Electronic Newsletter

From the Iowa Dental Board

January 2006

Nitrous Oxide Use and Rules About Sedation

Nitrous Oxide Inhalation Analgesia

In Board rules, nitrous oxide inhalation analgesia refers to the administration by inhalation 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.  Dentists do not have to hold a permit to utilize nitrous oxide in their dental offices provided they are not allowing their patients to reach a state of conscious or deep sedation/general anesthesia.

Conscious sedation is defined in Board rules as a depressed level of consciousness produced by the administration of pharmacologic substances, that retains the patient’s ability to independently and continuously maintain an airway and respond appropriately to physical stimulation or verbal command.

Deep sedation/general anesthesia is defined in Board rules as a controlled state of unconsciousness, produced by a pharmacologic agent, accompanied by a partial or complete loss of protective reflexes, including inability to independently maintain an airway and respond purposefully to physical stimulation or verbal command.

Dentists who utilize nitrous oxide in their dental offices must have:

Dentists may delegate the administration of nitrous oxide to a dental hygienist provided:

Direct supervision means that the dentist is present in the treatment facility, but it is not required that the dentist be physically present in the treatment room.

Dentists may also delegate the monitoring of a patient under nitrous oxide inhalation analgesia to a dental hygienist or a dental assistant provided all of the following requirements are met:

Dentists are not allowed to utilize conscious sedation or deep sedation/general anesthesia in a dental office for dental patients unless the dentist possesses a current permit issued by the Iowa Dental Board.  For information concerning these permits, please call the office of the Board for information, or see IAC 650 – Chapter 29.  You can access an electronic copy of Board rules on the Board’s website, http://www.dentalboard.iowa.gov/boardrules.html. 

Dental Assistant Trainee Status

New rules concerning dental assistant trainees went into effect July 1, 2005.  Dental assistant trainees now have twelve months from the first date of employment as a dental assistant to meet the requirements of registration.  These requirements include completing examinations in infection control/hazardous materials and jurisprudence, providing evidence of current certification in CPR, and meeting educational and training requirements as required by Iowa Code and Board rules.

The Board wants to remind licensees that Board rules require dental assistant trainees to work under the personal supervision of a licensed dentist.  Personal supervision means the dentist is physically present in the treatment room to oversee and direct the services of the dental assistant.  Dental assistant trainees are not allowed to work under direct or general supervision. 

Board rules require applicants for registration to complete a minimum of six months of on-the-job training or successfully complete an accredited post-secondary dental assisting program before the Board can issue registration.  Dental assistant trainees can apply for registration after successfully completing the examination requirements, a minimum of six months of on-the-job training, and the requirements for current certification in CPR.  Dental assistant trainees who are graduates of an accredited dental assisting program can apply for registration as soon as they meet Board requirements for registration.  Board rules do not require graduates of an accredited post-secondary dental assisting program to complete a minimum of six-months under trainee status.

It is in the best interest of the dentist and the dental assistant to meet the requirements for registration and make application as early as possible.  Once registered, a dental assistant is no longer required to work under the personal supervision of a dentist.  Board rules allow registered dental assistants to work under direct supervision for intraoral functions and general supervision for extraoral duties and intraoral suctioning. 

You can find applications for dental assistant trainee status and dental assistant registration and radiography qualification, along with other applications and forms, on the Board website at http://www.dentalboard.iowa.gov/forms.html.  The Board has also provided helpful information for dental assistants at http://www.dentalboard.iowa.gov/da.html, including a list of frequently asked questions about dental assisting. 

You can find dental assistant rules in Chapter 20 of Board rules (Iowa Administrative Code 650).  Rules for dental assistant radiography qualification can be found in Chapter 22 of Board rules (Iowa Administrative Code 650).  You can access an electronic copy of Board rules on the Board website at http://www.dentalboard.iowa.gov/boardrules.html.  If you would like to order a paper-copy of Board rules, submit a written request to the Board office along with a check or money order for $15.

If you continue to have questions or concerns regarding dental assistants, do not hesitate to contact the Board office. 

Update on Dental Assistant Renewal

The renewal season for dental assistants ended September 1, 2005.  There are approximately 3,500 dental assistants currently registered on active status through June 30, 2007.  You can find a list of names of the currently registered dental assistants on the Board’s website at http://www.dentalboard.iowa.gov/da.html#List.  The Board updates these lists about once a month.  Please keep in mind that these lists do not include the names of dental assistant trainees.  If a name does not appear on the active list, it is possible that registration or reinstatement was issued after the list was last updated, or that the registration is on inactive status.  If you are unsure about the status of a dental assistant, do not hesitate to contact the Board office to verify registration or trainee status.

Dental assistant registrations that were not renewed prior to the September 1, 2005, deadline, have now lapsed and became invalid for practice effective September 1, 2005.  A dental assistant, whose registration has lapsed, is ineligible to practice dental assisting in Iowa until the Board has issued reinstatement.  Please remember that dental assistants who have previously been registered are not eligible for dental assistant trainee status.  Chapter 20 of Board rules clearly states that a dental assistant with a lapsed registration is prohibited from practicing until the Board has issued reinstatement. 

A number of dental assistants renewed their registrations on inactive status.  As a reminder, dental assistants on inactive status are ineligible to practice dental assisting until the Board has reinstated the registration to active status.

