New york state renew parenteral sedation permit

The following provides information regarding the basic requirements and procedures that New York State licensed dentists must follow when applying for a certificate(s) to administer dental anesthesia/sedation in their professional practice at locations other than general hospitals.

There are five separate dental anesthesia certificates:

1. General Anesthesia Certificate, which authorizes a licensed dentist to employ conscious (moderate) sedation (enteral or parenteral route with or without inhalation agents), deep sedation, and general anesthesia;
2. Dental Parenteral Conscious (Moderate) Sedation for patients 13 years old and older, which authorizes a licensed dentist to employ conscious (moderate) sedation (enteral or parenteral route with or without inhalation agents) on all patients 13 years old and older;
3. Dental Parenteral Conscious (Moderate) Sedationfor patients 12 years old and younger, which authorizes a licensed dentist to employ conscious (moderate) sedation (enteral or parenteral route with or without inhalation agents) on all patients;
4. Dental, Enteral Conscious (Moderate) Sedation for patients 13 years old and older, which authorizes a licensed dentist to employ conscious (moderate) sedation (enteral route only with or without inhalation agents) on all patients 13 years old and older; and
5. Dental Enteral Conscious (Moderate) Sedationfor patients 12 years old and younger, which authorizes a licensed dentist to employ conscious (moderate) sedation (enteral route only with or without inhalation agents) on all patients.

General Requirements

To be certified to administer dental anesthesia/sedation in New York State you must:

• be a New York State licensed dentist currently registered to practice; and
• meet additional education and training requirements outlined below.

You must file an application for certification and any other forms indicated. Submit all forms, along with the appropriate fee, to the Division of Professional Licensing Services (DPLS) of the New York State Education Department. It is your responsibility to follow up with anyone you have asked to send us material.

The specific requirements for certification are contained in Title 8, Article 133, section 6605-a of the New York State Education Law and Part 61.10 of the Commissioner's Regulations.

You should also read the general licensing information applicable for all professions.

Fees

The fee for a dental anesthesia/sedation certificate is $100.

The fee listed is the fee in place when this page was posted. Fees are subject to change. The fee due is the one in law when your application is received (unless fees are increased retroactively). You will be billed for the difference if fees have been increased.

• Do not send cash.
• If you apply for licensure electronically using the online Application for Licensure, you will be required to pay by credit card.
• Other payments must be made by personal check or money order payable to the New York State Education Department. Your cancelled check is your receipt.
• Mail any required forms and fees to the indicated address on the form.

Please Note: Payment submitted from outside the United States should be made by check or draft on a United States bank and in United States currency; payments submitted in any other form will not be accepted and will be returned.

Partial Refunds

Individuals who withdraw their certification application may be entitled to a partial refund.

• For the procedure to withdraw your application, contact the Dentistry Unit at opunit3@nysed.gov or by calling 518-474-3817 ext. 270 or by fax at 518-402-5354.
• The State Education Department is not responsible for any fees paid to an outside testing or credentials verification agency.

If you withdraw your application, obtain a refund, and then decide to seek New York State certification at a later date, you will be considered a new applicant, and you will be required to pay the certification fee and meet the certification requirements in place at the time you reapply.

Definitions

1. Acceptable accrediting body means an accrediting body which is accepted by the Department as a reliable authority for the purpose of accrediting educational programs in anesthesia, applying its criteria for granting accreditation in a fair, consistent, and nondiscriminatory manner, and which accredits such programs on a national basis.
2. Conscious (moderate) sedation means a drug-induced depression of consciousness during which patients respond purposefully to verbal commands, either alone or accompanied by light tactile stimulation. Reflex withdrawal from a painful stimulus is not considered a purposeful response. No interventions are required to maintain a patent airway, and spontaneous ventilation is adequate. Cardiovascular function is usually maintained.
3. Deep sedation means a drug-induced depression of consciousness during which patients cannot be easily aroused but respond purposefully following repeated or 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.
4. 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.
5. Enteral means a technique of administration in which the agent is absorbed through the gastrointestinal tract or oral mucosa, including but not limited to oral, rectal, and sublingual administration.
6. Parenteral means a technique of administration in which the drug bypasses the gastrointestinal tract, including but not limited to intramuscular, intravenous, intranasal, submucosal, subcutaneous, and intraocular administration.
7. Inhalation means a technique of administration in which a gaseous or volatile agent is introduced into the pulmonary tree and whose primary effect is due to the absorption through the pulmonary bed.
8. Continual or continually means repeated regularly and frequently in a steady succession.
9. Continuous or continuously means prolonged without any interruption in time.
10. Patent means open, unobstructed, or not closed.
11. Time-oriented anesthesia record means an organized document which shows at appropriate time intervals, drugs and doses administered, and physiologic data obtained through patient monitoring, during the course of conscious (moderate) sedation, deep sedation, or general anesthesia, to include the preoperative, intraoperative and recovery stages of treatment.
12. American Society of Anesthesiologists (ASA) Patient Physical Status Classification:
    1. ASA I – A normal healthy patient;
    2. ASA II – A patient with mild systemic disease;
    3. ASA III – A patient with severe systemic disease;
    4. ASA IV – A patient with severe systemic disease that is a constant threat to life;
    5. ASA V – A moribund patient who is not expected to survive without the operation;
    6. ASA VI – A declared brain-dead patient whose organs are being removed for donor purposes;
    7. E – Emergency operation of any variety (used to modify one of the above classifications, i.e., ASA III-E).

