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 referenced in Iowa Administrative Code 650 Chapter 11, the applicant must also document ongoing experience administering local anesthesia in another state.
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.
Dental Hygienists
Administration
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).
Monitoring
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
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).
Definitions for Sedation in Dentistry
Definitions for terms related to the use of sedation in dentistry as defined in Iowa Administrative Code 650 - Chapter 29.
“ASA” refers to the American Society of Anesthesiologists Patient Physical Status Classification System. Category I means normal healthy patients, and category II means patients with mild systemic disease. Category III means patients with severe systemic disease, and category IV means patients with severe systemic disease that is a constant threat to life.
“Conscious sedation” means moderate sedation.
“Deep sedation” means drug-induced depression of consciousness during which patients cannot be easily aroused but respond purposefully following repeated painful stimulation. The ability to independently maintain ventilatory function may be impaired. Patients may require assistance in maintaining a patent airway, and spontaneous ventilation may be inadequate. Cardiovascular function is usually maintained.
“Facility” means any dental office or clinic where sedation is used in the practice of dentistry. The term “facility” does not include a hospital.
“General anesthesia” means a drug-induced loss of consciousness during which patients are not arousable, even by painful stimulation. The ability to independently maintain ventilatory function is often impaired. Patients often require assistance in maintaining a patent airway, and positive pressure ventilation may be required because of depressed spontaneous ventilation or drug-induced depression of neuromuscular function. Cardiovascular function may be impaired.
“Minimal sedation” means a minimally depressed level of consciousness produced by a pharmacological method that retains the patient’s ability to independently and continuously maintain an airway and respond normally to tactile stimulation and verbal command. Although cognitive function and coordination may be modestly impaired, ventilatory and cardiovascular functions are unaffected. A patient whose only response reflex is withdrawal from repeated painful stimuli is not considered to be in a state of minimal sedation.
“Moderate sedation” means a drug-induced depression of consciousness, either by enteral or parenteral means, during which patients respond purposefully to verbal commands, either alone or accompanied by light tactile stimulation. No interventions are required to maintain a patent airway and spontaneous ventilation is adequate. Cardiovascular function is usually maintained. Prior to January 1, 2010, moderate sedation was referred to as conscious sedation.
“Nitrous oxide inhalation analgesia” refers to the administration by inhalation of a combination of nitrous oxide and oxygen producing an altered level of consciousness that retains the patient’s ability to independently and continuously maintain an airway and respond appropriately to physical stimulation or verbal command.
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.
Requirements for Moderate Sedation & General Anesthesia Permits
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.
The following courses were submitted to the Anesthesia Credentials Committee for review. The committee approved the courses for the purposes of applying for a moderate sedation permit.
Note: It is possible that some of the following courses are no longer offered. Applicants will need to contact the organization or training provider for more information.
American Society for Advancement of Anesthesia and Sedation in Dentistry in conjunction with St. Joseph's University Medical Center New Jersey Paterson, NJ Contact: Dr. Joseph Portale, 201.723.4679
Miami Valley Hospital (Ohio) Dayton, Ohio Contact: Theresa Cory, 937.208.2144
Montefiore Medical Center Dept. of Dentistry
Herman Ostrow School of Dentistry of USC Los Angeles, CA Contact: cedental@usc.edu
Oregon Academy of General Dentistry Portland, Oregon Instructor: Dr. Kenneth Reed, D.M.D.
University of Minnesota School of Dentistry Contact: cdeumn@umn.edu
UCLA School of Dentistry – Wendel Family Dental Centre
Training Course Provided by Kevin Croft, D.D.S. Contact: k.croft@greenstatesanesthesia.com
Western Surgical and Sedation Contact: hollis@westernsurgicalandsedation.com
DOCS Education in conjunction with Meharry Medical College School of Dentistry Contact: 855.227.6505
DOCS Education in conjunction with Idaho State University Contact: 855.227.6505
Stay in the Box Sedation Contact: stayintheboxsedation@gmail.com
Vesper Institute IV Sedation Contact: April Thomas, April.Thomas@vesperinstitute.com
Note: The Anesthesia Credentials Committee may place restrictions on the types and combinations of drugs used when administering moderate sedation in Iowa. The committee often restricts permit holders to using those drugs in which they completed training.
