STATE OF WISCONSIN
Dentistry Examining Board
IN THE MATTER OF RULEMAKING
PROCEEDINGS BEFORE THE
DENTISTRY EXAMINING BOARD
ORDER OF THE
DENTISTRY EXAMINING BOARD
ADOPTING RULES
CLEARINGHOUSE RULE 15-056
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ORDER
An order of the Dentistry Examining Board to amend DE 3.03 (1) and 11.03 (1) and to create Chapter
DE 15
relating to certificate for dental hygienists to administer nitrous oxide inhalation analgesia.
Analysis prepared by the Department of Safety and Professional Services.
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ANALYSIS
Statutes interpreted:
Statutory authority:
Explanation of agency authority:
Section
15.08
(5)
(b)
, Stats.
Each examining board shall promulgate rules for its own guidance and for the guidance of the trade or profession to which it pertains, and define and enforce professional conduct and unethical practices not inconsistent with the law relating to the particular trade or
profession
Section
227.11 (2) (a)
, Stats., provides that “[e]ach agency may promulgate rules interpreting the provisions of any statute enforced or administered by the agency, if the
agency considers it necessary to effectuate the purpose of the statute, but a rule is not valid if the rule exceeds the bounds of correct interpretation.”
Section
447.02 (2) (j)
, Stats. The examining board shall promulgate rules specifying, “[t]
he educational requirements for a dental hygienist licensed under this chapter to administer nitrous oxide inhalation analgesia under s.
447.06 (2) (e) 4.
”
Related statute or rule:
Plain language analysis:
2013 Wisconsin Act 354
required the Dentistry Examining Board to grant a certificate to administer nitrous oxide inhalation analgesia to a dental hygienist who is licensed by the Board and who satisfies certain educational requirements that the Act directs the Board to establish by rule. Under
2013 Wisconsin Act 354
, the certificate to administer nitrous oxide inhalation analgesia remains in effect while the dental hygienist holds a valid license to practice dental hygiene in Wisconsin, unless the Dentistry Examining Board suspends or revokes the certificate. The proposed rule implements
2013 Wisconsin Act 354
by establishing the requirements for the certificate.
Summary of, and comparison with, existing or proposed federal regulation:
None.
Comparison with rules in adjacent states:
Illinois
: Dental hygienists may administer and monitor nitrous oxide provided they complete a 14 hour course relative to nitrous oxide analgesia and submit certification of completion of the required course to the supervising dentist. An individual who graduated from an approved dental hygiene program after January 1, 1998 that contained nitrous oxide analgesia administration and monitoring shall not be required to complete the 14 hour course upon proof to the dentist of the required curriculum. The dental hygienist must maintain BLS certification or its equivalent in addition to the required courses (Ill. Admin. Code tit. 68 pt. 1220).
Iowa
: A dental hygienist may administer nitrous oxide inhalation analgesia provided the administration of nitrous oxide inhalation analgesia has been delegated by a dentist and the hygienist has completed a board approved course of training (Iowa Admin. Code r. 650- 29.6 (4)).
Michigan
:
A dentist may delegate administering nitrous oxide analgesia to a registered dental hygienist under direct supervision to a patient 18 years of age or older if the dental hygienist has met all of the following: (1) Successfully completed an approved course in the administration of nitrous oxide analgesia including content in n
itrous oxide analgesia
medical emergency techniques
, p
harmacology of nitrous oxide
, n
itrous oxide techniques
, and i
f such a course is available, selection of pain control modalities
. The course must consist of a minimum of 4 hours didactic instruction and 4 hours of clinical experience; (2) Successfully completed a state or regional board administered written examination in local anesthesia within 18 months of completion of the approved course; (3) Successfully completed a state or regional board administered written examination on nitrous oxide analgesia, within 18 months of completion of the approved course; and (4) Maintains and provides evidence of current certification in basic or advanced cardiac life support. A dental hygienist shall not administer more than 50% nitrous oxide (Mich. Admin. Code r. 338.11410 and MCL 333.16611 (4)).
Minnesota
:
A dental hygienist may administer nitrous oxide inhalation analgesia in accordance with all of the following: (1) Completion of CPR training and current CPR certification; (2) Usage of only use fail-safe anesthesia equipment capable of positive pressure respiration; (3) Successful completion of a course on the administration of nitrous oxide inhalation analgesia from an institution accredited by the Commission on Dental Accreditation. The course must be a minimum of 12 hours comprised of didactic instruction, personally administering and managing at least three individual supervised cases of analgesia, and supervised clinical experience using fail-safe anesthesia equipment capable of positive pressure respiration; (4) Under the appropriate level of supervision by a dentist who is current with the requirements to administer nitrous oxide inhalation analgesia (Minn. Admin. Code 3100.3600 subp. 4.).
Summary of factual data and analytical methodologies:
This rule implements
2013 Wisconsin Act 354
. Numerous other states’ requirements were reviewed and considered while drafting these rules.
Analysis and supporting documents used to determine effect on small business or in preparation of economic impact
analysis
:
The rule was posted for public comment on the economic impact of the proposed rule, including how this proposed rule may affect businesses, local government units, and individuals, for a period of 14 days. No comments were received.
Fiscal Estimate and Economic Impact Analysis:
The Fiscal Estimate and Economic Impact Analysis document is attached.
