PURPOSE: This rule defines terms used throughout the rules of Chapter 4.

1. (1) The following words and terms, when used in this rule, shall have the following meanings.

   1. (A) Anesthesiologist—a physician licensed by the Missouri State Board of Registration for the Healing Arts in accordance with Chapter 334, RSMo, with privileges in general anesthesia at an institution accredited by the Joint Commission on Accreditation of Healthcare Organizations (JCAHO) or the American Osteopathic Association (AOA).
   2. (B) Anxiolysis—the diminution or elimination of anxiety. Anxiolysis is not conscious sedation.
   3. (C) 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. Conscious sedation is not deep sedation or general anesthesia.
   4. (D) Conscious sedation permit—a document issued by the Missouri Dental Board to a dentist that allows the dentist to administer enteral and/or parenteral conscious sedation.
   5. (E) Conscious sedation site certificate—a document issued by the Missouri Dental Board to a specific dental office where conscious sedation is administered.
   6. (F) 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 a combination thereof.
   7. (G) Deep sedation/general anesthesia permit—a document issued by the Missouri Dental Board to a dentist that allows the dentist to administer deep sedation/general anesthesia.
   8. (H) Deep sedation/general anesthesia site certificate—a document issued by the Missouri Dental Board to a specific dental office where deep sedation/general anesthesia is administered.
   9. (I) Dentist-in-charge—a dentist duly licensed by the board to practice at a facility in which sedation anesthesia services are to be offered and who assumes the responsibility to assure that the facility is properly equipped and the sedation team is properly trained.
   10. (J) Dental office—a facility where dentistry is practiced in accordance with the provisions of section 332.071, RSMo.
   11. (K) Dentist—one who is currently licensed to practice as a dentist in Missouri and is ultimately responsible for the sedation procedure of a dental patient under his/her care.
   12. (L) Enteral conscious sedation—a technique of administration in which the drug is absorbed through the gastrointestinal tract or oral mucosa (i.e. oral, rectal, or sublingual). Enteral conscious sedation is not parenteral conscious sedation, deep sedation or general anesthesia.
   13. (M) Facility inspection—an inspection confirming the adequacy of the dental office to provide enteral and/or parenteral conscious sedation by consultants appointed by the board to insure public safety.
   14. (N) General anesthesia—a controlled state of unconsciousness accompanied by partial or complete loss of protective reflexes, including the inability to independently and continuously 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.
   15. (O) Nurse anesthetist—a licensed registered professional nurse recognized as an advanced practice nurse by the Missouri State Board of Nursing, who is certified to administer anesthesia by a nationally recognized certifying body approved by the Missouri State Board of Nursing in accordance with Chapter 335, RSMo.
   16. (P) On-site evaluation—a performance evaluation of the competency of the sedation team by consultants appointed by the board to insure public safety.
   17. (Q) Parenteral conscious sedation—a technique of administration in which the drug bypasses the gastrointestinal tract, i.e., routes of administration: intravenous (I.V.), intramuscular (I.M.), intranasal (I.N.), subcutaneous (S.C.), intraoccular (I.O). Parenteral conscious sedation is not deep sedation or general anesthesia.
   18. (R) Sedation team—those individuals qualified pursuant to 4 CSR 110-4.030(7)(B) and employed by the dental office involved with the treatment and/or monitoring of a sedation patient. 20 CSR 2110-4

   19. (S) Qualified sedation provider—any of the following who have satisfied the provisions of this rule:

       1. 1. A currently licensed dentist in Mis-

souri with a valid permit to administer enteral and/or parenteral conscious sedation;

1. 2. A currently licensed [physician] anes-

thesiologist; or

1. 3. A currently licensed nurse anes-

thetist.

AUTHORITY: sections 332.031 and 332.361, RSMo 2000 and 332.071, RSMo Supp. 2004.* This rule originally filed as 4 CSR 110-4.010. Original rule filed Sept. 15, 2004, effective April 30, 2005. Moved to 20 CSR 2110-4.010, effective Aug. 28, 2006.

*Original authority: 332.031, RSMo 1969 amended 1981, 1993, 1995; 332.071, RSMo 1969, amended 1976, 1995, 2003, 2004; and 332.361, RSMo 1969, 1981.