Section 1070.8 - Approval of Dental Sedation Assistant Permit CoursesIn addition to the requirements of Sections 1070 and 1070.1, the following criteria shall be met by a dental sedation assistant permit course to secure and maintain approval by the Board. As used in this section, the following definitions apply: "IV" means intravenous, "AED" means automated external defibrillator, "CO2" means carbon dioxide, and "ECG" and "EKG" both mean electrocardiogram.
(a)(1) The course director, designated faculty member, or instructional staff member may, in lieu of a license issued by the Board, possess a valid, active, and current license issued in California as a physician and surgeon.(2) The course director, designated faculty member, or instructional staff member responsible for clinical evaluation shall have completed a two-hour methodology course in clinical evaluation prior to conducting clinical evaluations of students.(3) Clinical instruction shall be given under direct supervision of the course director, designated faculty member, or instructional staff member who shall be the holder of a valid, active, and current general anesthesia or moderate sedation permit issued by the Board. Evaluation of the condition of a sedated patient shall remain the responsibility of the director, designated faculty member, or instructional staff member authorized to administer moderate sedation, deep sedation, or general anesthesia, who shall be at the patient's chairside while moderate sedation, deep sedation, or general anesthesia is being administered.(b) The course shall be of a sufficient duration for the student to develop minimum competence in all of the duties that dental sedation assistant permitholders are authorized to perform, but in no event less than 110 hours, including at least 40 hours of didactic instruction, at least 32 hours of combined laboratory and preclinical instruction, and at least 38 hours of clinical instruction. Clinical instruction shall require completion of all of the tasks described in subsections (j), (k), (l), (m), and (n) during no less than twenty (20) supervised cases utilizing moderate sedation, deep sedation, or general anesthesia.(c) The following are minimum requirements for equipment and armamentaria: (1) One pulse oximeter for each six students; one AED or AED trainer; one capnograph or teaching device for monitoring of end tidal CO2; blood pressure cuff and stethoscope for each six students; one pretracheal stethoscope for each six students; one electrocardiogram machine, one automatic blood pressure/pulse measuring system/machine, and one oxygen delivery system including oxygen tank; one IV start kit for each student; one venous access device kit for each student; IV equipment and supplies for IV infusions including hanging device infusion containers and tubing for each six students; one sharps container for each six students; packaged syringes, needles, needleless devices, practice fluid ampules and vials for each student; stopwatch or timer with second hand for each six students; one heart/lung sounds mannequin or teaching device; tonsillar or pharyngeal suction tip, endotracheal tube forceps, endotracheal tube and appropriate connectors, suction equipment for aspiration of oral and pharyngeal cavities, and laryngoscope in the ratio of at least one for each six students; any other monitoring or emergency equipment required by Section 1043 for the administration of general anesthesia, deep sedation, or moderate sedation; and a selection of instruments and supplemental armamentaria for all of the procedures that dental sedation assistant permitholders are authorized to perform according to Section 1750.5 of the Code.(2) Each operatory used for preclinical or clinical training shall contain either a surgery table or a power-operated chair for treating patients in a supine position, an irrigation system or sterile water delivery system as they pertain to the specific practice, and all other equipment and armamentarium required to instruct in the duties that dental sedation assistant permitholders are authorized to perform according to Section 1750.5 of the Code.(3) All students, faculty, and staff involved in the direct provision of patient care shall be certified in basic life support procedures, including the use of an automatic electronic defibrillator.(d) Areas of instruction shall include, at a minimum, the instruction specified in subsections (e) to (n), inclusive, as they relate to the duties that dental sedation assistant permitholders are authorized to perform.(e) General didactic instruction shall contain: (1) Patient evaluation and selection factors through review of medical history, physical assessment, and medical consultation.(2) Characteristics of anatomy and physiology of the circulatory, cardiovascular, and respiratory systems, and the central and peripheral nervous system.(3) Characteristics of anxiety management related to the surgical patient, relatives, and escorts, and characteristics of anxiety and pain reduction techniques.(4) Overview of the classification of drugs used by patients for cardiac disease, respiratory disease, hypertension, diabetes, neurological disorders, and infectious diseases.(5) Overview of techniques and specific drug groups utilized for sedation and general anesthesia.(6) Definitions and characteristics of levels of sedation achieved with general anesthesia and sedative agents, including the distinctions between moderate sedation, deep sedation, and general anesthesia.(7) Overview of patient monitoring during moderate sedation, deep sedation, and general anesthesia.(8) Prevention, recognition, and management of complications.