6.3 Permit Categories, Training, Facility Standards, Staffing & Inspections

Permits, Training, Facilities and Inspections

Permit categories and training — Rule 64B5-14.003

General Anesthesia Permit — 64B5-14.003(1)

Eligibility requires compliance with Rule 64B5-14.0025 and one of:

1. Completion of a minimum of a two year residency program accredited by the Commission on Dental Accreditation in dental anesthesiology, or completion of a CODA-accredited oral and maxillofacial surgical residency program beyond the undergraduate dental school level;
2. Being a diplomate of the American Board of Oral and Maxillofacial Surgery; or
3. Being eligible for examination by the American Board of Oral and Maxillofacial Surgery.

Two years, not one. Study material describing "at least one year of continuous clinical anesthesia training" understates the Florida requirement.

Staffing: administration of general anesthesia or deep sedation requires at least three individuals, each trained in accordance with the chapter: the operating dentist, a person responsible for monitoring the patient, and a person to assist the operating dentist.

Life support: the dentist and all assistant/dental hygienist personnel must be certified in an AHA, Red Cross or equivalent agency-sponsored CPR course at the basic life support level, including one-person CPR, two-person CPR, infant resuscitation and obstructed airway, with periodic update not to exceed two years, and must be trained in the use of an AED or a defibrillator and electrocardiograph as part of that course. In addition, a dentist using general anesthesia or deep sedation must be currently trained in ACLS. And, effective March 1, 2022, if treating a patient 7 years of age or under, a dentist using any level of sedation must be currently trained in PALS.

Scope: a general anesthesia permit holder may also administer moderate sedation, pediatric moderate sedation, and nitrous-oxide inhalation moderate sedation.

Moderate Sedation Permit — 64B5-14.003(2)

Requires completion of a formal training course through a CODA-accredited dental school or program or an accredited teaching hospital, with clinical training taking place at the accredited dental school or accredited teaching hospital, plus certification by that institution that the dentist is competent in administering moderate sedation and competent to handle all related emergencies. The institution's certification must specify the type, number of hours, number of patients treated, and length of training. The minimum number of didactic hours is sixty (60).

Pediatric Moderate Sedation Permit — 64B5-14.003(3)

Requires formal training through a CODA-accredited dental school or program, an accredited teaching hospital, or an accredited pediatric residency program, with clinical training at the accredited school or teaching hospital, plus institutional certification of competence. Specific quantitative requirements:

• Minimum 60 didactic hours, which must include 4 hours of airway management;
• Clinical training including personal administration for at least 20 patients, with supervised training, management of sedation, clinical experience, and demonstrated competence in airway management of the compromised airway; and
• Certification that 3 hours of clinical training were dedicated to hands-on simulated training in emergency airway management of the compromised airway.

Credit rule — 64B5-14.003(3)(c): the Board awards credit toward the 20 pediatric patients only if the applicant is responsible for and remains with the patient from pre-anesthetic evaluation through discharge, covering pre-anesthetic evaluation, induction, maintenance, emergency, recovery, and approval for discharge. No credit is given for procedures greater than or less than pediatric moderate sedation.

Staffing: at least three individuals — operating dentist, monitor, and assistant. Life support: basic-level CPR as above, plus current PALS training for the dentist. Scope: a pediatric moderate sedation permit holder may also administer nitrous-oxide inhalation moderate sedation.

Facility standards — Rules 64B5-14.008, .009 and .010

Rule 64B5-14.008 governs general anesthesia or deep sedation; Rule 64B5-14.009 governs moderate sedation; Rule 64B5-14.010 governs pediatric moderate sedation. Requirements must be met and equipment permanently maintained and available at each location where anesthesia procedures are performed.

Operatory (64B5-14.008(1)): of a size and design to accommodate the patient on a table or operating chair and to permit an operating team of at least three individuals to move freely; an operating table or chair permitting airway maintenance, rapid repositioning in an emergency, and a firm platform for CPR; a chair or CPR board suitable for CPR; and suction and backup suction, including suction catheters and tonsil suction.

Recovery room (64B5-14.008(2)): if present, equipped with suction and backup suction, positive pressure oxygen, and sufficient light for emergency treatment; of adequate size and design for emergency access; and situated to allow the patient to be observed by the dentist or an office team member at all times.

Standard equipment (64B5-14.008(3)): a positive pressure oxygen delivery system and backup system with full face masks for adults and, if treated, pediatric patients; oral and nasal airways of various sizes; blood pressure cuff and stethoscope; cardioscope/EKG machine, pulse oximeter, and capnograph; precordial stethoscope; suction with backup; thermometer (a continuous temperature monitoring device if volatile gases are used); a backup lighting system; and a scale to weigh patients.

Emergency equipment (64B5-14.008(4)): appropriate I.V. set-up with supplies and fluids; laryngoscope with spare batteries and spare bulbs; McGill forceps, endotracheal tubes, and stylet; appropriate syringes; tourniquet and tape; CPR board or chair; defibrillator equipment appropriate for the patient population; cricothyrotomy equipment; and a Supraglottic Airway Device (SAD) or Laryngeal Mask Airway (LMA).

Medicinal drugs (64B5-14.008(5)): maintained with a current shelf life, easily accessible from operatory and recovery room, in sufficient amounts for medical emergencies — epinephrine; a narcotic antagonist (e.g., naloxone) and benzodiazepine antagonist (e.g., flumazenil) if those agents are used; an antihistamine; a corticosteroid; nitroglycerin; a bronchodilator; an antihypoglycemic agent; amiodarone; a vasopressor; an anticonvulsant; and an antihypertensive.

Two of these are easy to overlook and both appear on examinations: a scale to weigh patients and cricothyrotomy equipment.

Inspections — Rule 64B5-14.007

The Department, in consultation with the Anesthesia Chair, appoints consultants who are Florida licensed dentists holding an active general anesthesia, moderate sedation, or pediatric moderate sedation permit to inspect facilities. Consultants receive instruction in inspection procedures before inspecting.

Before a permit issues, the applicant must pass an initial inspection demonstrating compliance with Rule 64B5-14.008, .009 or .010 as applicable, and knowledge of the required equipment and drugs. For general anesthesia and deep sedation, a procedure must be observed and evaluated, including placement of an intravenous catheter, with the patient monitored while sedated and during recovery. The dentist and team must then physically demonstrate by simulation a response to emergencies including airway obstruction, bronchospasm, aspiration of a foreign object, angina pectoris, myocardial infarction, hypotension and hypertension.

Routine inspections shall be conducted, at a minimum, every three years. Not five.

A dentist may also earn 2 hours of continuing education per biennium for serving as an anesthesia inspection consultant (Rule 64B5-12.013(6)(i)), and Rule 64B5-14.004 sets a distinct continuing education requirement for permit holders.