Anesthesia and Pain Control

Enteral Conscious Sedation in the Dental Practice




These two courses will present an update and review of physiology and physical evaluation of the medically complex patient. A detailed review of the pharmacology of enteral medications and the recognition and management of anesthesia complications will be presented. We will also discuss proper patient monitoring using the required monitoring equipment. Setting up a proper emergency kit and the management of medical and anesthesia related emergencies will also be presented. 

Objectives:

  • Review anatomy and physiology of the cardiac and respiratory system.
  • Review common medical conditions and current therapeutic interventions.
  • Relate medical conditions to their impact on delivery of dental services.
  • Discuss patient evaluation in ascertaining relative risks in performing dental procedures under enteral sedation.
  • Establish guidelines and limitations in the delivery of dental services based upon medical conditions.
  • Understand the pharmacology of enteral medications and its effect on organ systems.
  • Set up and maintain the armamentarium needed for the delivery of enteral sedation.
  • Understand the technologies and equipment necessary to monitor patients under enteral sedation.
  • Recognize and manage anesthesia complications.
  • Recognize and manage common medical emergencies.

Registrants will participate in the hands-on monitoring of conscious sedation patients.


40-Hour Program has minimum enrollment requirement.
Dates:
Five Wednesdays: October 4,18 & 25, November 1 & 8, 2017
Time:
9 a.m. to 5 p.m. each day
Location:
The Rutgers School of Dental Medicine
Tuition:
$1,995 for Dentists
Credit:
40 credit hours
Code:
18D0903B


Please feel free to contact us if you need help with your on-line account.
E-mail: cde@sdm.rutgers.edu • Phone: 973-972-6561
(Office hours are Monday to Friday, 8:30 a.m.–4:30 p.m.)
  

Objectives:

  • Review the anatomy and physiology of the cardiac and respiratory system.
  • Review common medical conditions and current therapeutic interventions.
  • Relate medical conditions to their impact on delivery of dental services.
  • Discuss patient evaluation in ascertaining relative risks in performing dental procedures under enteral sedation.
  • Establish guidelines and limitations in the delivery of dental services based upon medical conditions.
  • Update on the pharmacology of enteral medications.
  • Update on the technologies and equipment necessary to monitor patient under enteral sedation.
  • Recognize and manage anesthesia complications.
  • Recognize and manage common medical emergencies.

Dates:
Three Wednesdays: October 4, 18 & 25, 2017
Time:
9 a.m. to 5 p.m. each day
Location:
The Rutgers School of Dental Medicine
Tuition:
$845 for Dentists
Credit:
20 credit hours
Course code:
18D0903A


Please feel free to contact us if you need help with your on-line account.
E-mail: cde@sdm.rutgers.edu — Phone: 973-972-6561
(Office hours are Monday to Friday, 8:30 a.m. - 4:30 p.m.)
  

FACULTY

Department of Oral and Maxillofacial Surgery

PAMELA L. ALBERTO, DMD - Course Director, Associate Professor

HANI BRAIDY, DMD, Associate Professor

MAANO MILLES, DDS, Professor

GAETANO SPINNATO, DMD, Professor

VINCENT ZICCARDI, DDS, MD, Professor and Chairman

BARRY ZWEIG, DDS, Professor


DAY 1:  (20 & 40 hours)