(9) Obtaining informed consent.(f) With respect to medical emergencies, didactic instruction shall contain: (1) An overview of medical emergencies, including, but not limited to, airway obstruction, bronchospasm or asthma, laryngospasm, allergic reactions, syncope, cardiac arrest, cardiac dysrhythmia, seizure disorders, hyperglycemia and hypoglycemia, drug overdose, hyperventilation, acute coronary syndrome including angina and myocardial infarction, hypertension, hypotension, stroke, aspiration of vomitus, and congestive heart failure.(2) Laboratory instruction shall include the simulation and response to at least the following medical emergencies: airway obstruction, bronchospasm, emesis and aspiration of foreign material under anesthesia, angina pectoris, myocardial infarction, hypotension, hypertension, cardiac arrest, allergic reaction, convulsions, hypoglycemia, syncope, and respiratory depression. Both training mannequins and other students or staff may be used for simulation. The student shall demonstrate proficiency in all simulated emergencies during training and shall then be eligible to complete a practical examination on this section.(g) With respect to sedation and the pediatric patient, didactic instruction shall contain the following: (1) Psychological considerations.(2) Patient evaluation and selection factors through review of medical history, physical assessment, and medical consultation.(3) Definitions and characteristics of levels of sedation achieved with general anesthesia and sedative agents, with special emphasis on the distinctions between moderate sedation, deep sedation, and general anesthesia.(4) Review of respiratory and circulatory physiology and related anatomy, with special emphasis on establishing and maintaining a patient airway.(5) Overview of pharmacology agents used in contemporary sedation and general anesthesia.(7) Obtaining informed consent.(8) Prevention, recognition, and management of complications, including principles of basic life support and resuscitation of pediatric patients.(h) With respect to physically, mentally, and neurologically compromised patients, didactic instruction shall contain the following: an overview of characteristics of Alzheimer's disease, autism, cerebral palsy, Down's syndrome, mental retardation, multiple sclerosis, muscular dystrophy, Parkinson's disease, schizophrenia, and stroke.(i) With respect to health history and patient assessment, didactic instruction shall include, at a minimum, the recording of the following:(1) Age, sex, weight, physical status as defined by the American Society of Anesthesiologists Physical Status Classification System, medication use, general health, any known or suspected medically compromising conditions, rationale for anesthesia or sedation of the patient, visual examination of the airway, and auscultation of the heart and lungs as medically required.(2) General anesthesia, deep sedation, or moderate sedation records that contain a time-oriented record with preoperative, multiple intraoperative, and postoperative pulse oximetry and blood pressure and pulse readings, frequency and dose of drug administration, length of procedure, complications of anesthesia or sedation, and a statement of the patient's condition at time of discharge.(j) With respect to monitoring heart sounds with pretracheal/precordial stethoscope and EKG and use of AED: (1) Didactic instruction shall contain the following:(A) Characteristics of pretracheal/precordial stethoscope.(B) Review of anatomy and physiology of circulatory system: heart, blood vessels, and cardiac cycle as it relates to EKG.(C) Characteristics of rhythm interpretation and waveform analysis basics.(D) Characteristics of manual intermittent and automatic blood pressure and pulse assessment.(E) Characteristics and use of an AED.(F) Procedure for using a pretracheal/precordial stethoscope for monitoring of heart sounds.(G) Procedure for use and monitoring of the heart with an EKG machine, including electrode placement, and the adjustment of such equipment.(H) Procedure for using manual and automatic blood pressure/pulse/respiration measuring system.(2) Preclinical instruction: Utilizing another student or staff person, the student shall demonstrate proficiency in each of the following tasks during training and shall then be eligible to complete an examination on this section. (A) Assessment of blood pressure and pulse both manually and utilizing an automatic system.(B) Placement and assessment of an EKG. Instruction shall include the adjustment of such equipment.(C) Monitoring and assessment of heart sounds with a pretracheal/precordial stethoscope.(D) Use of an AED or AED trainer.(3) Clinical instruction: Utilizing patients, the student shall demonstrate proficiency in each of the following tasks, under supervision of faculty or instructional staff as described in Section 1070.8(a)(3), and shall then be eligible to complete an examination on this section. (A) Assessment of blood pressure and pulse both manually and utilizing an automatic system.(B) Placement and assessment of an EKG. Instruction shall include the adjustment of such equipment.(C) Monitoring and assessment of heart sounds with a pretracheal/precordial stethoscope.(k) With respect to monitoring lung/respiratory sounds with pretracheal/precordial stethoscope and monitoring oxygen saturation end tidal CO2 with pulse oximeter and capnograph: (1) Didactic instruction shall contain the following: (A) Characteristics of pretracheal/precordial stethoscope, pulse oximeter and capnograph for respiration monitoring.(B) Review of anatomy and physiology of respiratory system to include the nose, mouth, pharynx, epiglottis, larynx, trachea, bronchi, bronchioles, and alveolus.