What Does an Unrestricted Permit Allow?
An Unrestricted Permit applies only to one office location where anesthesia is administered. The two types of Unrestricted Permits are Individual and Facility. The type of permit selected determines who is allowed to administer anesthesia at that location, as follows:
- An Unrestricted Permit-Individual allows the dentist to administer conscious sedation, general anesthesia and deep sedation, as defined by the Board’s Rules and Regulations governing anesthesia, at the location. If you wish to employ a certified registered nurse anesthetist (CRNA) for deep sedation or general anesthesia at an office location, you must also hold an Unrestricted Permit-Individual.
- An Unrestricted Permit-Facility allows a board-certified anesthesiologist, who is employed by or working in conjunction with the dentist, to administer general anesthesia, deep sedation, and conscious sedation at the location. The board-certified anesthesiologist must have an active Delaware license, and must remain on the premises of the dental facility until any patient given a general anesthetic or deep sedation regains consciousness.
Important Information about Anesthesia
Before applying for a permit for sedation or anesthesia, it is imperative for you to thoroughly review Section 7.0 of the Rules and Regulations of the Delaware Board of Dentistry and Dental Hygiene. The Board’s rules define conscious sedation (both via nitrous oxide inhalation and by the parenteral route), deep intravenous sedation and general anesthesia using definitions adapted from the American Dental Association (ADA). The educational requirements for deep sedation and general anesthesia are much more stringent than for conscious sedation. This distinction is important both from the standpoint of this permit application and from the standpoint of clinical practice.
- Conscious Sedation: a minimally depressed level of consciousness that retains the patient’s ability to independently and continuously maintain an airway and respond appropriately to physical stimulation and verbal command and that is produced by a pharmacologic or non-pharmacologic method or a combination thereof
- General Anesthesia: a controlled state of unconsciousness accompanied by partial or complete loss of protective reflexes, including inability to independently maintain an airway and respond purposefully to physical stimulation or verbal command, and is produced by a pharmacologic or non-pharmacologic method or a combination thereof
- Deep Sedation: a controlled state of depressed consciousness accompanied by partial loss of protective reflexes, including the inability to continually maintain an airway independently and/or to respond purposefully to verbal command, and is produced by a pharmacologic or non-pharmacologic method or combination thereof
The Anesthesia Advisory Committee (AAC) must complete a satisfactory inspection of your office before a permit is issued. The AAC reviews applications and performs inspections under the Board’s direction.
- Submit a separate application for each location where you will administer sedation or anesthesia.
- Submit your application for a permit only when the location is ready for AAC inspection.
Requirements for All Unrestricted Permit Applications
It is your responsibility to arrange for the Board office to receive all documents listed below. If clarification is needed, the Board may request more information or documents.
- Enclose the non-refundable processing fee by check or money order made payable to the “State of Delaware.”
The additional documentation you must submit depends on whether you are applying for an Individual or Facility type.
Additional Requirements for Unrestricted Permit-Individual
If you are applying to administer the anesthesia yourself or wish to employ a CRNA to administer the anesthesia, the following additional requirements apply.
- Enclose a copy of your current Advanced Cardiac Life Support (ACLS) certification card.
- Submit documentation that you meet at least one of the following qualifications:
- You have two years of advanced training in Anesthesiology and related academic subjects (or its equivalent) beyond the undergraduate dental school level in a training program as described in Part II of the Guidelines for Teaching the Comprehensive Control of Pain and Anxiety in Dentistry.
- You are certified as a diplomate of the American Board of Oral and Maxillofacial Surgeons.
- You have satisfactorily completed a residency in Oral and Maxillofacial Surgery at an institution approved by the ADA Council of Dental Education.
- You are a fellow of the American Dental Society of Anesthesiology.
Additional Requirement for Unrestricted Permit-Facility
If you employ or work in conjunction with a board-certified, Delaware-licensed anesthesiologist to administer the anesthesia at the office location, the following additional requirement applies.
- Arrange for the Board to receive a letter directly from the individual anesthesiologist or the anesthesiology practice stating that you are employing their services and attesting that they will remain on the premises of the dental facility until any patient given a general anesthetic or deep sedation regains consciousness.