  • Anatomy, Physiology and Physical Diagnosis
  • Anatomy and Physiology of the Cardiac and Respiratory System
  • Cardiac Arrest
  • Hypertension
  • Renal Disease
  • Pulmonary Disease
  • Lunch & Learn (40 hours only)
  • Endocrine Disease
  • Neurologic Disease
  • Peptic Ulcer Disease/ GERD
DAY 2:  (20 & 40 hours)
  • Patient Monitoring / Medical Emergencies
  • Office Preparedness / Crash Cart
  • Monitoring Equipment and Interpretation
  • Management of Patient with L.O.C.
  • Management of Chest Pain
  • Lunch & Learn (40 hours only)
  • Management of Neurologic Emergencies
  • Management of Respiratory Distress
  • Management of Allergies, Drug Reactions and Overdose
DAY 3:  (20 & 40 hours)
  • Pharmacology of Enteral Medication, Local Anesthesia, and Nitrous Oxide
  • Commonly Used Medications and Herbs
  • Comparison /Contrast of Analgesic and Sedation Techniques
  • Pharmacology and Techniques of Enteral Sedation
  • Lunch & Learn (40 hours only)
  • Pharmacology of Local Anesthesia
  • Techniques of Nitrous Oxide Administration
  • Adverse Effects of Nitrous Oxide and Local Anesthesia
DAY 4:  (40 hours)
  • Patient Monitoring / Medical Emergencies
  • Intravenous Placement
  • Hands-on Practical Management of Medical Emergencies
  • Mock Emergency Drills, Intubation, I.V. Placement
  • Lunch & Learn
  • Clinical Patient Monitoring
DAY 5:  (40 hours)
  • Anesthesia Management of the Medical and Physically Compromise Patient
  • Anesthetic Management of the Physically Compromised Patient
  • Anesthetic Management of the Geriatric Patient
  • Anesthetic Management of the Pediatric Patient
  • Lunch & Learn
  • Anesthetic Management of the Medically Compromised Patient
  • Case-Based Patient Simulations
  • Clinical Patient Monitoring

What is covered under the new regulation?

The new rule defines enteral sedation to include the prescription or administration of one or more pharmacological agents, used for the purpose of causing a depressed level of consciousness, but not a loss of consciousness. Pharmacological agents include any non-parenteral agent, but do not include any agent that is introduced by intravenous, intramuscular, subcutaneous, submucosal or inhalation routes, including nitrous oxide inhalation.

When is the new rule effective?

The regulation became effective upon its adoption on September 6, 2005.  Any New Jersey dentist who wishes to administer any pharmacological agent in any dose for the purpose of inhibiting patient response beyond diminishing patient anxiety must possess an enteral sedation permit. The Board will consider applications beginning in the first quarter of 2006.  Enteral Sedation permits will be required after July 1, 2006.

I advertise “Sleep Dentistry.” 
May I continue to do so after I get permit?

No. The use of these terms are prohibited effective with the adoption of the new rule, unless a dentist holds a general anesthesia permit.

The Board is aware that some dentists have been advertising the provision of "sleep dentistry" services as a way for very apprehensive patients to undergo dental procedures. Patients are sedated and are placed in a very "sleep-like" state prior to the start of the dental services and are "awakened," or brought out of this sedated state, once the procedures are complete. The Board believes that some dentists who advertise or offer "sleep dentistry" services and are placing patients under deep sedation in order to achieve the desired sleep-like state, are doing so without the benefit of a GA permit. If a patient is going to be placed under deep sedation, which is necessary if a "sleep-like" state is the desired effect, the Board believes that the dentist must possess a GA permit in order to properly handle any untoward reaction the patient may experience during the procedure. The new regulation provides that a dentist who uses or advertises the terms "sleep," "sleep dentistry," or "sleeplike-state," or any other similar words, in connection with the provision of dental services will be considered to be inducing deep sedation. Such a dentist must possess a GA permit.

How does the Board define "deep sedation?"

The term “deep sedation” is defined to mean the administration of pharmacological and/or non-pharmacological agents, or a combination of the two, to induce a state of depressed consciousness in a patient, which is accompanied by a partial loss of protective reflexes, including the inability of the patient to continually maintain an airway independently and/or to respond purposefully to painful physical stimulation or verbal command. The new rules prohibit a dentist from administering, dispensing or prescribing any pharmacological agent that will cause a patient to lapse into this type of sedation unless the dentist possesses a GA permit issued by the Board. The Board believes that the risks associated with this type of sedation are such that only those dentists who are properly trained in the administration of general anesthesia and have satisfied the requirements necessary to obtain a GA permit should be authorized to employ it in their dental practices.