Applicants who wish to complete training as a continuing education course with another training provider may submit a request to the Anesthesia Credentials Committee for review. Requests should include, at a minimum, the following information.
Course syllabus or other detailed course outline. The course must comply with the ADA Guidelines for the Use of Sedation and General Anesthesia by Dentists.
Minimum of 60 hours of instruction; and
Minimum 20 management of at least 20 patients.
Includes training for rescuing patients under a deeper level of sedation than intended, including the airway management, intravascular or intraosseous access, and reversal medications.
Information about the drugs, which will be included as part of the training.
To be eligible to administer sedation to pediatric patients, or medically compromised patients (ASA III-IV), applicants must have completed a CODA-accredited residency program that included moderate sedation training for these patients as part of its curriculum.
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.
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.
Requirements for Sedation Permit Holders
An overview of the standard requirements for moderate sedation and general anesthesia permit holders in Iowa.
Dental facilities where moderate sedation, deep sedation, or general anesthesia is administered shall be permanently equipped.
A dentist who administers moderate sedation, deep sedation or general anesthesia in a facility is required to be trained in and maintain, at a minimum, the following equipment to be properly equipped:
Electrocardiogram (EKG) monitor;
Positive pressure oxygen;
Suction;
Laryngoscope and blades;
Endotracheal tubes;
Magill forceps;
Oral airways;
Stethoscope;
Blood pressure monitoring device;
Pulse oximeter;
Emergency drugs;
Defibrillator;
Capnography machine to monitor end-tidal carbon dioxide;
Pretracheal or precordial stethoscope; and
Any additional equipment necessary to establish intravascular or intraosseous access, which shall be available until the patient meets discharge criteria.
A dentist administering moderate sedation, deep sedation or general anesthesia must maintain current ACLS or PALS certification.
A dentist shall evaluate a patient prior to the start of any sedative procedure.
A dentist who administers sedation or anesthesia shall ensure that there is sufficient staffing to reasonably handle emergencies incident to the administration of sedation. A patient monitor shall be present in the treatment room and continually monitor the patient until the patient returns to a level of minimal sedation.
The dentist must not leave the facility until the patient meets the criteria for discharge. The dentist must provide postoperative verbal and written instructions to the patient and caregiver prior to discharging the patient.
The dentist or another designated permit holder or licensed sedation provider must be available for postoperative aftercare for a minimum of 48 hours following the administration of sedation.
The dentist must establish emergency protocols which comply with the following:
A dentist must establish a protocol for immediate access to backup emergency services;
A patient monitor shall employ initial life-saving measures in the event of an emergency and shall activate the EMS system for life-threatening complications;
A dentist who utilizes an immobilization device must avoid chest or airway obstruction when applying the device and shall allow a hand or foot to remain exposed; and
The recovery room for a pediatric patient must include a functioning suction apparatus as well as the ability to provide >90% oxygen and positive-pressure ventilation, along with age- and size-appropriate rescue equipment.
Record keeping: A time-oriented anesthesia record must include preoperative and postoperative vital signs, drugs administered, dosage administered, anesthesia time in minutes, and monitors used. Pulse oximetry, heart rate, respiratory rate, and blood pressure must be recorded continually until the patient is fully ambulatory. The chart should contain the name of the person to whom the patient was discharged.
A dentist administering moderate sedation shall have at least one patient monitor observe the patient while under moderate sedation.
Note: The administration of anesthetic sedative agents intended for deep sedation or general anesthesia, including but not limited to Propofol, Ketamine and Dilaudid, shall constitute deep sedation or general anesthesia.
Moderate Sedation for ASA I or II Nonpediatric Patients
A dentist may prescribe or administer a single enteral drug in excess of the MRD on the day of treatment.
A dentist may prescribe or administer a combination of more than one enteral drug.
A dentist may administer a medication for moderate sedation via the parenteral route.
A dentist may administer a medication for moderate sedation via the parenteral route in incremental doses.
