Minimal and Moderate Sedation
All dentists or certified specialists who administer minimal or moderate sedation must comply with the requirements outlined in the most current version of CDSBC's
Minimal and Moderate Sedation Services (non-hospital facilities) Standards (and related addendum).
Keep up to date on sedation and GA news here>>
Note: those who administer
only minimal sedation do not need to register their sedation qualifications with CDSBC.
Moderate Sedation
CDSBC registers qualifications for three levels of
moderate sedation:
- Moderate – oral (two or more drugs)
- Moderate – IV level 1 (one drug)
- Moderate – IV level 2 (two drug)
You must advise the College of your intent to provide moderate sedation either in your own facility or as a visiting practitioner by emailing
sedation@cdsbc.org.
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[accordion title="I%20want%20to%20administer%20moderate%20sedation%20to%20patients%20in%20my%20office"]
If you own a dental office and intend to administer moderate sedation to your patients, you must first register your qualifications with CDSBC.If you own a dental office and administer parenteral (IV) moderate sedation, you must inform the College by emailing sedation@cdsbc.org to be added to the register of facilities administering parenteral (IV) moderate sedation.[/accordion]
[accordion title="I%20want%20to%20have%20another%20dentist%20or%20physician%20administer%20moderate%20sedation%20to%20patients%20in%20my%20office"]
You are responsible for ensuring that any visiting dentist or physician who administers sedation in your office has the appropriate qualifications.If you own a dental office, and intend to have another dentist or physician administer parenteral (IV) moderate sedation, you must inform the College by emailing sedation@cdsbc.org to be added to the register of facilities that administer parenteral (IV) moderate sedation.[/accordion]
[accordion title="I%20want%20to%20administer%20moderate%20sedation%20to%20patients%20in%20other%20practitioners'%20offices"]
If you intend to administer moderate sedation to patients in other dentists’ offices, you must have your qualifications registered with the College.[/accordion]
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Registrants may only administer moderate sedation sedation to patients who are 12 years of age and under in out-of-hospital dental facilities when they are qualified and authorized to provide deep sedation and/or GA, or have completed training in a formal postgraduate program in pediatric dentistry that meets CDSBC Standards. Practitioners who do not fall under these categories cannot provide moderate sedation services to patients 12 years of age and younger.
Moderate sedation
[accordions title-color="primary-dark" color="primary" title-text-size="20px"]
[accordion title="What%20is%20moderate%20sedation%3F"]According to the
Minimal and Moderate Sedation in Dentistry Standards and Guidelines, moderate sedation is defined as a drug-induced depression of consciousness during which patients respond 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 rarely compromised.
The drugs and/or technique used in moderate sedation 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 dentist. Further, a patient whose only response is reflex withdrawal from a painful stimulus is not considered to be in a state of moderate sedation but, rather, deep sedation.
The usual modalities of moderate sedation are one of the following:
- Oral (enteral) administration of multiple sedative drugs, with or without nitrous oxide and oxygen;
- Parenteral administration of benzodiazepine drugs (intravenous, intramuscular, subcutaneous, submucosal or intranasal); or
- Parenteral administration of benzodiazepine and narcotic drugs (intravenous, intramuscular, subcutaneous, submucosal or intranasal).
Registrants must first be authorized and registered with CDSBC through the Sedation & General Anesthesia Committee before providing moderate sedation services.[/accordion]
[accordion title="What%20are%20the%20requirements%20for%20CDAs%20to%20assist%20with%20moderate%20sedation%3F"]Requirements vary depending on the level of sedation CDAs assist and the roles they function on the clinical team. Please refer to Sedation and General Anesthesia Standards and Guidelines for details.
CDAs who function as moderate sedation assistants or recovery supervisors must have current BLS and DAANCE, OMAAP, or CDAAC.
CDAs who function as operative assistants are required to have current BLS.[/accordion]
[accordion title="I%20am%20a%20regulated%20professional%20who%20provides%2Fassists%20with%20moderate%20sedation%20services%2C%20but%20I%20am%20not%20the%20facility%20owner.%20What%20are%20my%20responsibilities%3F"]Regulated professionals who provide and/or assist with sedation services should ensure they are in full compliance with CDSBC standards and guidelines. All sedation providers, operating dentists (i.e., non-sedation providers treating sedated patients) and support staff
will be assessed with the CDSBC’s Minimal and Moderate Sedation in Dentistry Standards & Guidelines, including assessment of each team member’s credentials.
[/accordion]
[accordion title="I%20only%20provide%20moderate%20sedation%3B%20do%20I%20need%20to%20have%20current%20BLS%20and%2For%20ACLS%3F"]Yes, all clinical sedation and general anesthesia staff are required to have current BLS designed for health professionals, and the course must contain all of the following components:
- Bag-valve-mask
- Hands-on components
- Certification no longer than 24 months
All moderate sedation providers who sedate patients 13 years of age and over are required to have current ACLS.[/accordion]
[accordion title="How%20frequently%20am%20I%20required%20to%20renew%20my%20BLS%20and%2For%20ACLS%3F"]This depends on your course provider. If your certificate is valid for one year, annual
retraining is required. If your certificate is valid for two years, retraining every two years is permitted.
