California Pediatric Dental Oral Sedation Laws
California Dental
Pediatric
Oral Sedation Laws
BPC Division 2, Chapter 4, Article 2.85 sunsets January 1, 2022 and will be replaced with Article 2.87.
This will also replace the term "conscious sedation" with the term "Pediatric Minimal Sedation".
Article 2.85 Oral Conscious Sedation for Pediatric Patients
Sunsets on January 1, 2020
Replaced with Article 2.87
BPC Division 2, Chapter 4, Article 2.85
Minor is defined as under age of 13.
BPC Division 2, Chapter 4, Article 2.85 Section 1647.10(2)(b)
Certificate renews biennially
Minimum of 7 hours of approved courses of study related to oral conscious sedation of minor patients for each renewal.
“Oral conscious sedation” means
a minimally depressed level of consciousness produced by oral medication
that retains the patient’s ability to maintain independently and continuously an airway,
and respond appropriately to physical stimulation or verbal command.
The drugs and techniques used in oral conscious sedation
shall have a margin of safety wide enough to render unintended loss of consciousness unlikely.
Further, patients whose only response is reflex withdrawal from painful stimuli
would not be considered to be in a state of oral conscious sedation.
BPC Division 2, Chapter 4, Article 2.85 Section 1647.10
To qualify for "Conscious sedation for Pediatric Patients" permit,
must satisfy any
of the following requirements:
(a) Satisfactory completion of a postgraduate program in oral and maxillofacial surgery or pediatric dentistry approved by either the Commission on Dental Accreditation or a comparable organization approved by the board.
(b) Satisfactory completion of a periodontics or general practice residency or other advanced education in a general dentistry program approved by the board.
(c) Satisfactory completion of a board-approved educational program on oral medications and sedation.
[atleast 25 hours of instruction including a clinical component utilizing at least one age-appropriate patient.
CCR Title 16, Division 10, Chapter 2, Article 5.5 Section 1044.3(b)]
A violation of any provision of this article constitutes unprofessional conduct and is ground for the revocation or suspension of permit or dental license or both.
BPC Division 2, Chapter 4, Article 2.85 Section 1647.17
Equipment and Supply Requirements
CCR Title 16, Division 10, Chapter 2, Article 5, Section 1044.5
Lighting
Battery powered backup sufficient to complete procedure underway in case of power failure
Suction
Functional Suction
and Back up Suction for power failure
Oxygen
Capable of 90% oxygen at 10 liters/minute for 60 minutes
Positive pressure ventilation
Functional during Power Failure
"(1) Age-appropriate oral airways
capable of accommodating patients of all sizes.
(2) An age-appropriate sphygmomanometer with cuffs
of appropriate size for patients of all sizes.
(3) A precordial/pretracheal stethoscope.
(4) A pulse oximeter."
Emergency Cart or Kit
"(d) An emergency cart or kit shall be available and readily accessible and shall include the necessary and appropriate drugs and age- and size-appropriate equipment to resuscitate a nonbreathing and unconscious patient and provide continuous support while the patient is transported to a medical facility. There must be documentation that all emergency equipment and drugs are checked and maintained on a prudent and regularly scheduled basis. Emergency drugs of the following types shall be available:
(1) Epinephrine
(2) Bronchodilator
(3) Appropriate drug antagonists
(4) Antihistaminic
(5) Anticholinergic
(6) Anticonvulsant
(7) Oxygen
(8) Dextrose or other antihypoglycemic"
Summary of Changes
Effective January 1, 2022
BPC Division 2, Chapter 4, Article 2.87
(Effective January 1, 2022)
"(a) As used in this article, “minimal sedation”
means a drug-induced state during which patients respond normally to verbal commands. Although cognitive function and coordination may be impaired, airway reflexes, ventilatory, and cardiovascular functions are unaffected.
(b) The drugs and techniques used in minimal sedation shall have a margin of safety wide enough to render unintended loss of consciousness unlikely. Further, patients who require tactile stimulation to elicit a response to verbal commands shall not be considered to be in a state of minimal sedation."
BPC Division 2, Chapter 4, Article 2.87 Section 1647.30
"A dentist with a pediatric minimal sedation permit
shall possess the training, equipment, and supplies
to rescue a patient from an unintended deeper level of sedation."
BPC Division 2, Chapter 4, Article 2.87 Section 1647.31 (c)
Requirements to be eligible to administer Pediatric Minimal Sedation:
(1) The dentist holds a current permit for deep sedation and general anesthesia, or holds a current permit for moderate sedation with a pediatric endorsement, or obtains a pediatric minimal sedation permit.
BPC Division 2, Chapter 4, Article 2.87 Section 1647.31
Requirements for a Pediatric Minimal Sedation Certificate:
(c)Training in the administration of pediatric minimal sedation shall be acceptable if it meets either of the following
as approved by the board:
(1) Consists of at least 24 hours of pediatric minimal sedation instruction in addition to one clinical case. The pediatric minimal sedation instruction shall include training in pediatric monitoring, airway management, and resuscitation and patient rescue from moderate sedation.
(2) Completion of a CODA-approved residency in pediatric dentistry.
BPC Division 2, Chapter 4, Article 2.87 Section 1647.32
"(d) A dentist shall be limited to administering a single drug
whose primary purpose is sedative via the oral route, either singly or in divided doses, not to exceed the manufacturer’s maximum recommended dose, plus a mix of nitrous oxide and oxygen and adjunctive agents such that the drugs either singly or in combination are unlikely to produce a state of unintended moderate sedation. This section shall not be construed to restrict the administration of adjunctive medication intended to relieve pain, affect the onset or duration of the primary sedative agent, or to reduce the side effects of sedation, including nausea or emesis.
(e) The operating dentist and a minimum of one additional personnel who are both trained in the monitoring and resuscitation of pediatric patients, as approved by the board, shall be present during the administration of minimal sedation."
BPC Division 2, Chapter 4, Article 2.87 Section 1647.32
(a) Every health care service plan contract, other than a specialized health care service plan contract, that is issued, amended, renewed, or delivered on or after January 1, 2000, shall be deemed to
cover general anesthesia and associated facility charges for dental procedures rendered in a hospital or surgery center setting, when the clinical status or underlying medical condition of the patient requires dental procedures that ordinarily would not require general anesthesia to be rendered in a hospital or surgery center setting.
cover general anesthesia and associated facility charges for dental procedures rendered in a hospital or surgery center setting, when the clinical status or underlying medical condition of the patient requires dental procedures that ordinarily would not require general anesthesia to be rendered in a hospital or surgery center setting.
The health care service plan may require prior authorization of general anesthesia and associated charges required for dental care procedures in the same manner that prior authorization is required for other covered diseases or conditions.
(b) This section shall apply only to general anesthesia and associated facility charges for only the following enrollees, and only if the enrollees meet the criteria in subdivision (a):
(1)
Enrollees who are under seven years of age.
(2) Enrollees who are
developmentally disabled, regardless of age.
(3) Enrollees whose
health is compromised and for whom general anesthesia is medically necessary, regardless of age.
(c) Nothing in this section shall require the health care service plan to cover any charges for the dental procedure itself, including, but not limited to, the professional fee of the dentist. Coverage for anesthesia and associated facility charges pursuant to this section shall be subject to all other terms and conditions of the plan that apply generally to other benefits.
(d) Nothing in this section shall be construed to allow a health care service plan to deny coverage for basic health care services, as defined in Section 1345 .
(e) A health care service plan may include coverage specified in subdivision (a) at any time prior to January 1, 2000.