(C) Characteristics of respiratory monitoring/lung sounds: mechanism of respiration, composition of respiratory gases, oxygen saturation.(D) Characteristics of manual and automatic respiration assessment.(E) Procedure for using a pretracheal/precordial stethoscope for respiration monitoring.(F) Procedure for using and maintaining pulse oximeter for monitoring oxygen saturation.(G) Procedure for use and maintenance of capnograph.(H) Characteristics for monitoring blood and skin color and other related factors.(I) Procedures and use of an oxygen delivery system.(J) Characteristics of airway management to include armamentaria and use.(2) Preclinical instruction: Utilizing another student or staff person, the student shall demonstrate proficiency in each of the following tasks during training and shall then be eligible to complete an examination on this section.(A) Assessment of respiration rates.(B) Monitoring and assessment of lung sounds and ventilation with a pretracheal/precordial stethoscope.(C) Monitoring oxygen saturation with a pulse oximeter.(D) Use of an oxygen delivery system.(3) Clinical instruction: Utilizing patients, the student shall demonstrate proficiency in each of the following tasks, under supervision by faculty or instructional staff as described in Section 1070.8(a)(3), and shall then be eligible to complete an examination on this section. (A) Assessment of respiration rates.(B) Monitoring and assessment of lung sounds and ventilation with a pretracheal/precordial stethoscope.(C) Monitoring oxygen saturation with a pulse oximeter.(D) Use of an oxygen delivery system.(l) With respect to drug identification and draw: (1) Didactic instruction shall contain: (A) Characteristics of syringes and needles: use, types, gauges, lengths, and components.(B) Characteristics of drug, medication, and fluid storage units: use, type, components, identification of label including generic and brand names, strength, potential adverse reactions, expiration date, and contraindications.(C) Characteristics of drug draw: armamentaria, label verification, ampule and vial preparation, and drug withdrawal techniques.(2) Laboratory instruction: The student shall demonstrate proficiency in the withdrawal of fluids from a vial or ampule in the amount specified by faculty or instructional staff and shall then be eligible to complete a practical examination.(3) Clinical instruction: The student shall demonstrate proficiency in the evaluation of vial or container labels for identification of content, dosage, and strength and in the withdrawal of fluids from a vial or ampule in the amount specified by faculty or instructional staff as described in Section 1070.8(a)(3), and shall then be eligible to complete an examination on this section.(m) With respect to adding drugs, medications, and fluids to IV lines: (1) Didactic instruction shall contain: (A) Characteristics of adding drugs, medications, and fluids to IV lines in the presence of a licensed dentist.(C) Procedures for adding drugs, medications, and fluids, including dosage and frequency.(D) Procedures for adding drugs, medications, and fluids by IV bolus.(E) Characteristics of patient observation for signs and symptoms of drug response.(2) Laboratory instruction: The student shall demonstrate proficiency in adding fluids to an existing IV line on a venipuncture training arm or in a simulated environment, and shall then be eligible to complete a practical examination on this section.(3) Clinical instruction: The student shall demonstrate proficiency in adding fluids to existing IV lines in the presence of course faculty or instructional staff as described in Section 1070.8(a)(3), and shall then be eligible to complete an examination on this section.(n) With respect to the removal of IV lines:(1) Didactic instruction shall include overview and procedures for the removal of an IV line.(2) Laboratory instruction: The student shall demonstrate proficiency on a venipuncture training arm or in a simulated environment for IV removal, and shall then be eligible for a practical examination.(3) Clinical instruction: The student shall demonstrate proficiency in removing IV lines in the presence of course faculty or instructional staff as described in Section 1070.8(a)(3), and shall then be eligible to complete an examination on this section.(o) Each student shall pass a written examination that reflects the curriculum content, which may be administered at intervals throughout the course as determined by the course director.(p) To maintain approval, programs approved prior to the effective date of these regulations shall submit to the Board a completed "Notice of Compliance with New Requirements for Dental Sedation Assistant Permit Courses (New 10/10)", hereby incorporated by reference, within ninety (90) days of the effective date of these regulations.Cal. Code Regs. Tit. 16, § 1070.8
1. New section filed 10-12-2011; operative 11-11-2011 (Register 2011, No. 41).
2. Amendment of subsections (a)(3), (b), (c)(1)-(2), (d), (e)(6)-(7), (g)(3), (g)(8) and (i)(2) and amendment of NOTE filed 8-16-2022; operative 8-16-2022 pursuant to Government Code section 11343.4(b)(3) (Register 2022, No. 33). Note: Authority cited: Section 1614, Business and Professions Code. Reference: Sections 1750.4, 1750.5 and 1752.4, Business and Professions Code.
1. New section filed 10-12-2011; operative 11-11-2011 (Register 2011, No. 41).
2. Amendment of subsections (a)(3), (b), (c)(1)-(2), (d), (e)(6)-(7), (g)(3), (g)(8) and (i)(2) and amendment of Note filed 8-16-2022; operative 8/16/2022 pursuant to Government Code section 11343.4(b)(3) (Register 2022, No. 33).