ACLS must be renewed every two years or as recommended by course provider, whichever is more frequent. [/accordion]
[accordion title="What%20does%20the%20moderate%20sedation%20assessment%20cycle%20look%20like%3F"]The assessment cycle for moderate sedation facilities will be four years, one of which will require an in-office assessment by College-appointed sedation assessors:
- In the first year of the cycle (2022-23), all moderate sedation facilities will complete a self-assessment.
- Between years two and four of the cycle, each moderate sedation facility will be visited and assessed once by a College-appointed assessment team. Depending on the findings, additional assessments may be required. Annual self-assessments will be required in the years other than the year when an in-office facility assessment is conducted.
- The four-year cycle is repeated until moderate sedation services are no longer provided in the facility.
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[accordion title="What%20payment%20methods%20are%2Fare%20not%20accepted%3F"]Accepted payment methods include cheque (by mail), Mastercard and Visa credit cards, and Interac for RBC Royal Bank, TD Bank, First Nations Bank of Canada, Scotiabank, and most BC credit unions. Mastercard/Visa debit cards are not accepted.
CDSBC does not accept payments by telephone, in cash, or those delivered in person as the CDSBC office remains closed to the public. [/accordion]
[accordion title="My%20online%20payment%20won%E2%80%99t%20go%20through.%20What%20should%20I%20do%3F"]Mastercard and Visa credit cards are accepted, but Mastercard/Visa debit cards are not. Interac for RBC Royal Bank, TD Bank, First Nations Bank of Canada, Scotiabank, and most BC credit unions are accepted.
If you receive an error message while paying, please contact your bank to ensure there are no issues on their end before making another attempt with payment using the same credit card. If the issue is not banking-related, try another payment method or email
sedation@cdsbc.org.[/accordion]
[accordion title="I%20do%20not%20personally%20administer%20moderate%20sedation%2C%20but%20I%20have%20a%20visiting%20dentist%20provide%20this%20service.%20Do%20I%20still%20need%20to%20complete%20the%20initial%20Moderate%20Sedation%20Self-Assessment%3F"]Yes,
all registrants who own facilities that provide moderate sedation services are
required to complete the initial Moderate Sedation Self-Assessment.[/accordion]
[accordion title="My%20moderate%20sedation%20facility%20is%20co-owned%20by%20a%20number%20of%20registrants.%20Do%20we%20each%20need%20to%20complete%20a%20separate%20self-assessment%3F%20"]No,
each facility is required to submit only one initial self-assessment. All
owners of the facility should be listed in the package. [/accordion]
[accordion title="Can%20licensed%20practical%20nurses%20(LPNs)%20function%20as%20moderate%20sedation%20assistants%20or%20recovery%20supervisors%3F%20"]No, only the following may function as moderate sedation and/or recovery supervisors:
- A registered nurse (RN)
- A CDA with Dental Anesthesia Assistant National Certification (DAANCE), Oral and Maxillofacial Anesthesia Assistants Program (OMAAP), or Canadian Dental Anaesthesia Assistant Certification (CDAAC)
A dental hygienist with DAANCE, OMAAP, or CDAAC[/accordion]
[accordion title="Are%20all%20my%20staff%20required%20to%20have%20basic%20life%20support%20(BLS)%3F%20"]All clinical sedation and/or general anesthesia staff are required to have current BLS designed for healthcare professionals, and the course must contain all of the following:
- Bag-valve-mask
- Hands-on component
- Certification no longer than 24 months
CPR-Level C is not acceptable for sedation. If by chance the course you took met all of the requirements above, it is beneficial to obtain written confirmation from course provider to keep on file for record.
