a patient under moderate sedation 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; and

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

3)         Proof of current ACLS certification or PALS certification; and

4)         The required fee set forth in Section 1220.415.

c)         Dentists who have a current valid permit for moderate sedation (conscious sedation) issued by the Division shall be permitted to administer without additional application.

d)         In accordance with the standards set forth in this Section, the Division will:

1)         Issue a moderate sedation (conscious sedation) permit (Permit A).

2)         Re-issue a moderate sedation (conscious sedation) permit to Permit A holders who attest to completing continuing education.

e)         Licensees qualified to administer deep sedation (Permit B) pursuant to Section 1220.520 may administer moderate sedation (conscious sedation) without a Permit A.

f)         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.

g)         A properly equipped facility for the administration of moderation sedation (conscious sedation) shall include at 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)         A pulse oximeter;

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

8)         Advanced airway devices that would isolate the trachea and facilitate positive pressure oxygen administration in sizes appropriate for the patient population being served (e.g., endotracheal tubes or laryngeal mask airway);

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

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

11)         Defibrillator (an automated external defibrillator is an acceptable defibrillator);

12)         Equipment for the establishment of an intravenous infusion;

13)         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

14)         A recovery area that has available oxygen, lighting, suction and electrical outlets.  The Permit A 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.

h)         The following records shall be kept during the administration of moderate sedation (conscious sedation):

1)         Medical history of the patient and consent for administration of anesthesia 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)         Drugs and dosages of these drugs used during the operative procedure, including the identification of the person administering drugs and times of their administration over the course of the procedure.

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

j)          A licensed dentist shall hold Permit A in order to perform dentistry while a licensed certified nurse anesthetist administers moderate sedation (conscious sedation).  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 [225 ILCS 65].  The dentist shall enter into a written collaborative agreement with the nurse anesthetist consisting of the requirements of this section as follows:  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.  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.

k)         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 A.

l)          A treating dentist does not need to hold Permit A to perform dentistry when another dentist, who holds Permit A or Permit B, or a physician or dental anesthesiologist assists the treating dentist by administering moderate sedation (conscious sedation). 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 [225 ILCS 60] 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 to the following if requested by the Division:

A)        That the facility used for sedation meets the criteria of subsection (g) of this Section;

B)        That the dentist shall staff the facility with a team, supervised by the permit 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; the treating dentist; and the dentist who holds a Permit A or B providing the anesthesia services; or

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

C)        That the permit holder or physician will remain immediately available to the patient after being treated under moderate sedation. A dental hygienist or dental assistant trained to monitor a patient under moderate sedation will remain with the sedated patient until the patient is no longer sedated.

2)         All members of the team, including the treating dentist (non-permit holder) must maintain current BLS certification or its equivalent. 

3)         In addition, the dentist (non-permit holder) shall report adverse occurrences to the Division as set forth in Section 1220.405 and accept the responsibility to verify the certification and licensure of any licensed provider present during the moderate sedation (conscious sedation) of a patient who is receiving dental care.

m)        A dentist holding a Permit A 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. 

n)         A dentist holding a Permit A 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.

o)         A dentist holding a Permit A 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)