The Texas State Board of Dental Examiners (TSBDE or Dental Board) establishes standards for and regulates the practice of dentistry in Texas and enforces the Dental Practice Act and other statutes relating to the practice of dentistry.
To administer nitrous oxide/oxygen inhalation sedation or Levels 1, 2, 3, or 4 sedation Texas dentists must hold a permit from the Dental Board. 22 Tex. Admin. Code §110.2.
No permit from the TSBDE is required for a dentist to administer Schedule II drugs, such as oxycodone, Percocet, and Dilaudid, for the purpose of pain control or post-operative care. However, dentists are subject to other requirements and regulations related to prescribing Schedule II drugs and the Prescription Monitoring Program.
Sedation and Anesthesia Required Preoperative Checklist for Texas Dentists
Texas dentists administering nitrous oxide or Level 1, 2, 3, or 4 sedation/anesthesia must create, maintain, and include in the patient’s dental records a document titled “preoperative sedation/anesthesia checklist.” 22 Tex. Admin. Code §110.113(a).
The checklist may be done on paper or electronically and must be completed prior to beginning a procedure for which the dentists will be administering nitrous oxide or any level of sedation. 22 Tex. Admin. Code §110.113(a).
The Information That Must be Included in the Preoperative Checklist
Under the code, at a minimum, the preoperative checklist must include documentation of the following:
- Medical history, including documentation of the following:
- review of patient medical history;
- review of patient allergies;
- review of patient surgical and/or anesthesia history;
- review of family surgical and/or anesthesia history; and
- review of patient medications and any modifications;
- Confirmation that written and verbal preoperative and post-operative instructions were delivered to the patient, parent, legal guardian, or caregiver;
- Medical consults, as needed;
- Physical examination, including documentation of the following:
- American Society of Anesthesiologists Physical Status Classification (ASA) classification;
- NPO status; and
- Preoperative vitals, including height, weight, blood pressure, pulse rate, and respiration rate;
- Anesthesia-specific physical examination including documentation of the following as necessary for the level of sedation/anesthesia administered:
- Airway assessment, including Mallampati score and/or Brodsky score as necessary for adequate patient evaluation; and
- Ventilation and respiratory rate obtained through patient observation, auscultation, or capnography;
- Confirmation of pre-procedure equipment readiness check;
- Confirmation of pre-procedure treatment review (correct patient and procedure); and
- Special preoperative considerations as indicated for sedation/anesthesia administered to pediatric or high-risk patients.
22 Tex. Admin. Code §110.113(c). The information required by this subsection may be gathered at any time, but the dentist administering the sedation/anesthesia must verify the information as current and correct prior to administration of sedation. 22 Tex. Admin. Code §110.113(e). If any items required by subsection (c) above are missing, then the preoperative checklist must include documentation of the reason for the omission. 22 Tex. Admin. Code §110.113(d).
The Dental Board is Conducting Anesthesia Inspections
The TSBDE is authorized by statute to conduct inspections to enforce the rules relating to sedation and anesthesia. 22 Tex. Admin. Code §110.18(a). The Board must provide you with notice at least 10 business days prior to conducting an on-site inspection under this subsection unless doing so would jeopardize an ongoing investigation. 22 Tex. Admin. Code §110.18(b).
The inspector will complete this Anesthesia Levels 2–4 Inspection Form. We encourage you to familiarize yourself with this form and the TSBDE Rules that govern the Level of Anesthesia for which you hold a permit.
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