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General anesthesia, sedation permit requirements changing Jan. 1 for California dentists

Licensees with permits expiring in 2022 should renew by Dec. 31 following dental board's new advisory

December 08, 2021 7991

12/17/21 update: Licensees with permits expiring in 2022 urged to renew by Dec. 31

The Dental Board of California today announced that licensees with anesthesia and sedation permits expiring in 2022 must renew by Dec. 31 "in order to continue to practice under the existing terms of ther permits beyond the scheduled 2022 expiration date." Read more in the Dental board's notice and in CDA's latest article.

Two permits to be replaced in 2022, new pediatric endorsement required

Dec. 8: Beginning Jan. 1, 2022, California-licensed dentists who administer or order the administration of general anesthesia, moderate sedation or minimal sedation will be subject to new requirements under legislation (Senate Bill 501) signed into law in 2018.

Most significantly, two permits ― conscious sedation and oral conscious sedation for minors ― will no longer be issued beginning Jan. 1 and will instead be replaced with new permits.

SB 501 also newly requires dentists to obtain a pediatric endorsement prior to administering general anesthesia or deep sedation to patients under age 7 or moderate or minimal sedation to patients under age 13. Therefore, dentists who currently hold a general anesthesia permit are also impacted.

Only one permit, the oral conscious sedation for adults, will remain unchanged.

Final regulations to come in 2022

The Dental Board of California has submitted regulatory language on permit application and maintenance to the Department of Consumer Affairs for review and potential approval by Jan. 1.

In an email sent Nov. 29 to dentists, also posted as an alert, the dental board warned that if the regulatory language is not approved and made effective by Jan. 1, “the board may not be able to issue the new permits required for the administration of sedation and anesthesia in California.” 

“Existing GA, MGA, CS, and OCS for Minors permit holders are encouraged to renew by December 31, 2021,” the board states. “Permit holders who renew by December 31, 2021, will be issued a permit that is valid for two years from the expiration date and may continue to practice under the existing terms of the permit, until it expires.”

The board’s alert states that its members “recognize the challenges associated with the delay in the implementation of SB 501” and have contacted state legislators to advise them of the bill’s implementation issues and the “looming gap in anesthesia and/or sedation administration to dental patients.”

CDA is pushing the board and the state Legislature to extend the bill’s implementation date until after the board passes regulations on the new permits, to limit any negative affect on access to dental sedation. All current permit holders can continue to administer or order the administration of general anesthesia or moderate or minimal sedation until their permit expires.

Moderate sedation permit will replace conscious sedation permit

The current conscious sedation permit will not be issued after Jan. 1 and will instead be replaced with the new moderate sedation permit. For dentists with current conscious sedation permits, this means:

  • Once a conscious sedation permit expires it will be considered invalid and nonrenewable.
  • Existing conscious sedation permits may be canceled upon expiration, and the dentist will not be able to administer sedation to adult or minor patients.
  • The permit holder may continue to follow the terms of that permit until it expires.
  • A new pediatric endorsement is required to administer or order the administration of moderate sedation to patients under age 13.

The regulation to implement the new moderate sedation permit is with the Department of Consumer Affairs for review and approval. Among other things, the regulation will define and specify the moderate-sedation permit application form, the pediatric-endorsement form and requirements and acceptable documentation for proof of training.

Pediatric minimal sedation permit will replace oral conscious sedation for minors permit 

The current conscious sedation for minors permit (OCS) will not be issued after Jan. 1 and will instead be replaced with the new pediatric minimal sedation permit. For dentists with current OCS permits, this means:

  • Once an OCS permit expires, it will be considered invalid and nonrenewable.
  • Existing OCS permits may be canceled upon expiration, and the dentist will not be able to administer oral sedation to patients under age 13.
  • The permit holder may continue to follow the terms of that permit until it expires.
  • A new pediatric endorsement is required to administer or order the administration of minimal sedation to patients under age 13.

As with the new moderate sedation permit, the board’s regulatory language to implement the new pediatric minimal sedation permit is with the Department of Consumer Affairs for review and approval. Among other things, the regulation will define and specify the pediatric minimal-sedation permit application form, the pediatric-endorsement form and requirements and acceptable documentation for proof of training.

Pediatric endorsement required to administer general anesthesia to patients under age 7

Although the general anesthesia permit will remain after SB 501 takes effect in January, the bill will define deep sedation and general anesthesia, which will result in changes to the permit application form, acceptable training in anesthesiology and other requirements.
For now, dentists with current general anesthesia permits should be aware that:

  • They are eligible to renew their general anesthesia permit after Dec. 31.
  • They must apply for the new pediatric endorsement to administer general anesthesia or deep sedation to patients under age 7.
  • Once their current general anesthesia permit expires, they cannot administer or order the administration of general anesthesia or deep sedation to patients under age 7 without the pediatric endorsement.

The dental board’s proposed regulation specifying the new pediatric endorsement is with the Department of Consumer Affairs for review and approval.

Bill was heavily negotiated with dental and physician specialties

Sen. Steve Glazer (D-Orinda) introduced SB 501 to address recommendations made in a 2016 report published by the dental board. That report stemmed from the death in 2015 of a 6-year-old boy who received dental treatment under general anesthesia.

CDA supported the board’s recommendation to define anesthesia by level of sedation and restructure the permitting system to ensure the appropriate level of expertise is always in the room. The bill was heavily negotiated with dental and physician specialties. CDA successfully pushed for amendments to streamline the new permitting structure, protect access to dental sedation and strike a balance between established practice and evidenced-based changes at all levels of sedation.  

CDA will keep members informed about final regulations. Until then, dentists can review CDA’s summary of current and future permit requirements. Dentists can also contact the dental board with questions at 916.263.2300 or by email at [email protected]

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