COMBINATION INHALATION-ENTERAL (ORAL) MINIMAL SEDATION

Level I Sedation




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Educational and Professional Requirements as defined by the TSBDE

Successful completion of this course of study will satisfy satisfactory completion of training to the level of competency in minimal sedation consistent with a course of study that has been developed to be consistent with the ADA Guidelines for teaching a comprehensive training program in minimal sedation. This meets educational and professional requirements as defined by the Texas State Board of Dental Examiners (TSBDE) for level I Minimal Sedation criteria.

The TSBDE Anesthesia Rules Ad-Hoc Committee was convened to update the agency’s sedation and anesthesia rules based on sedation guidelines adopted by the American Dental Association (ADA) House of Delegates in 2007.

The most significant change in the rules is the new permitting process for the various levels of anesthesia and sedation. The permitting process emphasizes the level of sedation of the patient rather than the route of administration of the medication. The new rules establish five levels of anesthesia and sedation permits beyond the standard dental license: Nitrous Oxide/ Oxygen Inhalation Sedation; Level 1-Minimal Sedation; Level 2-Moderate Sedation (enteral sedation); Level 3-Moderate Sedation (parenteral sedation); and Level 4-Deep Sedation or General Anesthesia.

Most levels of permitting will change in name only. Licensed dentists who lack sedation permits may continue to utilize local anesthetic and prescribe minor tranquilizers for anxiolysis. A licensed dentist in Texas who held an active Nitrous Oxide/Oxygen Inhalation Conscious Sedation permit, Parenteral Sedation permit, or Deep Sedation or General Anesthesia permit on or before the effective date of the new rules had his or her permit automatically reclassified as a Nitrous Oxide/Oxygen Inhalation Sedation permit, Level 3 permit, or Level 4 permit respectively, on June 1, 2011.

A licensed Texas Dentist who held an active Enteral Sedation permit on or before the effective date had his or her permit automatically reclassified as a Level 1 (Minimal Sedation) permit. Texas Dentists in this category may continue to administer Enteral Sedation as permitted by the current rules until January 1, 2013. A Texas Dentist who holds an active Enteral Sedation permit on or before June 1, 2011 who desires to administer Level 2 (Moderate-Enteral) sedation after January 1, 2013 must submit an application requesting a Level 2 permit prior to January 1, 2013. A Level 1 permit allows a dentist to use a single medication or a single medication in combination with nitrous oxide to achieve sedation. The sedation provided may only result in a minimally depressed level of consciousness. A Level 2 permit will be required to utilize two or more medications to achieve sedation or to achieve a moderate level sedation.

Individuals practicing outside of Texas should consult with their State Boards regarding recognition of this course to be acceptable for a level I sedation permit.

Course Description

This course is designed to provide the participant with didactic training and instruction in which competency in combined inhalation-enteral minimal sedation technique is demonstrated. The course of study will contain: Historical, philosophical and psychological aspects and definitions and description of all aspects of anxiety and pain; patient evaluation and selection, based on Standard of Care Requirements; consideration of clinical requirements, personnel and equipment requirements, monitoring , and maintaining proper records and chart entries, including all drugs administered doses and monitored physiological parameters necessary for proper documentation, recovery and discharge of the patient.

The course will also address necessary pharmacology, respiratory and circulatory physiology and related anatomy, as well as indications, and contra-indications for the use of enteral and or combination inhalation–enteral minimal sedation and the administration of local anesthesia in conjunction with inhalation sedation techniques. Description and use of inhalation sedation equipment and introduction to potential health hazards of trace anesthetics and proposed techniques for limiting occupational exposure and possible abuse potential will also be covered in this course. Finally to be considered are prevention, recognition and management of complications and life threatening situations associated with these techniques.

Course Directors/Faculty

GroganDAVID M. GROGAN, D.D.S., M.S.D., graduated from the Baylor College of Dentistry in 1981. He continued his postgraduate training and received his Certificate and MSD degree in Oral and and Maxillofacial Surgery from Baylor College of Dentistry in 1986. Dr. Grogan also earned a MS degree in Histology at Baylor in 1978. He is currently an Assistant Professor in the Department of Oral and Maxillofacial Surgery and Pharmacology at the Baylor College of Dentistry, Texas A&M University System Health Science Center in Dallas, Texas.

JeskeARTHUR H. JESKE, D.M.D., Ph.D., received his dental training at Georgia Health Sciences Univeristy College of Dental Medicine in 1978. He joined the faculty of the University of Texas School of Dentistry at Houston the same year, later serving as Chair of the Department of Dental Pharmacology (1987-1993) and, subsequently, Chair of the Department of Restorative Dentistry and Biomaterials.


LuceERNEST B. LUCE, D.D.S., received his DDS degree from the University of Texas Health Science Center at Houston in 1985. In June of 1986, he completed a one year General Practice Residency at The University of Texas Health Science Center at San Antonio. Upon completion of the residency, Dr. Luce joined the Department of Comprehensive Dentistry at The University of Texas Health Science Center at San Antonio. Currently, he is a Clinical Associate Professor at the Health Science Center, and he also maintains a part time private practice in general dentistry in San Antonio.

ValdezERNEST E. VALDEZ, D.D.S., received his DDS degree from The University of Texas Health Science Center at San Antonio, Dental School in 1993. He pursued a two year General Practice Residency at The University of Texas Health Science Center at San Antonio which he completed in 2001. Dr. Valdez is currently an Assistant Professor in the Department of Oral and Maxillofacial Surgery at the Dental School and maintains a practice at the UTHSCSA Dental School’s Dental Faculty Practice Clinic.