    Education Requirements

    1. Dental General Anesthesia Certificate. You must present evidence of completion of either:
       1. Prior to January 1, 2019 at least two years of post-doctoral education in anesthesia acceptable to the Department and accredited by an acceptable accrediting body; or
       2. As of January 1, 2019 at least three years of post-doctoral education in anesthesia acceptable to the Department and accredited by an acceptable accrediting body; or
       3. a graduate level program in oral and maxillofacial surgery acceptable to the Department and accredited by an acceptable accrediting body.

       You must also complete a course in Advanced Cardiac Life Support (ACLS), or its equivalent as determined by the Department, and have current documentation of course completion attesting to this fact. Additionally, if the licensed dentist is administering general anesthesia to patients 12 years old and younger, the applicant must complete a course in Pediatric Advanced Life Support (PALS), or its equivalent as determined by the Department, and have current documentation of course completion attesting to this fact.

       1. a course in ACLS, or its equivalent as determined by the Department, and have current documentation of course completion attesting to this fact; and
       2. pre-doctoral or post-doctoral education acceptable to the Department and accredited by an acceptable accrediting body, which must include a formal course consisting of at least 60 clock hours of coursework that is provided through didactic instruction and/or an anesthesia rotation, which has been previously approved by the Department. Simulation experiences may be part of the required coursework, which must include but not be limited to, coursework in patient evaluation and monitoring, management of emergencies, rescue of patients from deep sedation, management of the pediatric and adult airways, pediatric and adult cardiac and pulmonary anatomy and physiology, pediatric and adult pharmacology, and the control of pain and anxiety; and in addition to the 60 clock hours of coursework, a clinical experience demonstrating the successful use of dental parenteral conscious (moderate) sedation on no fewer than 20 live dental patients via the intravenous route who must be 13 years old or older in a 1 doctor/student to 1 patient ratio. The student/licensed dentist enrolled in the course must have his or her name listed on the anesthesia record and must be the individual administering the medications and documenting said administration, as well as the physiologic findings required on the anesthesia record. The patients must be monitored, at a minimum, pursuant to the practice requirements contained in 8 NYCRR §61.10(d). If the clinical portion of the course is given outside a teaching institution, a formal memorandum of understanding (MOU) between the teaching institution and the clinical teaching center (facility) must be in place attesting that the clinical facility is held to the same practice standards as the teaching institution.
       1. a course in ACLS, or its equivalent as determined by the Department, and have current documentation of course completion attesting to this fact;
       2. a course in PALS, or its equivalent as determined by the Department, and have current documentation of course completion attesting to this fact; and
       3. pre-doctoral or post-doctoral education accredited by an acceptable accrediting body, which must include a formal course consisting of at least 60 clock hours of coursework that is provided through didactic instruction and/or an anesthesia rotation, which has been previously approved by the Department. Simulation experiences can be part of the coursework which must include but not be limited to, coursework in patient evaluation and monitoring, management of emergencies, rescue of patients from deep sedation, management of the pediatric and adult airways, pediatric and adult cardiac and pulmonary anatomy and physiology, pediatric and adult pharmacology, and the control of pain and anxiety; and in addition to the 60 clock hours of coursework, a clinical experience, acceptable to and previously approved by the Department, demonstrating the successful use of dental parenteral conscious (moderate) sedation by the intravenous route on no fewer than 15 live dental patients who must be 12 years old or younger and five live dental patients who must be 13 years old or older in a 1 doctor/student to 1 patient ratio. The student/licensed dentist enrolled in the course must have his or her name listed on the anesthesia record and must be the individual administering the medications and documenting said administration, as well as the physiologic findings required on the anesthesia record. The patients must be monitored, at a minimum, pursuant to the practice requirements contained in 8 NYCRR §61.10(d). If the clinical portion of the course is given outside a teaching institution, a formal memorandum of understanding (MOU) between the teaching institution and the clinical teaching center (facility) must be in place attesting that the clinical facility is held to the same practice standards as the teaching institution.