All dental assistants currently working in the state of Iowa must hold a current registration on active status or train on the job under a current dental assistant trainee status. 

All dental assistants practicing in Iowa must display in the office a certificate of registration along with a current renewal card or a verification of current trainee status.  These documents ensure that those practicing dental assisting in the state of Iowa are legal to work.  The renewal card will show the date when the registration will expire, which is June 30, 2007, for all currently registered dental assistants.

The following are brief summaries of actions taken by the Board since February 16, 2005.  The Board is providing this information in the hopes that it will educate licensees and registrants about issues the Board faces.

A licensee was charged with administering conscious sedation without a conscious sedation permit, and for administering conscious sedation to patients in a dental facility not properly equipped.  The licensee agreed, among other terms, to retake the jurisprudence examination and that he would not make application for a conscious sedation permit for a minimum of four months from the date of the order.

A licensee was charged with failure to maintain a reasonably satisfactory standard of competency in the practice of dentistry and failure to maintain records in a manner consistent with the protection of the welfare of the patient.  The licensee, who has retired from the practice of dentistry in the state of Iowa, agreed not to practice dentistry in the state of Iowa until the Board issues an order authorizing his return to practice.  The Board shall determine the terms for the licensee’s return to practice.

A licensee was charged with failure to maintain a reasonably satisfactory standard of competency in the practice of dentistry, and failure to maintain records in a manner consistent with the protection of the welfare of the patient.  The license to practice dentistry in the state of Iowa shall be placed on probation for a period of five years subject to terms and conditions listed in the order.  Within sixty days of date of the order, the licensee shall undergo a comprehensive clinical assessment by a college of dentistry prior approved by the Board.  The licensee also agrees to, among other terms, restrict his practice of endodontics and refer all endodontic work to other providers, and to complete the assessing dental school’s recommended course of study within six months of the date of the order.

A licensee was charged with failure to maintain a reasonably satisfactory standard of competency in the practice of dentistry.  The licensee agreed to place her dental license on inactive status and agreed not to practice dentistry in the state of Iowa until the Board issues an order authorizing her return to practice.  The terms for the licensee’s return to practice shall be determined by the Board.  In the event the Board issues an order authorizing the licensee’s return to practice, the order shall place the license on probation subject to additional terms and conditions deemed appropriate at that time.

A licensee was charged with violating the terms of a recovery contract that she entered into with the Iowa Practitioner Review Committee (IPRC).  As a result, license to practice dental hygiene was suspended.  The dental hygienist agreed to not apply for reinstatement until all conditions listed in the order are met.

Three registrants were charged with failure to practice dental assisting with reasonable skill and safety by reason of habitual or excessive use of drugs, narcotics, chemicals or other types of materials.  The registrants agreed, among other terms, to cease and desist from the practice of dental assisting until such time as the Board authorizes their return to practice, undergo substance abuse evaluations, actively participate in the Board’s random drug and alcohol screening program, and to notify all current and future employers where they are employed as dental assistants, of this action against their registrations. 

A licensee was charged with delegating unauthorized duties to dental assistants, and for failure to protect the health of patients by assigning personnel duties which cannot be legally delegated to them.  As a result, the license to practice dentistry in the state of Iowa has been placed on probation.  The licensee may not petition the Board for termination of the probation for a minimum of three years from the date of the order.  The licensee, as part of the order, has agreed, among other terms, to successfully pass the jurisprudence examination within thirty days of the date of the order, and must disclose to all current and future staff the contents of this order.

Two registrants were charged with performing unauthorized services.  The registrants removed supra-gingival plaque, stain, and calculus, with scalers and explorers as part of their duties.  As a result, one of the registrants was required to successfully pass the jurisprudence examination within thirty days of the date of the order.  The second dental assistant attended dental hygiene school and already successfully passed the dental hygiene jurisprudence examination. 

A licensee was charged with failure to comply with universal precautions for preventing infectious diseases as issued by the Centers for Disease Control.  The licensee agreed, among other terms, to submit a written plan detailing office protocol changes that will insure that instances of similar circumstances will not occur again, fully disclose to all current and future staff the statement of charges and stipulation and consent order, successfully pass an infection control/hazardous materials examination administered by the Board within thirty days of the date of the order, and effective thirty days from the date of the order, the licensee shall not delegate any infection control duties to his dental assistants until such time that they pass the infection control/hazardous materials examination.

Three dental assistants were charged with failure to comply with universal precautions for the preventing transmission of infectious diseases as issued by the Centers for Disease Control.  As a result, the registrants agreed to successfully pass the infection control examination within thirty days of the date of the orders.

A licensee was charged with failure to report disciplinary action taken against his dental license by another licensing authority in another state within thirty days of the final action.  The licensee agreed to comply with all requirements of the Agreed Settlement that he entered into with the Nebraska Department of Health and Human Services Regulation and Licensure, and to notify the Board of any non-compliance with the requirements of the Agreed Settlement. 

The Board also approved five requests from dentists to modify stipulation and consent agreements previously entered into with the Board, a request from a dentist to modify her reinstatement order, a request for continuance in the matter concerning a dentist and the charges previously brought against her, and five orders to remove dentists from probationary status.