Dental Examiners, Board of

Dental Examiners, Board of

Chapter 5: Anesthesia Administration and Sedation Permit Procedures

Effective Date: 05/26/2026 to Current

Rule Type: Current Rules & Regulations

Reference Number: 034.0001.5.05262026

CHAPTER 5

ANESTHESIA ADMINISTRATION AND SEDATION PERMIT PROCEDURES

Section 1. Authority. The Board is authorized under Wyoming Statute § 33-15-130 to promulgate rules and regulations related to the application and licensure procedures to administer sedation and provide for sedation inspection in Wyoming.

Section 2. Statement of Purpose. These Board Rules are adopted to implement the Board's authority to establish a regulatory framework for issuance of a sedation permit pursuant to W.S. § 33-15-130.

Section 3. Definitions. For the purpose of this chapter, the following definitions shall apply:

1. (a) 'ACLS' means advanced cardiac life support.
2. (b) 'Anxiolysis' is minimal sedation.
3. (c) 'Applicant' means a Wyoming licensed dentist applying for a sedation permit.
4. (d) 'ASA' means American Society of Anesthesiology classification.
5. (e) 'Combination inhalation' means using an inhalation agent and a sedative agent at the same time.
6. (f) 'Competent' means displaying special skill or knowledge derived from training and experience.
7. (g) 'Deep sedation' means a drug-induced depression of consciousness during which the patient cannot be easily aroused but responds purposefully following repeated or painful stimulation. The ability to independently maintain ventilatory function may be impaired. The patient may require assistance in maintaining a patent airway, and spontaneous ventilation may be inadequate. Cardiovascular function is usually maintained.
8. (h) 'Dental hygienist' means a Wyoming licensed dental hygienist holding an appropriate expanded duties permit including local anesthesia and/or nitrous oxide anxiolysis.
9. (i) 'Enteral' means a route of administration in which the agent is absorbed through the gastrointestinal tract or mucosa [i.e., oral, rectal, nasal, or sublingual].
10. (j) 'Facility Permit' means a permit issued to any location where sedation is being performed that has been inspected and approved by the Board.
11. (k) 'Facility Permit Holder' means a Wyoming licensed dentist designated as the

responsible dentist for a facility permit.

(l) “General anesthesia” means a drug-induced loss of consciousness during which the patient is not arousable, even by painful stimulation. The ability to independently maintain ventilatory function is often impaired. The patient often requires assistance in maintaining a patent airway, and positive pressure ventilation may be required because of depressed spontaneous ventilation or drug-induced depression of neuromuscular function. Cardiovascular function may be impaired.

(m) “Inhalation” means a route of administration in which a gaseous or volatile agent is introduced into the pulmonary tree and whose primary effect is due to absorption through the pulmonary bed.

(n) “Local anesthesia” means the elimination of sensation, especially pain, in one part of the body by the topical application or regional injection of a drug.

(o) “Minimal sedation” (previously known as anxiolysis) means a minimally depressed level of consciousness produced by a pharmacological method that retains the patient’s ability to independently and continuously maintain an airway and respond normally to tactile stimulation and verbal command. Although cognitive function and coordination may be modestly impaired, ventilatory, and cardiovascular functions are unaffected. Minimal sedation includes administration of oral medication and/or nitrous oxide.

(p) “Moderate sedation” previously known as “conscious sedation and/or twilight sedation or parenteral sedation” means a drug-induced depression of consciousness during which the patient responds purposefully to verbal commands, either alone or accompanied by light tactile stimulation. No interventions are required to maintain a patent airway and spontaneous ventilation is adequate. Cardiovascular function is usually maintained. The drugs and/or techniques used should carry a margin of safety wide enough to render unintended loss of consciousness unlikely. Repeated dosing of an agent before the effects of previous dosing can be fully appreciated may result in a greater alteration of the state of consciousness than is the intent of the sedation permit holder. Further, a patient whose only response is reflex withdrawal from a painful stimulus is not considered to be in a state of moderate sedation.

(q) “MRD” means maximum recommended dose of a drug as printed on Food and Drug Administration approved labeling for unmonitored home use.

(r) “Nitrous oxide anxiolysis” means the administration by inhalation of a combination of nitrous oxide and oxygen producing an altered level of consciousness that retains the patient’s ability to independently and continuously maintain an airway and respond appropriately to physical stimulation or verbal command.

“PALS” means Pediatric Advanced Life Support.

(t) “Parenteral” means a route of administration in which the drug bypasses the gastrointestinal tract [i.e., intramuscular, intravenous, intranasal, submucosal, subcutaneous, or intraosseous].

