Lifeguard Sunset Catalina Turtle Orange County

Adult Oral Sedation Permit (CA)

c) "Oral conscious sedation" means a minimally depressed level of consciousness produced by oral medication that retains the patient's ability to maintain independently and continuously an airway, and respond appropriately to physical stimulation or verbal command. "Oral conscious sedation" does not include dosages less than or equal to the single maximum recommended dose that can be prescribed for home use.

Exempt: IVS and GA Permit holders. If the qualification method (exempt from 25 hour course) is a periodontics, general residency, or other advanced education in a general dentistry program, the applicant must also have his or her educational institution complete the Certification of Oral Conscious Sedation Training (OCS-2) form.


Section 1044.3. Board Approved Education.
(a) The goal of an instructional program in oral medications and sedation is to provide the educational opportunity for dentists to receive training in the techniques and skills required to safely and effectively administer oral pharmacologic agents, alone or in combination with nitrous oxide-oxygen inhalation, for the purpose of obtaining conscious sedation in the minor or adult dental patient.
(b) The educational program shall be approved by the board and shall consist of satisfactory completion of at least 25 hours of instruction including a clinical component utilizing at least one age-appropriate patient. The program shall be directed solely toward either the administration of oral conscious sedation to adult patients or the administration of oral conscious sedation to minor patients. The program shall include but not be limited to, the following areas:
  1. (1) Historical, philosophical, and legal aspects of age-appropriate oral conscious sedation of dental patients, including the Business and Professions Code.
  2. (2) Indications and contraindications for the utilization of age-appropriate oral conscious sedation in dental patients.
  3. (3) Patient evaluation and selection through a review of the medical history, physical assessment, and medical consultation.
  4. (4) Definitions and characteristics for levels of sedation achieved with oral sedative agents, with special emphasis on the distinctions between conscious sedation, deep sedation, and general anesthesia as recognized by such organizations as the American Dental Association, the American Academy of Pediatric Dentistry and the board.
  5. (5) Review of respiratory and circulatory physiology and related anatomy, with special emphasis on, and clinical experience in, establishing and maintaining an age-appropriate patent airway in the patient.
  6. (6) Pharmacology of agents used in contemporary oral conscious sedation techniques including drug interactions, incompatibilities and side effects and adverse reactions.
  7. (7) Indications, contraindications and technique considerations in the use of different contemporary age-appropriate oral conscious sedation modalities for dental patients.
  8. (8) Patient monitoring during all stages of the procedure by clinical observation and appropriate mechanical devices for responsiveness, airway patency, and recording of vital signs
  9. (9) Importantance of and techniques for maintaing proper documentation of the procedure, including aspects of informed consent, pre- and post- operative instructions, dietary considerations preoperative health evaluation, rationale for the procedure, baseline and intermittent, the patient response to the drugs, and recovery and discharge criteria.
  10. (10) Prevention, recognition and managment of complications and life-threating situations that may arise during age-appropriate oral consious sedation of the dental patient, including the principles of advanced life support.
  11. (c) A provider of a course in oral medications and sedation intending to meet requirements of this section shall submit to the board an application, on form OCS-6 (rev. 07/07), "Application for Course Approval for Oral Conscious Sedation," incorporated herein by reference. The board may approve or deny approval of any such course. Approval shall be granted after an evaluation of all components of the course has been performed and such evaluation indicates that the course meets the requirements of this section.
  12. (d)Approval by the board of a course in oral medications and sedation shall remain in effect for a period of twenty-four months, unless withdrawn sooner, after which a new application for approval must be submitted to the board.

Section 1044.5. Facility and Equipment Standards.
A facility in which oral conscious sedation is administered to patients pursuant to this article shall meet the standards set forth below.
(a) Facility and Equipment.

  1. (1) An operatory large enough to adequately accommodate the patient and permit a team consisting of at least three individuals to freely move about the patient.
  2. (2) A table or dental chair which permits the patient to be positioned so the attending team can maintain the airway, quickly alter patient position in an emergency, and provide a firm platform for the management of cardiopulmonary resuscitation.
  3. (3) A lighting system which is adequate to permit evaluation of the patient's skin and mucosal color and a backup lighting system which is battery powered and of sufficient intensity to permit completion of any treatment which may be underway at the time of a general power failure.
  4. (4) An appropriate functional suctioning device that permits aspiration of the oral and pharyngeal cavities. A backup suction device that can function at the time of general power failure must also be available.
  5. (5) A positive-pressure oxygen delivery system capable of administering greater than 90% oxygen at a 10 liter/minute flow for at least sixty minutes (650 liter "E" cylinder), even in the event of a general power failure. All equipment must be age-appropriate and capable of accommodating the patients being seen at the permit-holder's office.
  6. (6) Inhalation sedation equipment, if used in conjunction with oral sedation, must have the capacity for delivering 100%, and never less than 25%, oxygen concentration at a flow rate appropriate for an age appropriate patient's size, and have a fail-safe system. The equipment must be maintained and checked for accuracy at least annually.
(b) Ancillary equipment, which must include the following, and be maintained in good operating condition:
  1. (1) Age-appropriate oral airways capable of accommodating patients of all sizes.
  2. (2) An age-appropriate sphygmomanometer with cuffs of appropriate size for patients of all sizes.
  3. (3) A precordial/pretracheal stethoscope.
  4. (4) A pulse oximeter.
(c) The following records shall be maintained:
  1. (1) An adequate medical history and physical evaluation, updated prior to each administration of oral conscious sedation. Such records shall include, but are not limited to, an assessment including at least visual examination of the airway, the age, sex, weight, physical status (American Society of Anesthesiologists Classification), and rationale for sedation of the minor patient as well as written informed consent of the patient or, as appropriate, parent or legal guardian of the patient.
  2. (2) Oral conscious sedation records shall include baseline vital signs. If obtaining baseline vital signs is prevented by the patient's physical resistance or emotional condition, the reason or reasons must be documented. The records shall also include intermittent quantitative monitoring and recording of oxygen saturation, heart and respiratory rates, blood pressure as appropriate for specific techniques, the name, dose and time of administration of all drugs administered including local and inhalation anesthetics, the length of the procedure, any complications of oral sedation, and a statement of the patient's condition at the time of discharge.
(d) An emergency cart or kit shall be available and readily accessible and shall include the necessary and appropriate drugs and age- and size-appropriate equipment to resuscitate a nonbreathing and unconscious patient and provide continuous support while the patient is transported to a medical facility. There must be documentation that all emergency equipment and drugs are checked and maintained on a prudent and regularly scheduled basis. Emergency drugs of the following types shall be available:
  1. (1) Epinephrine
  2. (2) Bronchodilator
  3. (3) Appropriate drug antagonists
  4. (4) Antihistaminic
  5. (5) Anticholinergic
  6. (6) Anticonvulsant
  7. (7) Oxygen
  8. (8) Dextrose or other antihypoglycemic

NOTE: Authority cited: 1614, Business and Professions Code. Reference: Sections 1647.10, 1647.16, 1647.22 and 1647.24, Business and Professions Code.

2005 Evergreen Street, Suite 1550, Sacramento, CA 95815
T (916) 263-2300  F (916) 263-2140