Combination Inhalation-Enteral (Oral) Minimal Sedation

Level I Sedation

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.

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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.

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Presenter(s)

Disclosures & Policies

No Recording and Transcription Policy
To protect the privacy, security, and integrity of our programs, meetings, and events, recording of any kind is strictly prohibited unless expressly authorized in writing by the department director. This includes, but is not limited to:
- Video recordings (camera, phone, webcam, or other devices)
- Audio recordings (phone, microphone, digital recorders, etc.)
- Screen captures or screen recordings
- AI-based or automated transcription tools (e.g., apps or software that convert speech to text)

Guidelines: All participants are expected to respect this policy at all times. If recording is necessary as an accommodation, or for education or administrative purposes, prior approval must be obtained in writing. Unauthorized recording or transcription may result in removal from the session and/or further administrative action. Exceptions may only be granted by the department director in advance. Taking detailed notes is encouraged, and participants are welcome to take pictures of the presentation slides for personal use.

Purpose: This policy ensures a safe and respectful environment, protects sensitive and proprietary information, and upholds the confidentiality of all participants.

Course Refund Policy
Please review the Course Refund Policy by clicking here. This policy includes information regarding requirements that attendees must comply with to remain eligible to receive CE, cancelling your registration, course transfers, etc.

Financial Disclosure Statement
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.

This educational activity is free from commercial bias. The planning committee, presenters, and authors have disclosed all financial relationships with commercial interests relevant to this content, and any potential conflicts have been identified and mitigated according to ADA CERP standards. No commercial entities have influenced the content, selection, or presentation of materials, and no product endorsements or promotional activities are included in this presentation. Any mention of products, services, or companies is solely for educational purposes and does not imply endorsement.

There is nothing to disclose for this course.

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Tuition

• Course Fee: $515

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Credit

Hours: 18

This activity has been planned and implemented in accordance with the standards of the ADA Continuing Education Recognition Program (ADA CERP) through joint efforts of UT Health San Antonio. UT Health San Antonio is recognized by the ADA CERP as a provider of continuing dental education. ADA CERP does not approve or endorse individual courses or instructors, nor does it imply acceptance of credit hours by boards of dentistry.

Specialty/AGD Code

• 340 - Anesthesia and Pain Management

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

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• For help or questions about this program, you can contact us at:
• Phone: 210-567-3177
  Email: smile@uthscsa.edu
  
  Business hours are Monday - Friday, 8:00 AM - 5:00 PM Central Time

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