Fla. Admin. Code R. 64B5-14.003

Current through Reg. 50, No. 253; December 31, 2024

Section 64B5-14.003 - Training, Education, Certification, and Requirements for Issuance of Permits

(1) General Anesthesia Permit.

(a) To be eligible for a permit to authorize the use of general anesthesia or deep sedation at a specified practice location or locations on an outpatient basis for dental patients the dentist shall comply with Rule 64B5-14.0025, F.A.C., and:

1. Complete a minimum of a two year residency program accredited by the Commission on Dental Accreditation in dental anesthesiology or complete an oral and maxillofacial surgical residency program accredited by the Commission on Dental Accreditation beyond the undergraduate dental school level, or

2. Is a diplomate of the American Board of Oral and Maxillofacial Surgery, or

3. Is eligible for examination by the American Board of Oral and Maxillofacial Surgery.

(b) A dentist employing or using general anesthesia or deep sedation shall maintain a properly equipped facility for the administration of general anesthesia, pursuant to Rule 64B5-14.008, F.A.C. Administration of general anesthesia or deep sedation requires at least three individuals, each trained in accordance with this chapter: the operating dentist, a person responsible for monitoring the patient, and a person to assist the operating dentist.

(c) A dentist employing or using general anesthesia or deep sedation and all assistant/dental hygienist personnel shall be certified in an American Heart Association or American Red Cross or equivalent Agency sponsored cardiopulmonary resuscitation course at the basic life support level to include one person CPR, two person CPR, infant resuscitation and obstructed airway, with a periodic update not to exceed two years. A dentist and all assistant/dental hygienist personnel shall also be trained in the use of either an Automated External Defibrillator or a defibrillator and electrocardiograph as part of their cardiopulmonary resuscitation course at the basic life support level. In addition to CPR certification, a dentist utilizing general anesthesia or deep sedation must be currently trained in ACLS (Advanced Cardiac Life Support). Effective March 1, 2022, if treating a patient 7 years of age or under, a dentist utilizing any level of sedation must be currently trained in PALS (Pediatric Advanced Life Support).

(d) A dentist permitted to administer general anesthesia or deep sedation under this rule may administer moderate sedation, pediatric moderate sedation and nitrous-oxide inhalation moderate sedation.

(2) Moderate Sedation Permit.

(a) To be eligible for a permit to authorize the use of moderate sedation at a specified practice location or locations on an outpatient basis for dental patients, the dentist shall comply with Rule 64B5-14.0025, F.A.C., and:

1. Complete a formal training course offered through a Commission on Dental Accreditation accredited dental school or program in the use of moderate sedation or though an accredited teaching hospital. Clinical training must take place at the accredited dental school or accredited teaching hospital; and,

2. Is certified by the institution where the formal training was received to be competent in the administration of moderate sedation; and, is competent to handle all emergencies relating to moderate sedation.

(b) The institution's certification shall specify the type, the number of hours, the number of patients treated and the length of training. The minimum number of didactic hours shall be sixty (60), which must include four (4) hours of airway management. Airway management must include emergency airway management protocols. Clinical training shall include personal administration for at least twenty (20) patients including supervised training, clinical experience and demonstrated competence in airway management of the compromised airway. The program must certify that a total of three (3) hours of clinical training was dedicated to hands-on simulated training in emergency airway management of the compromised airway.

(c) Personal Administration of Moderate Sedation: The board shall award credit towards the required twenty (20) dental patients, if and only if, the applicant is responsible for and remains with the patient from pre-anesthetic evaluation through discharge. The evaluation and responsibilities include the following: pre-anesthetic evaluation, induction, maintenance, emergency, recovery, and approval for discharge. The board will not award credit for dental anesthetic procedures performed that are greater than or less than the administration of moderate sedation.

(d) A dentist utilizing moderate sedation shall maintain a properly equipped facility for the administration of moderate sedation, pursuant to Rule 64B5-14.009, F.A.C. Administration of moderate sedation requires at least three individuals, each trained in accordance with this chapter: the operating dentist, a person responsible for monitoring the patient, and a person to assist the operating dentist.

(e) A dentist utilizing moderate sedation and his assistant/dental hygienist personnel shall be certified in an American Heart Association or American Red Cross or equivalent agency sponsored cardiopulmonary resuscitation course at the basic life support level to include one person CPR, two person CPR, infant resuscitation, and obstructed airway with a periodic update not to exceed two years. A dentist and all assistant/dental hygienist personnel shall also be trained in the use of either an Automated External Defibrillator or a defibrillator and electrocardiograph as part of their cardiopulmonary resuscitation course at the basic life support level. In addition to CPR certification, a dentist utilizing moderate sedation must be currently trained in ACLS (Advanced Cardiac Life Support). Effective March 1, 2022, if treating a patient 7 years of age or under, a dentist utilizing moderate sedation must be currently trained in PALS (Pediatric Advanced Life Support).

