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Combination Inhalation-Enteral (Oral) Minimal Sedation

Level I Sedation

Not Supported.

Course overview

Successful completion of this course of study will satisfy satisfactory completion of training to the level of competency in minimal sedation consistent with a course of study that has been developed to be consistent with the ADA Guidelines for teaching a comprehensive training program in minimal sedation. This meets educational and professional requirements as defined by the Texas State Board of Dental Examiners (TSBDE) for level I Minimal Sedation criteria.

The TSBDE Anesthesia Rules Ad-Hoc Committee was convened to update the agency’s sedation and anesthesia rules based on sedation guidelines adopted by the American Dental Association (ADA) House of Delegates in 2007.

The most significant change in the rules is the new permitting process for the various levels of anesthesia and sedation. The permitting process emphasizes the level of sedation of the patient rather than the route of administration of the medication. The new rules establish five levels of anesthesia and sedation permits beyond the standard dental license: Nitrous Oxide/ Oxygen Inhalation Sedation; Level 1-Minimal Sedation; Level 2-Moderate Sedation (enteral sedation); Level 3-Moderate Sedation (parenteral sedation); and Level 4-Deep Sedation or General Anesthesia.

Most levels of permitting will change in name only. Licensed dentists who lack sedation permits may continue to utilize local anesthetic and prescribe minor tranquilizers for anxiolysis. A licensed dentist in Texas who held an active Nitrous Oxide/Oxygen Inhalation Conscious Sedation permit, Parenteral Sedation permit, or Deep Sedation or General Anesthesia permit on or before the effective date of the new rules had his or her permit automatically reclassified as a Nitrous Oxide/Oxygen Inhalation Sedation permit, Level 3 permit, or Level 4 permit respectively, on June 1, 2011.

A licensed Texas Dentist who held an active Enteral Sedation permit on or before the effective date had his or her permit automatically reclassified as a Level 1 (Minimal Sedation) permit. Texas Dentists in this category may continue to administer Enteral Sedation as permitted by the current rules until January 1, 2013. A Texas Dentist who holds an active Enteral Sedation permit on or before June 1, 2011 who desires to administer Level 2 (Moderate-Enteral) sedation after January 1, 2013 must submit an application requesting a Level 2 permit prior to January 1, 2013. A Level 1 permit allows a dentist to use a single medication or a single medication in combination with nitrous oxide to achieve sedation. The sedation provided may only result in a minimally depressed level of consciousness. A Level 2 permit will be required to utilize two or more medications to achieve sedation or to achieve a moderate level sedation.

Individuals practicing outside of Texas should consult with their State Boards regarding recognition of this course to be acceptable for a level I sedation permit.

Participation in the course requires that you:

  • Register online with the our secured server.
  • Pay a registration fee.
    • Paying With A Credit Card – Once you complete your registration, an e-mail will automatically be sent to you, at the address you provided, containing your User Code and Password and link to a Logon Session page to begin the course.
    • Not Paying With a Credit Card – Once our office receives your form of payment, the following business day an e-mail will be sent to you, at the address you provided, containing your User Code, Password and a link to a Logon Session page to begin the course
  • Complete all course sections yielding to 18 hours of CE credit


  • At the end of each course section/part, you will take the exam that will be graded and you will see your results instantaneously. You will have 1 month to complete the course. Once you begin the course, you will have the ability to Log Out and Log In. This may only be done during a presentation not during an examination. The module exam cannot be paused once started.
    After you have successfully completed the 11 course content sections, you will take the required comprehensive exam to finalize your participation in this course. You will be required to achieve a passing score of 80%. If you fail to answer enough questions correctly, you will be instructed to re-take the exam and a new set of questions will be provided. You will have three chances to fulfill the requirements. If you are not successful, you will be instructed to contact the Office of Continuing Dental Education.
    Upon successful completion of this course, you will complete a course evaluation which will direct you to an electronic verification for 18 hour(s) of combined video streaming and testing didactic continuing dental education credit. Print this verification document and save for your reference – follow the prompts allowing you to print the certificate.