       1. a course in ACLS, or its equivalent as determined by the Department, and have current documentation of course completion attesting to this fact; and
       2. pre-doctoral education or post-doctoral education accredited by an acceptable accrediting body, and which must include a formal course consisting of at least 60 clock hours of coursework that is provided through didactic instruction and/or an anesthesia rotation, which has been previously approved by the Department. Simulation experiences may be part of the required coursework which must include but not be limited to, coursework in patient evaluation and monitoring, management of emergencies including IV access, rescue of patients from deep sedation, management of the pediatric and adult airways, pediatric and adult cardiac and pulmonary anatomy and physiology, pediatric and adult pharmacology, and the control of pain and anxiety; and in addition to the 60 clock hours of coursework, a clinical experience, acceptable to and previously approved by the Department, demonstrating the successful use of dental enteral conscious (moderate) sedation on no fewer than 10 live clinical dental patients who must be 13 years old or older and who are physically present in the same location as the students. The students may be in groups no larger than five. The patients must be monitored, at a minimum, pursuant to the practice requirements contained in 8 NYCRR §61.10(d). If the clinical portion of the course is given outside a teaching institution, a formal memorandum of understanding (MOU) between the teaching institution and the clinical teaching center (facility) must be in place attesting that the clinical facility is held to the same practice standards as the teaching institution.
       1. a course in ACLS, or its equivalent as determined by the Department, and have current documentation of course completion attesting to this fact;
       2. a course in pediatric advanced life support (PALS), or its equivalent as determined by the Department and have current documentation of course completion attesting to the fact; and
       3. pre-doctoral or post-doctoral education acceptable to the Department and accredited by an acceptable accrediting body, which must include a formal course consisting of at least 60 clock hours of coursework that is provided through didactic instruction and/or an anesthesia rotation, which has been previously approved by the Department. Simulation experiences can be part of the coursework which must include but not be limited to coursework in patient evaluation and monitoring, management of emergencies, including IV access, rescue of patients from deep sedation, management of the pediatric and adult airways, pediatric and adult cardiac and pulmonary anatomy and physiology, pediatric and adult pharmacology, and the control of pain and anxiety; and in addition to the 60 clock hours of coursework, a clinical experience demonstrating the successful use of dental enteral conscious (moderate) sedation on no fewer than 15 live clinical dental patients 12 years old or younger and five live clinical dental patients 13 years old or older in a 2:1 doctor/student to patient ratio. For the purpose of this requirement, a 2:1 doctor/student to patient ratio means the doctor/student providing dental care to the patient and a second doctor/student monitoring and documenting the sedation care can receive credit for the procedure as it relates to the minimum number of sedations required for certification. Both of these doctors/students must be with the patient during the entire time of treatment and cannot be involved with any other activities or responsibilities. Only the two doctors/students involved in direct patient care/monitoring can receive credit for treating the patient undergoing the procedure and sedation. The student/licensed dentist enrolled in the course must have his or her name listed on the anesthesia record and must be the individual administering the medications and documenting said administration, as well as the physiologic findings required on the anesthesia record. The patients must be monitored, at a minimum, pursuant to the practice requirements contained in 8 NYCRR §61.10(d). If the clinical portion of the course is given outside a teaching institution, a formal memorandum of understanding (MOU) between the teaching institution and the clinical teaching center (facility) must be in place attesting that the clinical facility is held to the same practice standards as the teaching institution.

       Approved Post-Doctoral Coursework for Moderate Conscious Sedation

       Please note: Residency programs do not offer enteral/parenteral coursework for any dentist not enrolled in their residency programs.