(f) Dentists permitted to administer moderate sedation may administer nitrous-oxide inhalation moderate sedation.

(g) Dentists permitted to administer moderate sedation may also administer pediatric moderate sedation in compliance with Rule 64B5-14.010, F.A.C.

(3) Pediatric Moderate Sedation Permit.

(a) To be eligible for a permit to authorize the use of pediatric moderate sedation at a specified practice location or locations on an outpatient basis for dental patients, the dentist shall comply with Rule 64B5-14.0025, F.A.C., and:

1. Complete formal training in the use of pediatric moderate sedation through a Commission on Dental Accreditation accredited dental school or program, or through an accredited teaching hospital, or through an accredited pediatric residency program. Clinical training must take place at the accredited dental school or accredited teaching hospital; and,

2. Is certified by the institution where the formal training was received to be competent in the administration of pediatric moderate sedation and is competent to handle all emergencies relating to pediatric moderate sedation. This certification shall specify the type, the number of hours, the number of patients treated and the length of training. The minimum number of didactic hours shall be sixty (60), which must include four (4) hours of airway management. Clinical training shall include personal administration for at least twenty (20) patients including supervised training, management of sedation, clinical experience and demonstrated competence in airway management of the compromised airway. The program must certify that three (3) hours of clinical training was dedicated to hands-on simulated training in emergency airway management of the compromised airway.

(b) This certification shall specify the type, the number of hours, the number of patients treated and the length of training. The minimum number of didactic hours shall be sixty (60), which must include four (4) hours of airway management. Clinical training shall include personal administration for at least twenty (20) patients including supervised training, management of sedation, clinical experience and demonstrated competence in airway management of the compromised airway. The program must certify that three (3) hours of clinical training was dedicated to hands-on simulated training in emergency airway management of the compromised airway; and,

(c) Personal Administration of Pediatric Moderate Sedation: The board shall award credit towards the required twenty (20) pediatric dental patients, if and only if, the applicant is responsible for and remains with the patient from pre-anesthetic evaluation through discharge. The evaluation and responsibilities include the following: pre-anesthetic evaluation, induction, maintenance, emergency, recovery, and approval for discharge. The board will not award credit for dental anesthetic procedures performed that are greater than or less than the administration of pediatric moderate sedation.

(d) A dentist utilizing pediatric moderate sedation shall maintain a properly equipped facility for the administration of pediatric moderate sedation, pursuant to Rule 64B5-14.010, F.A.C. Administration of pediatric moderate sedation requires at least three individuals, each trained in accordance with this chapter: the operating dentist, a person responsible for monitoring the patient, and a person to assist the operating dentist.

(e) A dentist utilizing pediatric moderate sedation and his assistant/dental hygienist personnel shall be certified in an American Heart Association or American Red Cross or equivalent agency sponsored cardiopulmonary resuscitation course at the basic life support level to include one person CPR, two person CPR, infant resuscitation, and obstructed airway with a periodic update not to exceed two years. A dentist and all assistant/dental hygienist personnel shall also be trained in the use of either an Automated External Defibrillator or a defibrillator and electrocardiograph as part of their cardiopulmonary resuscitation course at the basic life support level. In addition to CPR certification, a dentist utilizing pediatric moderate sedation must be currently trained in PALS (Pediatric Advanced Life Support).

(f) Dentists permitted to administer pediatric moderate sedation may administer nitrous-oxide inhalation moderate sedation.

(4) Nitrous-Oxide Inhalation Analgesia.

(a) A dentist may use, or employ and authorize a dental hygienist to assist the dentist in initiating under indirect supervision, as specified by Rule 64B5-16.006, F.A.C., nitrous-oxide inhalation analgesia on an outpatient basis for dental patients provided such dentist and dental hygienist have:

1. Completed no less than a two-day course of training as described in the American Dental Association's "Guidelines for Teaching Pain Control and Sedation to Dentists and Dental Students (eff. 10/16), which is hereby incorporated by reference and available at http://www.flrules.org/Gateway/reference.asp?No=Ref-11670 or available at http://www.floridadentistry.gov, or its equivalent. For the training of Dental Hygienists or Dental Assistants, the instructor is required to have an unencumbered Florida dental license or be on the faculty of a dental school and be fully trained in the administration of nitrous oxide as outlined in herein. A moderate sedation permit is not required to teach the program.