(u) “Qualified anesthesia provider” means a licensed anesthesiologist, certified registered nurse anesthetist, or sedation permit holder with appropriate sedation level permit.

(v) “Responsible dentist” means a licensed dentist who assumes responsibility for a facility permit.

(w) “Sedation Inspector” means a Board-approved inspector of sedation facilities and sedation permit applicant’s surgical/anesthetic technique cases.

(x) “Sedation permit” means a permit issued by the Board for administration of moderate sedation or deep sedation and/or general anesthesia by a sedation permit holder.

(y) “Titration” means administration of multiple or incremental doses of a drug until a desired effect is reached. Knowledge of each drug’s time of onset, peak response, and duration of action is essential to avoid over sedation. Although the concept of titration of a drug to effect is critical for patient safety, when the intent is moderate sedation one must know whether the previous dose has taken full effect before administering an additional drug increment.

Section 4. Standard of Care.

(a) For all levels of sedation, a dentist or sedation permit holder shall have the training, skills, drugs, and equipment to identify and manage such an occurrence until either assistance arrives (emergency medical services) or the patient returns to the intended level of sedation without airway or cardiovascular complications.

(b) A dentist or sedation permit holder shall be responsible for the sedative management, adequacy of the facility and staff, diagnosis and treatment of emergencies related to the administration of moderate sedation, deep sedation, and/or general anesthesia and providing the equipment, drugs, and protocol for patient rescue.

(c) Because sedation and general anesthesia are a continuum, it is not always possible to predict how an individual patient will respond. Hence, a dentist or sedation permit holder intending to produce a given level of sedation shall be able to diagnose and manage the physiologic consequences (rescue) for patients whose level of sedation becomes deeper than initially intended.

(d) The concept of rescue is essential to safe sedation. A dentist or sedation permit holder shall have the skills to rescue the patient from a deeper level than that intended for the procedure. The ability to rescue means that a dentist or sedation permit holder shall be able to recognize the various levels of sedation and have the skills necessary to provide appropriate cardiopulmonary support if needed.

(i) If the intended level of sedation is “minimal,” a dentist or sedation permit holder shall be able to rescue from “moderate sedation.”

(ii) If the intended level of sedation is “moderate,” a sedation permit holder shall have the skills to rescue from “deep sedation.”

(iii) If the intended level of sedation is “deep sedation,” a sedation permit holder shall have the skills to rescue from a state of “general anesthesia.”

(e) If a patient enters a deeper level of sedation than the dentist or sedation permit holder is qualified to provide, the dentist or sedation permit holder shall stop the dental procedure until the patient returns to the intended level of sedation.

(f) Children (under the age of 12) may become moderately sedated despite the intended level of minimal sedation; if this occurs, the requirements for moderate sedation shall apply.

(g) Except in extraordinary situations, the dentist or sedation permit holder shall not use preoperative sedatives for children prior to arrival in the dental office due to the risk of unobserved respiratory obstruction during transport by untrained individuals.

(h) All local anesthetic agents are cardiac depressants and may cause central nervous system excitation or depression. Particular attention shall be paid to dosage in children. To ensure that the patient will not receive an excessive dose, the maximum allowable safe dosage (i.e., mg/kg) shall be calculated before administration. There may be enhanced sedative effects when the highest recommended doses of local anesthetic drugs are used in combination with other sedatives or narcotics.

(i) Patients considered for minimal sedation, moderate sedation, and/or general anesthesia must be suitably evaluated prior to the start of any sedative procedure. In healthy or medically stable individuals (ASA I, II) this may consist of a review of their current medical history and medication use. However, patients with significant medical considerations (ASA III, IV) may require consultation with their primary care physician or consulting medical specialist.

(j) Pre-operative preparation shall include:

(i) Consideration of dietary restrictions based on the sedative technique prescribed; and

(ii) Verbal and written instructions shall be given to the patient, parent, escort, guardian or care giver.

(k) An appropriate scavenging system shall be available if gases other than oxygen are used.

Section 5. Requirements for Administering Minimal Sedation.

(a) A sedation permit shall not be required for a dentist to administer minimal sedation.