Educational Objectives

After completing this course of study the participant should be able to:

  1. Understand historical, philosophical and psychological aspects, as well as definitions and descriptions of all aspects of anxiety and pain
  2. Understand the basic components of inhalation sedation equipment and the function of each of these components.
  3. List and discuss the advantages and disadvantages of enteral and/or combination inhalation-enteral minimal sedation (combination minimal sedation)
  4. List and discuss the indications and contraindications for the use of enteral and/or combination inhalation-enteral minimal sedation (combination minimal sedation).
  5. Understand the complications associated with enteral and/or combination inhalation-enteral minimal sedation (combined minimal sedation).
  6. Discuss prevention, recognition and management of complications associated with enteral and or combination inhalation-enteral minimal sedation (combined minimal sedation).
  7. Administer enteral and/or combination inhalation-enteral sedation (combined minimal sedation) to patients in a clinical setting in a safe and effective manner.
  8. Discuss the abuse potential, occupational hazards and other effects of enteral and inhalation agents.
  9. Describe the pharmacology of the enteral and inhalation drugs selected for administration.
  10. Discuss the precautions, contraindications and adverse reactions associated with the enteral and inhalation drugs selected.
  11. Utilize a protocol for management of emergencies in the dental office and list the emergency drugs and equipment required for management of life threatening situations.
  12. Implement the ability to manage life threatening emergency situations, including having certification in Basic Life Support for Healthcare Providers
  13. Understand the pharmacological effects of combined drug therapy, their implications and management including understanding that Nitrous oxide/oxygen when used in combination with sedative agents may produce minimal, moderate, deep sedation or general anesthesia.

Please Note:
All dentists participating in this course should be aware of specific regulations required in the state in which they are licensed to practice. This course addresses regulations specific to the Texas State Board of Dental Examiners and after completing this course, the participant should also be able to:

  1. Understand the Guidelines from the TSBDE requiring that at least one BLS trained assistant is present during minimal sedation during this procedure including recovery
  2. Be aware that a dentist who holds a minimal sedation permit shall not intentionally administer moderate, deep or general anesthesia.
  3. Be aware that when sedating children twelve years or younger the dentist should observe the American Academy of Pediatrics Guidelines for monitoring and management of the pediatric patient during and after sedation for diagnostic and therapeutic procedures.
  4. Maintain proper records, chart entries, including medical history, physical exam, informed consent, anesthesia records and monitoring of physiologic parameters.

Course Sections Summary

After you have successfully completed at section, you will takea required exam. You must achieve a passing score of 90%. If you fail to answer enough questions correctly, you will be instructed to re-take the exam and a new set of questions will be provided. You will have three chances to fulfill the requirements. If you are not successful, you will be instructed to re-take the section.

section 01: Introduction to Sedation
Pain -drug induced depression conscious & unconscious; use of combination minimal sedation procedures for enteral & combination minimal sedation

section 02: History
All aspects of Anxiety and Pain control

section 03: Patient Evaluation
Patient Evaluation & selection thru medical history, diagnosis, and profiling; review of respiratory & circulatory physiology and related anatomy

section 04: Pharmacology
Pharmacology of agents used in enteral and combination inhalation enteral minimal sedation including drug interactions and incompatibilities

section 05: Monitoring
Patient monitoring using observation, monitoring equipment, with attention to vital signs & reflexes related to consciousness

section 06: Rules and Records
Maintaining records with accurate chart entries medical history, physical exam, informed consent, time oriented anesthesia record, including names of all drugs administered including local anesthesia doses and monitored physiological parameters

section 07: Nitrous Equipment
Description & use of inhalation sedation equipment

section 08: Nitrous Hazards
Introduction to potential health hazards of trace anesthetics & proposed techniques for limiting occupation exposure

section 09: Local Anesthesia
Administration of local anesthesia in conjunction with enteral and /or combination inhalation-enteral minimal sedation techniques
Review of dental procedures possible under enteral and/or combination inhalation enteral minimal sedation

section 11: Emergencies
Prevention, recognition and management of complications & life threatening situations

section 12: Comprehensive Exam/Evaluation
After you have successfully completed the 11 course content sections, you will take the required comprehensive exam to finalize your participation in this course. You will be required to achieve a passing score of 80%. If you fail to answer enough questions correctly, you will be instructed to re-take the exam and a new set of questions will be provided. You will have three chances to fulfill the requirements. If you are not successful, you will be instructed to contact the Office of Continuing Dental Education.

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Participation in the course requires that you:

  • Register online with the our secured server.
  • Pay a $495.00 registration fee.
    • Paying With A Credit Card – Once you complete your registration, an email will automatically be sent to you, at the address you provided, containing your User Code and Password and link to a Logon Session page to begin the course.
    • Not Paying With a Credit Card – Once our office receives your form of payment, the following business day an email will be sent to you, at the address you provided, containing your User Code, Password and a link to a Logon Session page to begin the course
  • Complete all course sections yielding to 18 hours of didactic participation
  • AGD code: 132

At the end of each course section/part, you will take the exam that will be graded and you will see your results instantaneously. You will have 1 month to complete the course. Once you begin the course, you will have the ability to Log Out and Log In.  This may only be done during a presentation not during an examination.  The module exam cannot be paused once started.

After you have successfully completed the 11 course content sections, you will take the required comprehensive exam to finalize your participation in this course. You will be required to achieve a passing score of 80%. If you fail to answer enough questions correctly, you will be instructed to re-take the exam and a new set of questions will be provided. You will have three chances to fulfill the requirements. If you are not successful, you will be instructed to contact the Office of Continuing Dental Education.

POSTED: January 2, 2012 - REVIEW: August 31, 2015

Upon successful completion of this course, you will complete a course evaluation which will direct you to an electronic verification for 18 hour(s) of combined video streaming and testing didactic continuing dental education credit. Print this verification document and save for your reference – follow the prompts allowing you to print the certificate.

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