1. (a) Qualified dentist or operating dentist shall ensure that administered general anesthesia, deep sedation, or moderate sedation follows the clinical guidelines set forth in Part IV B. or C., as appropriate, of the American Dental Association “Guidelines for the Use of Sedation and General Anesthesia by Dentists” revised 2016, as specified in Appendix II or in the American Academy of Pediatrics “Guidelines for Monitoring and Management of Pediatric Patients Before, During, and After Sedation for Diagnostic and Therapeutic Procedures” revised 2019, as specified in Appendix II, including for patient history, pre-operative evaluation, and preparation, specific to the age demographic of the patient being treated.
2. (b) For administration of general anesthesia, deep sedation, or moderate sedation, an intravenous catheter shall be in place prior to administration or the equipment necessary to establish either intravascular or intraosseous access shall be immediately available until the patient meets discharge status.
3. (c) For administration of moderate sedation, with or without inhalation sedation, agents shall be limited to a single dose, as defined in Den 304.01(r), of one or more drugs, or multiple doses of a single drug, using manufacturer guidelines as found in the FDA “Online Label Repository” found at labels.fda.gov.
4. (d) A dentist shall not delegate to a dental assistant or hygienist any task that is outside of their scopes of practice, as defined in Den 404, Den 405, and Den 501.01(b), such as placement of an intravenous catheter, drawing up medications, or administering medications. PALS certification shall not supersede the duty restrictions outlined in Den 404, Den 405, and Den 501.01(b).

5. (e) When treating patients under 13 years of age by administering general anesthesia or deep sedation, the qualified dentist or operating dentist shall:

   1. (1) Obtain informed consent that includes the statement that the procedure may be alternatively performed in a hospital setting with additional anesthesia personnel; and
   2. (2) Ensure that in addition to the dentist performing the procedure there shall be a separate dedicated anesthesia qualified provider present to monitor the procedure and recovery from anesthesia.

6. (f) Qualified dentists who are board eligible or board certified by either the American Dental Board of Anesthesiology (ADBA) or the American Board of Oral and Maxillofacial Surgery (ABOMS) may apply to the board for exemption from the requirement for a separate dedicated anesthesia provider when treating patients under 13 years of age with administration of general anesthesia or deep sedation pursuant to RSA 317-A:12, XII-a(h)(1), and shall:

   1. (1) Have completed an advanced airway course with hands-on training within the previous 6 years;

   2. (2) When the qualified dentist is administering general anesthesia or deep sedation without a separate dedicated anesthesia provider present:

      1. a. Document a pre-operative physical examination of the patient’s airway consistent with the “2022 American Society of Anesthesiologists (ASA) Practice Guidelines for Management of the Difficult Airway”, as specified in Appendix II; and
      2. b. Ensure that a designated staff member currently certified in PALS or who has completed 36 hours of didactic instruction taught by an organization listed under Den 406.06(a)(1) in the underlying physiology and interpretation of monitoring used for patients under deep sedation and general anesthesia and principles of office-based anesthesia and anesthesia equipment is present during the procedure with the sole responsibility to constantly observe the patient’s vital signs, airway patency, and adequacy of ventilation.

   3. (3) Have completed the “Application for Exemption from the Requirement for a Separate Dedicated Anesthesia Provider When Treating Patients Under 13 Years of Age With General Anesthesia or Deep Sedation” by providing the following information:

      1. a. Applicant’s full legal name;
      2. b. Applicant’s NH dental license number;
      3. c. Applicant’s primary facility’s name;
      4. d. Primary facility’s physical address;
      5. e. Primary facility’s phone number;
      6. f. Applicant’s e-mail address;
      7. g. Answer yes or no to “I have completed an advanced airway course with hands-on training, within the previous 6 years.”;
      8. h. Answer yes or no to “Do you intend to treat patients under 13 years of age with administration of general anesthesia or deep sedation without a separate dedicated anesthesia provider?”;
      9. i. Answer yes or no to “Do you intend to treat patients 8 years of age or under with the administration of general anesthesia or deep sedation without a separate dedicated anesthesia provider?”; and
      10. j. Answer yes or no to “Are you board eligible or board certified by either the American Dental Board of Anesthesiology (ADBA) or the American Board of Oral and Maxillofacial Surgery (ABOMS)?”;