1. (b) A dentist shall only administer minimal sedation by an enteral route.
2. (c) To administer minimal sedation, a dentist or dental hygienist shall:
3. (i) Have adequate equipment with fail-safe features and 25% minimum oxygen flow; and
4. (ii) Demonstrate competency and/or training in administering minimal sedation by:
   1. (A) Completion of CODA recognized program; or
   2. (B) Completion of a Board-approved course.
5. (d) Office Equipment Requirements. Any dentist who administers minimal sedation shall provide the following equipment, which shall be functional and available at all times:
6. (i) A continuous pulse oximeter;
7. (ii) A blood pressure cuff of appropriate size;
8. (iii) Stethoscope or equivalent blood pressure monitoring devices;
9. (iv) An appropriate size bag-valve-mask apparatus or equivalent with an oxygen hook-up; and
10. (v) A manual or automatic external defibrillator.
11. (e) A dentist or sedation permit holder shall document every administration of minimal sedation. Documentation for administration of minimal sedation shall include, but is not limited to, the following:
12. (i) Pertinent medical history including, but not limited to:
    1. (A) Previous medication(s);
    2. (B) Allergies; and
    3. (C) Sensitivities;
13. (ii) Weight (nitrous oxide excluded);
14. (iii) Vital Signs, including, but not limited to:

(A) Baseline heart rate; and

(B) Blood pressure.

(iv) Beginning and ending oxygen saturation levels; and

(v) Medication(s) administered and dosage(s).

(f) All dental personnel shall be certified in administering BLS. A dentist or sedation permit holder may delegate patient monitoring to qualified dental personnel. During a procedure where nitrous oxide anxiolysis or minimal sedation is administered, at least one (1) dental personnel shall be present.

(g) When the intent is minimal sedation for adults, the appropriate initial dosing of a single enteral drug is no more than the MRD dose of a drug that can be prescribed for unmonitored home use.

(h) Nitrous oxide administration may be used in combination with a single enteral drug in minimal sedation.

(i) Nitrous oxide administration when used in combination with a sedative agent(s) may produce moderate sedation, deep sedation, and/or general anesthesia which requires a sedation permit.

Section 6. Requirements for Administering Moderate Sedation, Deep Sedation, and/or General Anesthesia.

(a) A sedation permit shall be required for a sedation permit holder to administer moderate sedation, deep sedation, and/or general anesthesia.

(b) Office Equipment Requirements.

(i) Any sedation permit holder who administers moderate sedation, deep sedation, and/or general anesthesia shall have available the required equipment in Section 5(d) and the following additional equipment and faculties, which shall be functional and available at all times:

(A) Suitable operating suite;

(B) Recovery area;

(C) Gas storage facilities with back up tanks and mobile back-up oxygen, which generally meet accepted safety standards;

(D) Suction system;

(E) Back-up suction equipment; (F) Back-up lighting equipment; (G) Parenteral access or the ability to gain parenteral access, if clinically indicated; (H) Capnograph (end tidal carbon dioxide monitor) printout; (I) EKG printouts; (J) Appropriate emergency medications; (K) Endotracheal tubes suitable for patients being treated; (L) Endotracheal tube forceps (i.e., magill); (M) A laryngoscope with reserve batteries and bulbs; (N) Oropharyngeal airways; (O) Nasopharyngeal airways; and (P) At least one (1) additional airway device.

(ii) Volatile Anesthesia Delivery Systems. Any sedation permit holder who administers volatile anesthesia shall provide the required equipment listed in Section 5(d) and Section 6(b)(i) and the following additional equipment and facilities, which shall be functional and available at all times:

(A) Capability to deliver oxygen to a patient under positive pressure, including a back-up oxygen system; (B) Gas outlets that meet generally accepted safety standards preventing accidental administration of inappropriate gases or gas mixture; (C) Fail-safe mechanisms for inhalation of nitrous oxide anxiolysis; (D) The inhalation equipment must have an appropriate scavenging system if volatile anesthetics are used; and (E) Gas storage facilities, which meet generally accepted safety standards.

(c) A sedation permit holder shall document every administration of moderate sedation, deep sedation, and/or general anesthesia. Documentation for administration of moderate sedation, deep sedation, and/or general anesthesia shall include the required documents listed in Section 5(e) and the following additional documentation:

1. (i) Current and comprehensive medical history, including:
2. (A) Medical conditions; and
3. (B) Age;
4. (ii) Physical examination, including:
5. (A) Airway assessment;
6. (B) Respiratory rate; and
7. (C) Temperature;
8. (iii) ASA Classification;
9. (iv) Procedure(s);
10. (v) Informed Consent;
11. (vi) Anesthesia Record, which shall include:
12. (A) Vital signs before and after anesthesia is utilized;
13. (B) Parenteral access site and method, if utilized;
14. (C) Medication(s) administered;
15. (D) Time anesthesia commenced and ended;
16. (E) Monitor blood pressure, heart rate, and oxygen saturation at least every five (5) minutes;
17. (F) EKG printouts;
18. (G) Capnograph (end tidal carbon dioxide monitor) printout;
19. (H) Ventilation status (spontaneous, assisted, or controlled);
20. (I) Intravenous fluids, if utilized;
21. (J) Response to anesthesia, including any complications;

(K) Starting time of recovery and time of discharge; and

(L) Condition of patient at discharge and authorization of sedation permit holder.