    Objectives

  • Understand historical, philosophical and psychological aspects, as well as definitions and descriptions of all aspects of anxiety and pain
  • Understand the basic components of inhalation sedation equipment and the function of each of these components.
  • List and discuss the advantages and disadvantages of enteral and/or combination inhalation-enteral minimal sedation (combination minimal sedation)
  • List and discuss the indications and contraindications for the use of enteral and/or combination inhalation-enteral minimal sedation (combination minimal sedation).
  • Understand the complications associated with enteral and/or combination inhalation-enteral minimal sedation (combined minimal sedation).
  • Discuss prevention, recognition and management of complications associated with enteral and or combination inhalation-enteral minimal sedation (combined minimal sedation).
  • Administer enteral and/or combination inhalation-enteral sedation (combined minimal sedation) to patients in a clinical setting in a safe and effective manner.
  • Discuss the abuse potential, occupational hazards and other effects of enteral and inhalation agents.
  • Describe the pharmacology of the enteral and inhalation drugs selected for administration.
  • Discuss the precautions, contraindications and adverse reactions associated with the enteral and inhalation drugs selected.
  • Utilize a protocol for management of emergencies in the dental office and list the emergency drugs and equipment required for management of life threatening situations.
  • Implement the ability to manage life threatening emergency situations, including having certification in Basic Life Support for Healthcare Providers
  • Understand the pharmacological effects of combined drug therapy, their implications and management including understanding that Nitrous oxide/oxygen when used in combination with sedative agents may produce minimal, moderate, deep sedation or general anesthesia.

  • Please Note:
    All dentists participating in this course should be aware of specific regulations required in the state in which they are licensed to practice. This course addresses regulations specific to the Texas State Board of Dental Examiners and after completing this course, the participant should also be able to:
  • Understand the Guidelines from the TSBDE requiring that at least one BLS trained assistant is present during minimal sedation during this procedure including recovery
  • Be aware that a dentist who holds a minimal sedation permit shall not intentionally administer moderate, deep or general anesthesia.
  • Be aware that when sedating children twelve years or younger the dentist should observe the American Academy of Pediatrics Guidelines for monitoring and management of the pediatric patient during and after sedation for diagnostic and therapeutic procedures.
  • Maintain proper records, chart entries, including medical history, physical exam, informed consent, anesthesia records and monitoring of physiologic parameters.

  • Table of Contents
    After you have successfully completed a section, you will take a required exam. You must achieve a passing score of 90%. If you fail to answer enough questions correctly, you will be instructed to re-take the exam and a new set of questions will be provided. You will have three chances to fulfill the requirements. If you are not successful, you will be instructed to re-take the section.

    section 01: Introduction to Sedation
    Pain-drug induced depression conscious & unconscious; use of combination minimal sedation procedures for enteral & combination minimal sedation

    section 02: History
    All aspects of Anxiety and Pain control

    section 03: Patient Evaluation
    Patient Evaluation & selection thru medical history, diagnosis, and profiling; review of respiratory & circulatory physiology and related anatomy

    section 04: Pharmacology
    Pharmacology of agents used in enteral and combination inhalation enteral minimal sedation including drug interactions and incompatibilities

    section 05: Monitoring
    Patient monitoring using observation, monitoring equipment, with attention to vital signs & reflexes related to consciousness

    section 06: Rules and Records
    Maintaining records with accurate chart entries medical history, physical exam, informed consent, time oriented anesthesia record, including names of all drugs administered including local anesthesia doses and monitored physiological parameters

    section 07: Nitrous Equipment
    Description & use of inhalation sedation equipment

    section 08: Nitrous Hazards
    Introduction to potential health hazards of trace anesthetics & proposed techniques for limiting occupation exposure

    section 09: Local Anesthesia
    Administration of local anesthesia in conjunction with enteral and /or combination inhalation-enteral minimal sedation techniques. Review of dental procedures possible under enteral and/or combination inhalation enteral minimal sedation

    section 11: Emergencies
    Prevention, recognition and management of complications & life threatening situations

    section 12: Comprehensive Exam/Evaluation
    After you have successfully completed the 11 course content sections, you will take the required comprehensive exam to finalize your participation in this course. You will be required to achieve a passing score of 80%. If you fail to answer enough questions correctly, you will be instructed to re-take the exam and a new set of questions will be provided. You will have three chances to fulfill the requirements. If you are not successful, you will be instructed to contact the Office of Continuing Dental Education.


    Presenter(s)

    • David M. Grogan, DDS, MSD
      • DAVID M. GROGAN, DDS, MSD, graduated from the Baylor College of Dentistry in 1981. He continued his post graduate training and received his Certificate and M.S.D. degree in Oral and and Maxillofacial Surgery from Baylor College of Dentistry in 1986. He is currently an Assistant Professor in the Department of Oral and Maxillofacial Surgery and Pharmacology at the Baylor College of Dentistry, Texas A&M University System Health Science Center in Dallas, Texas. Prior to joining the faculty at Baylor, he maintained a private practice limited to Oral and Maxillofacial Surgery in Waco, Texas from 1986 to 1999.
    • Arthur H. Jeske, DMD, PhD
      • ARTHUR H. JESKE, DMD, PhD, received his dental training at Georgia Health Sciences Univeristy College of Dental Medicine in 1978. He joined the faculty of the University of Texas School of Dentistry at Houston the same year, later serving as Chair of the Department of Dental Pharmacology (1987-1993) and, subsequently, Chair of the Department of Restorative Dentistry and Biomaterials.