A dentist shall ensure the drug(s) or techniques, or both, carry a margin of safety wide enough to render unintended loss of consciousness unlikely.
A dentist may administer nitrous oxide with more than one enteral drug.
Moderate Sedation for ASA III, ASA IV or Pediatric Patients
A permit holder who has not completed an accredited residency program with education and experience in sedation pediatric or ASA III or IV patients is prohibited from administering moderate sedation to those patients. The following constitutes moderate sedation:
The use of one or more enteral drugs in combination with nitrous oxide.
The administration of any intravenous drug.
The administration of anesthetic sedative agents intended for deep sedation or general anesthesia, including but not limited to Propofol, Ketamine and Dilaudid, shall constitute deep sedation or general anesthesia.
A dentist administering deep sedation or general anesthesia shall have at least two patient monitors observe the patient while the patient is under deep sedation or general anesthesia. The patient monitors who observe patients under deep sedation or general anesthesia shall be capable of administering emergency support.
If the dentist has a recovery area separate from the operatory, the recovery area must have oxygen and suction equipment.
Dental Board Application & Renewal Fees
A list of fees related to the application and renewal of licenses and registrations in Iowa.
DDS/DMD: Dental License on the Basis of Exam:* $200
DDS/DMD: Dental License on the Basis of Credentials or Verification: $550
Fee for Background Check Packet: $46
DDS/DMD: Faculty Permit: $200
MS: Moderate Sedation Permit: $500
GA: General Anesthesia Permit: $500
DDS/DMD: Resident License: $120
Resident License Extension : $40
*Applicants who were issued and held a license in another state for more than 12 months must apply on the basis of credentials or verification.
RDH: Dental Hygiene License on the Basis of Exam:* $100
RDH: Dental Hygiene License Application on the Basis of Credentials or Verification: $200
Fee for Background Check Packet: $46
LA: Local Anesthesia Permit Application: $70
RDH: Faculty Permit: $200
RDH: Resident License: $120
Resident License Extension Application: $40
*Applicants who were issued and held a license in another state for more than 12 months must apply on the basis of credentials or verification.
Effective Jan. 1, 2021, pursuant to HF 2627, individuals whose household adjusted gross income does not exceed 200% of the federal poverty level may request a waiver of application fees related to an initial application for license or registration. Please note: The fee waiver does not extend to applications for renewal, reinstatement or reactivation.
To determine eligibility, you must first identify the number of individuals in your household. Once this is determined, reference the Federal Poverty Level and identify the income that matches the number of individuals in your household. If your household adjusted gross income, as reported on your most recent federal tax return, is less than the identified value, you are eligible for the one-time fee waiver.
DOCUMENTATION FOR QUALIFICATION OF WAIVER
If you wish to apply for a fee waiver you must attest that your household adjusted gross income does not exceed 200% and agree to submit documentation of one of the following to verify your household income:
1. If you are married and filed separately, you will need to submit the Federal Tax Return for both your spouse and yourself.
2. If you were claimed as a dependent on another person’s tax return, you will need to submit the Federal Tax Return for the tax filer who claimed you as a dependent.
Reinstatement applications require payment of a reinstatement application fee and one past-due renewal fee. Additionally, dentists and dental hygienists must submit a background check packet for which the fee is $46.
If you will be volunteering dental services at a non-profit and you do not hold an active Iowa dental or dental hygiene license, you may apply for a temporary permit on the basis to volunteer. There is no fee for this application; though a completed application must be submitted via the Iowa Dental Board online services website.
EDUCATIONAL or URGENT NEED
Temporary permits on the basis of educational purpose or urgent need may be issued for up to three months at a predetermined location of practice. Applicants are limited to a maximum of three temporary permits in total. Thereafter, applicants would be required to apply for a permanent dental or dental hygiene license.
Note: Temporary permits on the basis of educational purpose or urgent need are not intended for individuals who will make application for a permanent dental license.
Fee for Educational Purpose or Urgent Need: $100
About the Dental Board
The Iowa Dental Board regulates the practice of dentistry in Iowa and issues licensees to dental professionals.