(d) All dental personnel shall be certified in administering BLS. A dentist or sedation permit holder may delegate patient monitoring to qualified dental personnel.

(i) Moderate Sedation. During a procedure where moderate sedation is administered, the sedation permit holder and at least one (1) other dental personnel shall be present.

(ii) Deep Sedation and/or General Anesthesia. During a procedure where deep sedation and/or general anesthesia is administered, the sedation permit holder and at least two (2) other dental personnel shall be present and at least one (1) shall be experienced in patient monitoring and documentation.

(e) A dentist or sedation permit holder shall be subject to disciplinary action if:

(i) A dentist administers moderate sedation, deep sedation, and/or general anesthesia without a sedation permit; or

(iii) A permit holder administers deep sedation and/or general anesthesia with a sedation permit for moderate sedation.

Section 7. Application Process for Administering Moderate Sedation.

(a) The applicant shall submit a completed application, including fees, and provide evidence of:

(i) Current certification in ACLS or PALS; and

(ii) Demonstrating competency and/or training in administering moderate sedation within two (2) years immediately preceding the application as follows:

(A) Completion of a specialty residency recognized by CODA;

(B) Completion of a general practice residency recognized by CODA that meets the minimal training requirements identified in subsection (D);

(C) Submit proof that applicant has administered moderate sedation, deep sedation and/or general anesthesia in another jurisdiction within generally accepted standards of dental practice and provide documentation of at least 40 moderate sedation cases; or

(D) Completion of a training course to administer and manage moderate sedation within twelve (12) months prior to application. For moderate sedation, such training shall include a minimum:

(I) 60 hours of didactic instruction; (II) 20 solo intubations (patient-based and/or acceptable electronic simulated manikin); (III) 20 moderate sedation cases; (IV) Physical diagnosis rotation; and (V) Advance Airways and Emergency Management.

(b) While reviewing a completed application, the ARC shall consider any pending complaints before the Board against the applicant.

(c) Surgical/Anesthetic Techniques. A sedation inspector shall review at least three (3) separate cases in which the applicant administered anesthesia. The sedation inspector may require additional cases to observe at his/her discretion. If no cases are available (i.e. the applicant has just completed a residency program), three (3) separate standardized cases shall be reviewed.

(d) Simulated Emergencies. The applicant and his/her team shall be able to demonstrate their expertise in managing the following emergencies:

(i) Laryngospasm; (ii) Bronchospasm; (iii) Emesis and aspirator of vomitus; (iv) Management of foreign bodies in the airway; (v) Angina Pectoris; (vi) Myocardial Infarction; (vii) Cardiopulmonary Resuscitation; (viii) Hypotension; (ix) Hypertensive crisis; (x) Acute allergic reaction; (xi) Convulsions; and (xii) Hyperventilation syndrome.

(e) Discussion Period. The applicant may be required to answer additional questions by the sedation inspector.

Section 8. Application Process for Administering Deep Sedation and/or General Anesthesia.

(a) The applicant shall submit a completed application, including fees, and provide evidence of:

(i) Current certification in ACLS or PALS, that included a hands-on component;

(ii) Demonstrating competency and/or training in administering deep sedation and/or general anesthesia within two (2) years immediately preceding the application as follows:

(A) Completion of a residency program that includes training in sedation and/or general anesthesia that is approved by CODA, the American Dental Society of Anesthesiology, the Accreditation Council for Graduate Medical Education, the American Osteopathic Association or any successor organization to any of the foregoing; or

(B) Completion of a post-doctoral training program (e.g., oral and maxillofacial surgery) that affords comprehensive and appropriate training necessary to administer and manage deep sedation and/or general anesthesia that is approved by CODA or other program approved by the Board.

(b) While reviewing a completed application, the ARC shall consider any pending complaints before the Board against the applicant.

(c) Surgical/Anesthetic Techniques. A sedation inspector shall review at least three (3) separate cases in which the applicant administered anesthesia. The sedation inspector may require additional cases to observe at his/her discretion. If no cases are available (i.e. the applicant has just completed a residency program), three (3) separate standardized cases shall be reviewed.