2. Training equivalent to that described above while a student in an accredited school of dentistry or dental hygiene; and,

3. A dental nitrous-oxide delivery system with fail-safe features and a 30% minimum oxygen flow.

(b) A dentist utilizing nitrous-oxide inhalation analgesia and such dentist's assistants and dental hygienist personnel shall be certified in an American Heart Association or American Red Cross or equivalent Agency sponsored cardiopulmonary resuscitation course at the basic life support level to include one man CPR, two man CPR, infant resuscitation and obstructed airway with a periodic update not to exceed two years. A dentist and all assistant/dental hygienist personnel shall also be trained in the use of either an Automated External Defibrillator or a defibrillator and electrocardiograph as part of their cardiopulmonary resuscitation course at the basic life support level. In addition to CPR certification, a dentist utilizing pediatric moderate sedation must be currently trained in PALS (Pediatric Advanced Life Support).

(c) A dentist who regularly and routinely utilized nitrous-oxide inhalation analgesia on an outpatient basis in a competent and efficient manner for the three-year period preceding January 1, 1986, but has not had the benefit of formal training outlined in subparagraphs 1. and 2. of paragraph (4)(a), above, may continue such use provided the dentist fulfills the provisions set forth in subparagraph 3. of paragraph (4)(a), and the provisions of paragraph (b), above.

(d) Nitrous oxide may be used in combination with a single dose enteral sedative or a single dose narcotic analgesic to achieve a minimally depressed level of consciousness so long as the manufacturer's maximum recommended dosage of the enteral agent is not exceeded. Nitrous oxide may not be used in combination with more than one (1) enteral agent, or by more than a single dose, or by dosing a single enteral agent in excess of the manufacturer's maximum recommended dosage unless the administering dentist holds a moderate sedation permit issued in accordance with subsection 64B5-14.003(2), F.A.C., or a pediatric moderate sedation permit issued in accordance with subsection 64B5-14.003(3), F.A.C.

(e) Dental assistants may monitor nitrous-oxide inhalation analgesia under the indirect supervision of a dentist if the dental assistant has complied with the training requirements in paragraph 64B5-14.003(4)(b), F.A.C., and has completed, at a minimum, a two-day course of training as described in the American Dental Association's "Guidelines for Teaching Pain Control and Sedation to Dentists and Dental Students" or its equivalent. After the dentist or dental hygienist has induced a patient and established the maintenance level, the assistant may monitor the administration of the nitrous-oxide oxygen making only diminishing adjustments during this administration and turning it off at the completion of the dental procedure.

(5) Local Anesthesia Certificate or Permit: A permit or certificate to administer local anesthesia under the direct supervision of a Florida licensed dentist to non-sedated patients eighteen (18) years of age or older shall be issued by the Department of Health to a Florida licensed dental hygienist who has completed didactic and clinical education and experience as required by Section 466.017(5), F.S., and who has been certified by the Board as having met all the requirements of Section 466.017, F.S.

(a) A registered dental hygienist who is seeking a permit or certificate for administering local anesthesia must apply to the department on form DH-MQA 1261 (08/2020), Application for Dental Hygiene Certification Administration of Local Anesthesia, herein incorporated by reference and available at http://www.flrules.org/Gateway/reference.asp?No=Ref-13368, or available on the Florida Board of Dentistry website at http://www.floridasdentistry.gov.

(b) An applicant shall submit the following with the application:

1. A thirty-five dollar ($35) non refundable certificate or permit fee,

2. A certified copy of the applicant's transcripts that reflect the required didactic and clinical education and experience,

3. A certified copy of the diploma or certificate issued by the applicant's institution, program, or school; and,

4. Proof of acceptable certification in Cardiopulmonary Resuscitation for health professionals or Advanced Cardiac Life Support as defined in Section 466.017, F.S.

Fla. Admin. Code Ann. R. 64B5-14.003

Rulemaking Authority 466.004(4), 466.017(3), (6) FS. Law Implemented 466.017(3), (4), (5), (6) FS.

New 1-31-80, Amended 4-20-81, 2-13-86, Formerly 21G-14.03, Amended 12-31-86, 11-8-90, 2-1-93, Formerly 21G-14.003, Amended 12-20-93, Formerly 61F5-14.003, Amended 8-8-96, 10-1-96, Formerly 59Q-14.003, Amended 2-17-98, 12-20-98, 5-31-00, 6-7-01, 11-4-03, 6-23-04, 6-11-07, 2-8-12, 8-16-12 (1)(a)-(f), 8-16-12 (5), 8-19-13, 12-16-13, 3-9-14, Amended by Florida Register Volume 42, Number 125, June 28, 2016 effective 7/14/2016, Amended by Florida Register Volume 43, Number 211, October 31, 2017 effective 11/13/2017, Amended by Florida Register Volume 46, Number 038, February 25, 2020 effective 3/10/2020, Amended by Florida Register Volume 47, Number 139, July 20, 2021 effective 8/5/2021, Amended by Florida Register Volume 48, Number 169, August 30, 2022 effective 9/12/2022, Amended by Florida Register Volume 50, Number 234, December 3, 2024 effective 12/15/2024.