Sometimes I prescribe a dose of medication to control anxiety before a patient visit.  Am I required to hold a permit?

No.  The new rule only applies to the administration of pharmacological agents with the purpose of inhibiting patient response beyond diminishing patient anxiety.

What kind of training is required for the issuance of an enteral sedation permit?

A dentist applying for this new permit must submit a certification verifying that the dentist has completed Board-approved post-doctoral course work at an accredited dental school, or in a college or university clinical setting, which has prepared the applicant to administer enteral sedation safely and effectively. The course work must consist of a minimum of 40 hours of didactic training in basic enteral sedation, physical evaluation, recognition and management of complications and emergencies, and patient monitoring. A list of approved courses is posted on the Board’s website.

Enteral Sedation permits for dentists who have completed a General Practice Residencies (GPR) or other residencies.

Any dentist who has completed a general practice residency or has graduated from a post-doctoral training program within three years of application will qualify for the issuance of an enteral sedation permit. A dentist completing a general practice residency or a post-doctoral training program more than three years prior to application may qualify for a permit if he or she has completed a board approved program of 20 hours of didactic training in enteral sedation within the three years immediately preceding the date of application. The Board believes that these modifications of the course work requirement are warranted because the training obtained by dentists who have completed a general practice residency or post-doctoral training program is comprehensive and will adequately prepare them to safely and effectively administer enteral sedation.  A list of approved courses is posted on the Board’s website.

Are permits renewable?

Enteral sedation permits are renewed every two years.

Are there continuing education requirements to renew the permit?

Yes. Each holder of an enteral sedation permit is required to complete at least 20 hours of continuing education in every biennial period in physiology, pharmacology, patient evaluation, patient monitoring, or medical emergencies. The 20 hours of training must be completed consistent with the requirements imposed by the Board pursuant to its existing continuing education rule for dentists. The Board has determined that completion of the 20 hours of continuing education required for the maintenance of an enteral sedation permit may be counted toward satisfaction of the total number of credits required of a dentist to renew a license.

Are there exemptions for holders of General Anesthesia (GA) and Parenteral Conscious Sedation (PCS) permits?

Holders of GA or PCS permits are not required to hold an Enteral Sedation permit to administer enteral sedation. The minimum training and standards imposed by the Board for those permits are higher than they would be under an enteral sedation permit and, therefore, the Board is confident that the holders of GA and PCS permits are already qualified to administer enteral sedation without an additional permit.

Are there any special staffing requirements when administering enteral sedation?

Yes. The enteral sedation permit holder must certify, on the initial application and upon permit renewal, that he or she employs a licensed healthcare professional who is present in the office and is trained to assist in the monitoring of the patient whenever enteral sedation is employed.

Are there any special equipment and supplies needed in my office?

Yes.  The regulations require the dentist to provide for appropriate monitoring of the patient during the administration of the sedation, to be prepared to manage any reasonably foreseeable complications and to be in attendance in the operatory until the patient's protective reflexes have returned and the patient is determined by the dentist to be stable and ambulatory.  Therefore, it is necessary that the dentist possess basic equipment and supplies to address emergency situations. At a minimum, a permit holder's office must contain suction equipment capable of aspirating gastric contents from the mouth and pharynx; a portable oxygen delivery system; a blood pressure cuff and stethoscope; a pulse oximeter; an emergency drug kit; and back-up lighting, suction and pulse oximeter by battery or generator power.

Is there any special patient evaluation or documentation required when administering enteral sedation?

Prior to the administration of enteral sedation the dentist is required to perform a physical evaluation of the patient and take a complete medical history, which must include the patient's medications, allergies and sensitivities. The patient history must be maintained in the patient record for at least seven years. In addition, subsection (l) requires that the patient record contain specific notations on the use of enteral sedation, including the type of agent, dosage, duration of the sedation, the patient's vital signs during the drug administration, and any untoward reactions the patient may have suffered.