(d) Simulated Emergencies. The applicant and his/her team shall be able to demonstrate their expertise in managing the following emergencies:

(i) Laryngospasm;

(ii) Bronchospasm;

(iii) Emesis and aspirator of vomitus;

(iv) Management of foreign bodies in the airway; (v) Angina Pectoris; (vi) Myocardial Infarction; (vii) Cardiopulmonary Resuscitation; (viii) Hypotension; (ix) Hypertensive crisis; (x) Acute allergic reaction; (xi) Convulsions; and (xii) Hyperventilation syndrome.

(e) Discussion Period. The applicant may be required to answer additional questions by the sedation inspector.

Section 9. Sedation Permit Renewal and Expiration.

(a) Sedation permits shall be renewed on or before December 31 every odd year. The renewal period shall be January 1 of even years through December 31 of odd years.

(b) A sedation permit holder shall submit a completed sedation permit renewal application, including fees, and provide evidence of:

(i) Current certification in ACLS or PALS, that included a hands-on component; and

(ii) Sixteen (16) hours of sedation education within the renewal period, with requirements that the course contain medical emergencies and airway management skills training with a hands on component.

(iii) The Board may request more documentation if necessary.

Section 10. Failure to Timely Renew.

(a) Unlicensed Practice. Failure to timely renew may subject the permit holder to disciplinary action for unlicensed practice.

(b) Administrative Grace Period.

(i) The administrative grace period shall be from January 1st to March 31st following the renewal period.

(ii) Permit holders who failed to timely renew may apply for renewal during the administrative grace period. However, permit holders shall not practice until the Board approves their license.

(iii) Permit holders who failed to timely renew shall:

(A) Submit a completed renewal application and payment of fee;

(B) Verify current certification in ACLS or PALS that meets the requirements in Section 9.

(C) Provide evidence of completion of sixteen (16) hours of sedation education within the renewal period, with requirements that the course contain medical emergencies and airway management skills training with a hands on component.

(iv) On April 1^st following the renewal period, any permit not renewed shall expire.

Section 11. Reinstatement of Expired and Revoked Sedation Permits.

(a) A dentist may apply for reinstatement of their expired sedation permit by meeting the application requirements established in Section 7 and/or Section 8.

(b) A dentist may apply for reinstatement of their revoked sedation permit by meeting the application requirements established in Section 7 and/or Section 8 and submit evidence of:

(i) Meeting requirements of previous Board order; and

(ii) Demonstrating just cause for reinstatement.

Section 12. Sedation Inspector Qualifications and Duties.

(a) Sedation Inspector Qualifications. The inspector shall:

(i) Submit a completed application;

(ii) Actively practice as a dental anesthesiologist, oral maxillofacial surgeon, anesthesiologist, or certified nurse anesthetist; and

(iii) Hold a current and unencumbered Wyoming license in their field.

(b) Sedation Inspector Duties. A Board-approved sedation inspector shall:

(i) Be considered an agent for the Board;

(ii) Comply with the Board Rules for inspecting sedation facilities within Wyoming;

(iii) Not have a conflict of interest with an applicant. A sedation inspector's receipt of payment from the applicant for services as a sedation inspector is acceptable and does not constitute a conflict of interest; and

(iv) Review a sedation permit applicant's surgical/anesthetic techniques required in Section 7(c) and Section 8(c).

Section 13. Initial Facility Permit Application Process.

(a) Application Requirements. Applicant shall:

(i) Submit a completed application and payment of fee; and

(ii) Have two (2) approved sedation inspectors submit sedation facility inspection reports for each location where sedation is intended to be administered.

(iii) Applicant shall be responsible for payment of sedation facility inspection fee to sedation inspectors.

(b) Renewal Requirements.

(i) Facility permits shall be renewed on or before December 31 every second year.

(ii) A facility permit holder shall submit a completed facility permit renewal application, including fees. The facility permit holder shall provide evidence of re-inspection every five (5) years.

Section 14. Sedation Facility Inspection Process.

(a) Initial Inspection Process.

(i) Each sedation inspector shall review the office equipment, documentation, and emergency medications as required in Section 6.

(ii) After a sedation inspector has completed the onsite sedation facility inspection, the sedation inspector shall submit his/her findings and necessary documentation.

(b) Re-Inspection Process.

(i) Permitted sedation facilities shall be re-inspected every five (5) years. Responsible dentist bears the burden of ensuring that their permitted sedation facilities are re-inspected no later than five (5) years from the previous inspection.

(ii) Each re-inspection of a permitted sedation facility may be inspected by one (1) Board approved sedation inspector.

(iii) The Board may require re-inspection of a permitted sedation facility.