   4. (4) Each applicant for exemption shall sign and date the application below the following attestation:

      “I am not under investigation by any professional licensing board and my credentials have not been suspended or revoked by any professional licensing board. The information and documentation provided are true, complete, and not misleading to the best of my knowledge and belief, I understand that providing false or misleading information constitutes grounds for denial, suspension, or revocation of a license, and that knowingly providing false material information constitutes a misdemeanor under RSA 641:3 relative to falsification in official matters.”;

   5. (5) When submitting the application described in (3) above, provide a copy of the document showing completion of an advanced airway course with hands-on training within the previous 6 years;

   6. (6) When submitting the application described in (3) above and answering “yes” to the question “Do you intend to treat patients 8 years of age or under with the administration of general anesthesia or deep sedation without a separate dedicated anesthesia provider?” provide the following:

      1. a. Evidence of successful completion of a CODA accredited dental anesthesiology residency program within the previous 2 years including documentation of supervision of your personal administration of deep sedation or general anesthesia to at least 20 patients who are 8 years of age or younger that occurred during the training;
      2. b. Evidence of successful completion of a CODA accredited oral and maxillofacial surgery residency program within the previous 2 years with documentation of supervision of your personal administration of deep sedation or general anesthesia to at least 20 patients who are 8 years of age or younger that occurred during the training; or
      3. c. For dentists who currently possess a permit for use of general anesthesia, deep sedation, and moderate sedation documentation that you personally administered deep sedation or general anesthesia to at least 20 patients 8 years of age or younger during the previous 2 years; and

   7. (7) Applicants who lack the required 20 pediatric cases within the previous 2 years in a manner described in (6) shall, if they wish to seek the exemption:

      1. a. Administer deep sedation or general anesthesia to patients 8 years of age or under, while not performing the surgical procedure, under the direct supervision of a dentist who holds a general anesthesia, deep sedation, and moderate sedation permit and has been granted the exemption described in Den 304.08(f); and
      2. b. Complete the requirement documenting administration of deep sedation or general anesthesia under direct supervision to at least 20 patients under 8 years of age over the span of no more than 2 years.

7. (g) When administering general anesthesia or deep sedation to patients 8 years of age or younger, without a separate dedicated anesthesia provider present, the qualified dentist shall:

   1. (1) Possess an exemption from the requirement for a separate dedicated anesthesia provider as required by Den 304.08(f) and have met the requirements in Den 304.08(f)(6)a., (6)b., (6)c., or (7); or

   2. (2) If general anesthesia or deep sedation was administered on an emergency basis the dentist shall complete and submit to the OPLC an “Emergency Exemption From the Requirement for a Separate Dedicated Anesthesia Provider Form” within 15 working days following the treatment of the patient. The dentist shall provide the following information:

      1. a. The dentist’s full legal name;
      2. b. The dentist’s NH dental license number;
      3. c. The name of the facility where general anesthesia or deep sedation was administered;
      4. d. The facility’s physical address;
      5. e. The facility’s phone number;
      6. f. The dentist’s e-mail address;
      7. g. A description of the dental procedure(s);
      8. h. A description of the pre-operative physical condition of the patient;
      9. i. A list of all personnel who assisted with the emergency dental procedure;
      10. j. A description of drug(s) and dosage(s) administered;
      11. k. A description of the techniques used in administering the drug(s);

      12. l. A description of any adverse occurrence(s), including but not limited to:

          1. 1. Patient’s signs and symptoms;
          2. 2. Treatment instituted in response to adverse occurrence(s); and
          3. 3. Patient’s response to the treatment(s);
      13. m. The patient’s condition on termination of any procedure(s) undertaken; and
      14. n. The signature of the dentist and date the dentist signed the form.
8. (h) The report described in (g) above shall not identify the patient for whom the report is being submitted.

Source. #14246, eff 8-3-25, EXPIRES: 8-3-35