• Wednesday, March 12th, 2014

Dental marketing for sedation dentistrySedation Dentistry: Legal Guidelines

John Bitting, Esq, is legal counsel for DOCS Education. Here, he answers this sedation dentistry question: “Can you give us a brief overview of the oral and IV sedation regulations in the US?”

John begins by explaining his professional role. “I am DOCS’ regulatory counsel, which means I help our members and the attendees of our courses comply with the regulations – the sedation regulations and advertising for that matter – of each of their states, because every state is different. I like to say that the sedation regulations anyway, advertising too – they’re like snowflakes. Every state is different, and that’s what I do for DOCS.

“I can imagine there’s an awful lot of information in your head,” says Julie Frey. “Let’s see if we can get some of it out right now. Can you give us a brief overview of the oral sedation regulations in the US?”

“I sure can,” John replies. “If I could make it brief, I would, but like I said, every state is different. Whereas with general anesthesia and intravenous sedation, where dental regulations are more or less uniform throughout the United States, the state-by-state requirements for oral sedation are that every state is different. Like I said, they’re like snowflakes. The majority of US states now require some combination of formal training and standard of care equipment, plus a permit issued by the state dental board, before dentists can provide oral sedation dentistry to their patients.

“For instance, these regulated states may require anywhere between zero and 75 hours of training for minimal and moderate oral sedation. Some of these states may also require certification and advanced cardiac life support or ACLS or even pediatric events life support, which is known by the moniker PALS. Every state requires a dentist to be certified in basic life support or BLS, which is CPR for healthcare providers, and is a requirement for licensure already.

“And every one of these regulated states requires some modicum of standard of care monitoring and emergency equipment for sedation. Many of the states have linked their dental sedation requirements to the recommendations of the American Dental Association, Anesthesia Sedation Guidelines. Those are revised from time to time, and the most recent version of the guidelines was released in October of 2007 after a great deal of input from interested stakeholders. And those ADA guidelines recommend special training for minimal and moderate sedation ranging anywhere from 16 hours for minimal sedation to 24 hours for moderate oral sedation and – I’ll get into this a little bit later – 60 hours for intravenous moderate sedation.

“This would be didactic construction, like I said IV sedation also has—we’ll talk about that later as a clinical requirement that goes beyond the 60 hours of didactic. A little overview there. I could go state by state, but we would be here all night.”

“Okay, well let’s move on to IV sedation then,” says Julie. “Can you give us a brief overview of the IV sedation regulations in the US?”

John replies, “IV sedation is much more uniform regulation across the country. Most states – in fact, I can’t think of any that don’t – so every state requires at least a 60-hour intravenous sedation didactic course plus 20 clinical patient experiences. This was culled from the ADA sedation dentistry guidelines that I referred to earlier. And most of the states also require advance cardiac life support.

“Answering the intravenous question is much easier than the oral sedation one, but the oral sedation—some states have no regulations, and some states have very minimal regulations. Others have heavier regulations, and others require an intravenous sedation permit in order to do oral sedation of any kind, but those are very few and far between.”

John Bitting, Esq., is legal counsel for DOCS Education. He is an expert on legal issues surrounding sedation dentistry and dental marketing. Learn more at

Let us know what you think! Leave a response...

2 Responses

  1. Just to remind: if I am not mistaking ,the dentists in the USA had been considered by the general public as the health-care professionals. As such they have to obey the first law of Medicine: “Prima non nocere” – First of all do not do the harm. ( The Hypocratis oath).
    In order to keep up with that law, they need to have their heart in the right place, to be professionally ethical, be properly trained and maintain their level of expertise by continuous diligent education.( The Rambam’s oath).
    “Oral sedation” is not a gimmick, and should not be used as the marketing/advertising tool to attract new clients (the term patients is not suitable in this case). Unfortunately commercialism, business mentality, etc. took over the Health-care profession.
    For all the problems in the current system the providers should blame themselves.

  2. 2

    Oral sedation is not a gimmick, it is just one of the tools in the arsenal of qualified professional to help apprehensive patients. Like all other tools, techniques and means of helping the patients( Implants, FM recons, TMJ problems etc.) it should not be used for marketing/advertising. Instead, why not the health care professionals start advertising their adherence to the First Law of Medicine : “Primum non nocere” – First of all do no harm(Hypocrates). Turning the Health care into the business, commercializing doctors service to their patients, getting the 3-rd parties( insurance companies, lawyers, advertising and governmental agencies) involved a the middlemen between the doctors and the patients created all the problems, that lead to the current Obamacare. Surprised?!

Leave a Reply