        During his 33-year teaching career, he has lectured both locally and internationally on dental pharmacology, local anesthesia and sedation. In addition, he has held several editorial positions, including Editor-in-Chief of Mosby’s Dental Drug Reference. He served on the American Dental Association’s Council on Scientific Affairs, serving as chair in 2004.

        Currently, he is Professor in the Department of Restorative Dentistry and Associate Dean for Strategic Planning, UT School of Dentistry. He is a Fellow of the International College of Dentists and the American College of Dentists, a Faculty Member of Omicron Kappa Upsilon, and a member of Delta Sigma Delta. He received the Distinguished Alumnus Award of Georgia Health Sciences University College of Dental Medicine and a Distinguished Service Award from the Texas Dental Association.
    • Ernest B. Luce, DDS
      • ERNEST B. LUCE, DDS, received his DDS degree from the University of Texas Health Science Center at Houston in 1985. In June of 1986, he completed a one year General Practice Residency at The University of Texas Health Science Center at San Antonio. Upon completion of the residency, Dr. Luce joined the Department of General Dentistry at The University of Texas Health Science Center at San Antonio. Currently he is a Clinical Associate Professor at the Health Science Center, and he also maintains a part time private practice in general dentistry in San Antonio.

        His teaching duties include didactic presentations as well as clinical supervision of graduate general dentistry residents. Dr. Luce served as Head of the Graduate Division of the Department of General Dentistry and Program Director for the General Practice Residency at The University of Texas Health Science Center at San Antonio from 1993 to 1999. He also served as the Department Chairman for the Department of Hospital Dentistry, University Hospital, in San Antonio during that same time period. You may contact this author at luce@uthscsa.edu
    • Ernest E. Valdez, DDS
      • ERNEST E. VALDEZ, DDS, received his DDS degree from The University of Texas Health Science Center at San Antonio, Dental School in 1993. He pursued a two year General Practice Residency at The University of Texas Health Science Center at San Antonio which he completed in 2001. Dr. Valdez also served as Clinical Assistant Professor in the Department of General Dentistry at The University of Texas Health Science Center at San Antonio as well as the Department of Dental Hygiene at the Texas State Technical College in Harlingen, Texas from 1996 to 1999.

        Dr. Valdez has served as co-investigator of numerous research projects. In 2000, he published articles in the Journal of Oral & Maxillofacial Surgery, British Journal of Oral & Maxillofacial Surgery, and the Journal of Periodontal Research. Dr. Valdez was the recipient of the 2000 Biotene Award for Excellence in Hospital Dentistry by the American Association of Hospital Dentists and Laclede Professional Products, Inc. He has been a member of the International Association of Student Clinicians since 1991, during which time he was the recipient of the ADA/Dentsply Student Clinician Program Award. He is also a member of the American Association of Hospital Dentists and Delta Sigma Delta Dental Fraternity.

        His experiences have included serving as staff dentist for a dental clinic, Las Clinicas Del Norte, in Ojo Caliente, New Mexico from 1993 to 1996, and Dental Department Director of Su Clinica Familiar in Harlingen, Texas from 1996 to 1999. While residing in Harlingen, Texas and Ojo Caliente, New Mexico, Dr. Valdez was active in community activities and served to facilitate and promote dental and medical health issues and presentations. Dr. Valdez also served as a Volunteer Fireman and on the Volunteer First Responders Team in Ojo Caliente, New Mexico. Dr. Valdez currently serves as an associate in a private practice in San Antonio.
    Disclosure

    It is the policy of the UT Health San Antonio Office of Continuing Dental Education to ensure balance, independence, objectivity and scientific rigor in all of its sponsored educational activities. All participating speakers, course directors, and planning committee members are required to disclose to the program audience any financial relationships related to the subject matter of this program. Relationships of spouse/partner with proprietary entities producing health care goods or services should be disclosed if they are of a nature that may influence the objectivity of the individual in a position to control the content of the CDE activity. Disclosure information is reviewed in advance in order to manage and resolve any possible conflicts of interest. Specific disclosure information for each speaker, course director, and planning committee member will be shared with the audience prior to the speaker’s presentation.

    Continuing Dental Education Staff members have nothing to disclose.


    Tuition

    • Course Fee: $515

    Credit

    Hours: 18

    Register now!

    Original Date: 12/21/2011 | Review Date: 08/31/2022 | Expiration Date: 08/30/2025

    Register now!

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    • For help or questions about this program, you can contact us at:
    • Phone: (210) 567-3177
      Email: smile@uthscsa.edu

    UT Health San Antonio
    School of Dentistry

    7703 Floyd Curl Drive
    San Antonio, TX 78229

    210-567-7000

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