It is best practice for staff whose role is purely administrative to have current BLS, but not mandatory.[/accordion]
[accordion title="A%20physician%20provides%20sedation%20in%20my%20office.%20What%20documents%20will%20they%20be%20required%20to%20%20submit%3F"]Physicians
are required to submit a copy of their current Certificate of Professional
Conduct (CPC) and a copy of their current hospital privileges (or current BLS, Advanced
Cardiovascular Life Support (ACLS), and/or Pediatric Advanced Life Support (PALS),
and difficult airway course).[/accordion]
[accordion title="What%20levels%20of%20moderate%20sedation%20are%20being%20assessed%3F"]Both
enteral (oral) and parenteral (IV) moderate sedation facilities are being
assessed. [/accordion]
[/accordions]
Minimal sedation
[accordions title-color="primary-dark" color="primary" title-text-size="20px"]
[accordion title="If%20I%20provide%20only%20minimal%20sedation%20services%2C%20am%20I%20required%20to%20complete%20a%20self-assessment%3F"]No. Minimal sedation providers and minimal sedation facility owners are not required to complete a self-assessment.[/accordion]
[accordion title="How%20frequently%20am%20I%20required%20to%20renew%20my%20BLS%3F"]This depends on your course provider. If your certificate is valid for one year, annual
retraining is required. If your certificate is valid for two years, retraining every two years is permitted.[/accordion]
[accordion title="My%20office%20provides%20only%20single%20oral%20agent%20sedation%20within%20maximum%20recommended%20dosage%20(MRD)%20(e.g.%2C%20triazolam).%20Am%20I%20a%20sedation%20facility%20owner%3F"]Yes.[/accordion]
[accordion title="How%20do%20I%20register%20my%20sedation%20credentials%20for%20minimal%20sedation%3F"]
Currently,
registration is not required for minimal sedation. Registrants may provide
minimal sedation services as long as they are in full compliance with the Minimal and Moderate Sedation
Standards & Guidelines
(e.g. education, training, staff, equipment, drugs, and protocols). [/accordion]
[accordion title="How%20do%20I%20register%20my%20minimal%20sedation%20facility%3F"]
Currently,
registration for minimal sedation facility is not required. Registrants may
provide minimal sedation services as long as they are in full compliance with
the Minimal and Moderate Sedation
Standards & Guidelines. [/accordion]
[accordion title="Do%20I%20need%20to%20stock%20flumazenil%20as%20an%20emergency%20drug%3F"]Yes,
one vial of flumazenil is required if benzodiazepines are used. [/accordion]
[accordion title="I%20provide%20only%20nitrous%20oxide%20or%20a%20single%20oral%20sedative%20within%20MRD.%20Am%20I%20required%20to%20have%20BLS%3F"]Yes, all clinical sedation and/or general anesthesia staff are required to have current BLS designed for healthcare professionals, and the course must contain all of the following:
- Bag-valve-mask
- Hands-on component
- Certification no longer than 24 months
CPR-Level C is not acceptable for sedation. If by chance the course you took met all of the requirements above, it is beneficial to obtain written confirmation from course provider to keep on file for record.
It is best practice for staff whose role is purely administrative to have current BLS, but it is not mandatory.[/accordion]
[/accordions]
FAQ for dentists
[accordions title-color="primary-dark" color="primary" title-text-size="20px"]
[accordion title="If%20I%20only%20administer%20minimal%20sedation%2C%20such%20as%20Ativan%2C%20do%20I%20still%20need%20to%20register%20my%20qualifications%20with%20CDSBC%3F"]No. Any dentist who holds practising status is authorized to provide minimal sedation provided they feel competent in this modality. [/accordion]
[accordion title="If%20I%20provide%20multiple%20oral%20sedatives%20is%20this%20considered%20minimal%20or%20moderate%20sedation%3F"]This is considered moderate sedation. In order to provide moderate sedation, you must first meet the educational requirements set out in the Standards and then register with, and have your qualifications approved, by CDSBC. [/accordion]
[accordion title="Can%20my%20CDAs%20give%20medications%20to%20patients%3F"]No, CDAs cannot give medications to patients. Only dentists, physicians, or registered nurses acting under orders and direct supervision of a dentist/physician may give medications to patients. [/accordion]
[accordion title="In%20order%20to%20register%20my%20CDAs%20for%20DAANCE*%2C%20I%E2%80%99m%20required%20to%20send%20them%20a%20copy%20of%20my%20sedation%20permit.%20What%20is%20this%3F"]Your letter from CDSBC approving your qualifications is your sedation permit. [/accordion]
[/accordions]
FAQ for certified dental assistants
[accordions title-color="primary-dark" color="primary" title-text-size="20px"]
[accordion title="Can%20I%20give%20medications%20to%20patients%3F"]No, CDAs cannot give medications to patients. Only dentists, physicians, or registered nurses acting under orders and direct supervision of a dentist/physician may give medications to patients.[/accordion]
[accordion title="%20Is%20DAANCE*%20only%20available%20in%20the%20U.S.%3F"]
No. DAANCE is an online self-study course that participants work through at their own pace over a period of six months. The final exam can be taken at one of seven testing centres throughout B.C. To find out more, visit www.aaoms.org or call 1-800-822-6637.[/accordion]
[accordion title="Are%20there%20any%20alternatives%20to%20DAANCE%20for%20CDAs%20Assisting%20with%20Moderate%20Sedation%3F"]Yes. Canadian Dental Anaesthesia Assistant Course is an accepted alternative to DAANCE for CDAs assisting with moderate sedation. [/accordion]
[accordion title="The%20new%20minimal%20and%20moderate%20sedation%20document%20refers%20to%20DAANCE%20and%20OMAAP.%20What%20is%20OMAAP%3F"]OMAAP is the Oral and Maxillofacial Surgery Anesthesia Assistants Program. This program was previously offered by the American Association of Oral and Maxillofacial Surgeons and was replaced by DAANCE.[/accordion]
[/accordions]
*Dental Anesthesia Assistant National Certification Examination offered by the American Association of Oral and Maxillofacial Surgeons.
Questions?
If you have questions, please email
sedation@cdsbc.org.
