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Local Anesthesia Permit
Iowa Administrative Code 650 authorizes a dental hygienist to administer local anesthesia provided the following requirements are met:
- The dental hygienist holds both an active dental hygiene license and local anesthesia permit issued by the Iowa Dental Board.
- The local anesthesia is prescribed by a licensed dentist.
- The local anesthesia is administered under the direct supervision of the dentist.
Obtaining a dental hygiene license does not automatically qualify a dental hygienist to administer local anesthesia. The application for a local anesthesia permit requires the applicant to have completed board-approved training (e.g. from an accredited school). If the training was completed outside of the timeframe refenced in Iowa Administrative Code 650--Chapter 11, the applicant must also document ongoing experience administering local anesthesia in another state.Back to top
A dentist shall provide direct supervision of the administration and monitoring of nitrous oxide, and establish a written office protocol for taking vital signs, adjusting anesthetic concentrations, and addressing emergency situations that may arise.
The dentist shall be responsible for dismissing the patient following completion of the procedure.
Record Keeping: The patient record must include the concentration of nitrous oxide administered, the duration of administration, and any vital signs taken.
A dental hygienist may administer nitrous oxide inhalation analgesia provided the administration of nitrous oxide inhalation analgesia has been delegated by a dentist and the the dental hygienist has completed board-approved training (e.g. from an accredited school).
A dental hygienist may monitor a patient under nitrous oxide inhalation analgesia provided all of the following requirements are met:
- The hygienist has completed a board-approved (e.g. from an accredited school) course of training or has received equivalent training while a student in an accredited school of dental hygiene;
- The task has been delegated by a dentist; and
- Any adverse reactions are reported to the supervising dentist immediately.
Dentists may use nitrous oxide inhalation analgesia sedation on an outpatient basis for dental patients provided the dentist has completed training and ensures the patient is continually monitored while receiving nitrous oxide.
Note: A sedation permit is not required for the administration of minimal sedation (anxiolysis).Back to top
Sedation Permit Required
Dentists licensed in this state shall not administer moderate sedation, deep sedation, or general anesthesia in the practice of dentistry unless they have obtained the appropriate sedation permit from the board. Note: A sedation permit is not required for the administration of minimal sedation (anxiolysis).
Applications for moderate sedation or general anesthesia permits shall be reviewed by the Anesthesia Credentials Committee prior to issuance. Additionally, if the applicant intends to administer sedation at a facility that has not been previously inspected by the board, a facility inspection must be completed before the board will issue the permit.
Sedation of Pediatric or Medically-Compromised Patients
Dentists who intend to administer moderate sedation to pediatric or medically-compromised (ASA III or IV) patients are required to complete an accredited residency program that includes formal training in anesthesia and clinical experience in managing pediatric or medically-compromised patients.
Use of Another Licensed Sedation Provider or Permit Holder
Dentists may only use the services of a licensed sedation provider or another sedation permit holder to administer moderate sedation, deep sedation, or general anesthesia in a dental facility if the dentist holds a current moderate sedation or general anesthesia permit.
A permit holder who does not meet the training requirement to administer moderate sedation to pediatric or medically-compromised patients may use a licensed sedation provider or another qualified permit holder to administer moderate sedation to those patients.
Note: A dentist who does not hold a sedation permit is prohibited from using a licensed sedation provider or permit holder to provide moderate sedation, deep sedation or general anesthesia.
Moderate Sedation Permit
To qualify for a moderate sedation permit, the applicant shall have successfully completed the following education and training:
- A training program, approved by the board, that consists of a minimum of 60 hours of instruction and management of at least 20 patients, or an accredited residency program that includes formal training and clinical experience in moderate sedation.
- Training that includes rescuing patients from a deeper level of sedation than intended, including managing the airway, intravascular or intraosseous access, and reversal medications.
- Current ACLS or PALS certification.
General Anesthesia Permit
To qualify for a general anesthesia permit, the applicant shall have successfully completed the following education and training:
- An advanced education program accredited by the Commission on Dental Accreditation that provides training in deep sedation and general anesthesia.
- A minimum of one year of advanced training in anesthesiology and related academic subjects beyond the undergraduate dental school level.
- Formal training in airway management.
- Current ACLS or PALS certification.