       • List of Adult Parenteral Programs (13 years of age and older)
       • List of Child Parenteral Programs (12 years of age and younger)
       • List of Adult Enteral Programs (13 years of age and older)
       • List of Child Enteral Programs (12 years of age and younger)

       Certification through Endorsement

       For endorsement of a dental anesthesia certificate from another jurisdiction of the United States or Canada, the applicant must submit to the Department a certificate of good standing from said jurisdiction and currently be registered to practice dentistry in the New York State, and must submit satisfactory evidence of having met the following requirements for the requested certificate:

       1. Dental General anesthesia: Certificate of completion of a Commission on Dental Accreditation (CODA) accredited oral and maxillofacial surgery residency program or a CODA accredited dental anesthesia residency program.
       2. Dental Parenteral Conscious (Moderate) Sedation for patients 13 years old and older:
          1. if the applicant has ever had any patients with irreversible morbidity or mortality due to the sedation provided by him or her, the applicant must provide an explanation of the incident(s) to the Department for review, in a form prescribed by the Department.
          2. provide 20 anesthesia records of patients that the applicant has administered parenteral conscious (moderate) sedation (by the intravenous route) in the licensed jurisdiction, within the three years immediately preceding the applicant’s submission of his or her application to the Department for review with no patients having had irreversible morbidity or mortality due to the sedation provided by the applicant. These records must include the monitoring that is required by 8 NYCRR §61.10(d)(4)(ii)(b) for the administration of parenteral conscious (moderate) sedation; and
          3. provide current documentation of completion of a course in advanced cardiac life support (ACLS) from a Department approved course sponsor, or its equivalent as determined by the Department.
          1. if the applicant has ever had any patients with irreversible morbidity or mortality due to the sedation provided by him or her, the applicant must provide an explanation of the incident(s) to the Department for review, in a form prescribed by the Department;
          2. have a certificate to provide parenteral conscious (moderate) sedation for, at least, the three years immediately preceding the applicant’s submission of his or her application to the Department for review;
          3. provide 15 anesthesia records of patients 12 years old and younger and five anesthesia records of patients 13 years old and older, that the applicant has administered parenteral conscious (moderate) sedation (via the intravenous route) in the licensed jurisdiction, within the three years immediately preceding the applicant’s submission of his or her application to the Department for review with no patients having had irreversible morbidity or mortality due to the sedation provided by the applicant. These records must include the monitoring that is required by 8 NYCRR §61.10(d)(4)(ii)(b) for the administration of parenteral conscious (moderate) sedation;
          4. provide current documentation of completion of a course in advanced cardiac life support (ACLS) from a Department approved sponsor, or its equivalent as determined by the Department; and
          5. provide current documentation of completion of a course in pediatric advanced life support (PALS) from a Department approved sponsor, or its equivalent as determined by the Department.
          1. if the applicant has ever had any patients with irreversible morbidity or mortality due to the sedation provided by him or her, the applicant must provide an explanation of the incident(s) to the Department for review, in a form prescribed by the Department;
          2. provide 20 anesthesia records of patients that the applicant has administered enteral conscious (moderate) sedation in the licensed jurisdiction, within the three years immediately preceding the applicant’s submission of his or her application to the Department for review, in a form prescribed by the Department. These records must include the monitoring that is required by 8 NYCRR §61.10(d)(4)(ii)(b) for the administration of enteral conscious (moderate) sedation; and
          3. provide current documentation of completion of a course in advanced cardiac life support (ACLS) from a Department approved course sponsor, or its equivalent as determined by the Department.
          1. if the applicant has ever had any patients with irreversible morbidity or mortality due to the sedation provided by him or her, the applicant must provide an explanation of the incident(s) to the Department for review, in a form prescribed by the Department;
          2. have a certificate to provide enteral conscious (moderate) sedation for at least the three years immediately preceding the applicant’s submission of his or her application to the Department for review;
          3. provide 15 anesthesia records of patients 12 years old and younger and 5 anesthesia records of patients 13 years old and older, that the applicant has administered enteral conscious (moderate) sedation in the licensed jurisdiction, within the three years immediately preceding the applicant’s submission of his or her application to the Department for review. These records must include the monitoring that is required by 8 NYCRR §61.10(d)(4)(ii)(b) for the administration of enteral conscious (moderate) sedation;
          4. provide current documentation of completion of a course in advanced cardiac life support (ACLS) from a Department approved sponsor, or its equivalent as determined by the Department; and
          5. provide current documentation of completion of a course in pediatric advanced life support (PALS) from a Department approved sponsor, or its equivalent as determined by the Department.

          Additionally, please be advised that if an applicant has ever had any patients with irreversible morbidity or mortality due to the sedation provided by him or her, the Department may, depending on the circumstances, require him or her to submit a time-oriented anesthesia record of the incident(s); and/or complete remedial education before a dental parenteral or enteral conscious sedation certificate of any category will be issued to him or her.