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07/16/2013

New dentists must follow substance permit protocol


New dentists have a lot to juggle and think about after graduating from dental school – one of the things that shouldn’t fall through the cracks is making sure they have the proper permits to dispense controlled substances and administer conscious sedation.

When dentists become licensed, they automatically have the ability to write prescriptions for antibiotics, fluoride and other non-controlled substances such as Ibuprofen. When it comes to prescribing, dispensing and administering controlled substances, however, they must first register with the U.S. Drug Enforcement Administration. (Separate registration in California is not required.)

“A dentist can prescribe non-controlled medicine when they get their license, but when you start moving up to narcotic-based drugs such as Vicodin, Demerol and Norco, those can only be prescribed if the dentist is registered with the DEA,” said Ron Goldman, a Tiburon attorney specializing in defending dentists and physicians in malpractice, business, and employment litigation.

The use of a DEA number at a second facility requires specific attention to detail. For example, if a dentist prescribes, stores, administers or directly dispenses controlled substances at more than one location, the dentist must obtain a separate DEA registration for each location. If a dentist prescribes, stores, administers or dispenses controlled substances at one location, but only prescribes controlled substances at other locations, the DEA allows an exception to the rule and does not require the dentist to register the locations where the dentist only prescribes non-controlled substances. The exception applies only to secondary locations within the same state in which the practitioner maintains his/her registration.

“For every location where you practice, you need to let the Dental Board know within 30 days of moving. It is grounds for discipline if you don’t provide those notices within 30 days of a change,” Goldman said.

More than one prescriber name can be preprinted on the secured prescription forms as long as each prescriber has a DEA number and all prescribers work at all addresses printed on the forms. Although it is not required, include the prescriber’s individual NPI number, or space to write it, on the prescription form because the dispensing pharmacy needs the number to obtain payment.

Goldman said dentists sometimes run into trouble when they feel it is their duty to prescribe controlled substances to patients for parts of the body other than the mouth. 

“That’s not appropriate and it’s only a matter of time before the pharmacy reports the doctor and then the Dental Board takes action,” Goldman said.

Staff members also can cause problems if they abuse the practice’s privilege to prescribe controlled substances.

“I’ve seen instances when staff members were calling in medications for themselves and using the prescription pad to self-prescribe narcotics,” Goldman said. “In those cases, the pharmacy notified the dentist and the dentist reported it to the authorities and terminated the employee.”

To avoid such situations, Goldman recommends keeping a close eye on the inventory and keeping the substances locked up. A drug log is required. A dentist with a DEA registration can also utilize the state’s Prescription Drug Monitoring Program to review prescriptions issued under the dentist’s name.

Sedation Permits

Dentists need a separate permit from the California Dental Board if they wish to perform sedation dentistry.

A dentist will need a permit for sedation if they:

  • Provide it to a patient 13 years or older, before treatment, oral medication in a dose that will exceed the single maximum recommended dose that can be prescribed for home use in order to induce a minimally depressed level of consciousness;
  • Induce conscious sedation in a patient under 13 years of age through provision of oral medication;
  • Induce conscious sedation in a patient without oral medication or a mixture of nitrous oxide and oxygen; or
  • Administer general anesthesia to a patient.

A permit is not required if sedation is accomplished through use of nitrous oxide and oxygen alone.

“There is a much higher exposure for malpractice cases with sedation dentistry. If something goes sideways such as a cardiac event or loss of airway where the patient stops breathing, a dentist can end up in a lot of trouble,” Goldman said. “So make sure you obtain the proper permits and do the correct amount of training required by the Dental Board.”

Dentists also may choose to hire an anesthesiologist to handle this area of the practice.

For more information on registering with the DEA, visit CDA Compass.

DEA registration is available online.





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Prescribing, dispensing, and administering controlled substances requires registration with the DEA and compliance with state and federal laws. Read this article to learn more about reporting lost/stolen drugs and prescription forms, disposing of controlled substances, and the state Prescription Drug Monitoring Program.