Effect on small business
:
These proposed rules do not have an economic impact on small businesses, as defined in s.
227.114 (1)
, Stats. The Department’s Regulatory Review Coordinator may be contacted by email at
Eric.Esser@wisconsin.gov
, or by calling (608) 267-2435.
Agency contact person
:
Sharon Henes
,
Administrative Rules Coordinator
,
Department of Safety and Professional Services
, Division of
Policy Development
, 1400 East Washington Avenue, Room 151, P.O. Box
8366
, Madison, Wisconsin 53708; telephone
(608) 261-2377
; email at
Sharon.Henes@wisconsin.gov
.
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TEXT OF RULE
Section 1.
DE 3.03 (1)
is amended to read:
DE 3.03 (1)
Administer or prescribe, either narcotic or analgesics or systemic-affecting no
nnarcotic drugs, or anesthetics
except as provided under ch.
DE 15
.
Section 2.
DE 11.03 (1) is amended to read:
DE 11.03 (1)
A dentist
or a dental hygienist who holds a valid certificate under ch.
DE 15
may use nitrous oxide inhalation on an outpatient basis for dental patients provided that he or she
has
utilizes
adequate equipment with failsafe features and a 25% minimum oxygen flow.
Section 3.
Chapter
DE 15
is created to read:
CERTIFICATION OF DENTAL HYGIENISTS TO ADMINISTER NITROUS OXIDE INHALATION ANALGESIA
DE 15.02 Definitions.
In this chapter:
(1)
“Accredited” has the meaning given in s.
447.01 (1)
, Stats.
(2)
“ADA CERP” means american dental association continuing education recognition program.
(3)
“AGD PACE” means academy of general dentistry program approval for continuing education.
DE 15.03 Qualifications for certification of licensed dental hygienists to administer nitrous oxide inhalation analgesia.
The board shall grant certification to administer nitrous oxide inhalation analgesia to an applicant who satisfies all of the following conditions:
(1)
The applicant holds a valid
license to practice as a dental hygienist in this state.
(2
)
The applicant has
completed the educational requirements of s.
DE 15.05
.
(3
)
The applicant has
submitted the information re
quired in the application under
s.
DE 15.04
.
DE 15.04
Application procedure.
An applicant for a certificate to administer
nitrous oxide inhalation analgesia
shall file a completed application on a form provided by the board. The application shall include all of the following:
(1)
The dental hygienist license number in this state and the signature of the applicant.
(2
)
Evidence of successful completion of a didactic and clinical
certification program
, resulting in the dental hygienist becoming competent to administer nitrous oxide inhalation analgesia under the delegation and supervision of a dentist, the curriculum of which meets or exceeds the basic course requirements set forth in s.
DE 15.05
.
DE 15.05 Educational requirements.
The board shall grant certification to administer nitrous oxide inhalation analgesia to a licensed hygienist who completes a certification program that meets all of the following:
(1)
The certification program
in the administration of nitrous oxide inhala
tion analgesia shall be sponsored
by an accredited dental or dental hygiene school
or be an approved ADA CERP or AGD PACE provider
.
(2
)
The nitrous oxide inhalation analgesia administration
certification program shall provide a minimum of 8
hours of instruction
and shall consist of all of the following
:
(a) Didactic instruction including all of the following:
1. Legal aspects of n
itrous oxide inhalation analgesia administration in Wisconsin.
2. Physiological and psychological aspects of anxiety.
3. Stages of consciousness and the levels of sedation.
4. Respiratory and circulatory physiology and related anatomy.
5. Pharmacology of nitrous oxide.
6. Advantages and disadvantages as well as the indications and contraindications for
n
itrous oxide inhalation analgesia administration
.
7. Patient evaluation, selection, and preparation for
n
itrous oxide inhalation analgesia administration
.
8. The function of the basic components of
n
itrous oxide inhalation analgesia
delivery and scavenging systems including all of the following:
a
.
Inspecting all components of the
n
itrous oxide inhalation analgesia delivery equipment.
b. Assembling and disassembling components.
c. Operating n
itrous oxide inhalation analgesia
equipment.
d. Disinfecting and sterilizing
n
itrous oxide inhalation analgesia
equipment.
9. Safe and effective administration of
n
itrous oxide inhalation analgesia
to patients in a clinical setting including all of the following:
a. Determining the patient’s ideal flow rate and tidal volume.
b. Performing titration to effect.
c. Determining the ideal percentage of n
itrous oxide flow rate for individual patients.
d. Calculating the percentage of
n
itrous oxide at peak flow.
10. Monitoring and documenting a patient undergoing
n
itrous oxide inhalation analgesia
.
11. Complications associated with
n
itrous oxide inhalation analgesia
administration and the prevention, recognition, and management of associated medical emergencies.
12. Troubleshooting problems with
n
itrous oxide inhalation analgesia
administration.
13. Potential health hazards associated with
n
itrous oxide inhalation analgesia administration
.
(b) Clinical experience consisting of three inductions of
n
itrous oxide in
halation analgesia on another person under supervision of the instructor.
(3)
The certification program shall have a
dentist licensed under ch.
447
, Stats., present in the facility and available to both the patients and to the students of the class.
(4)
The certification program shall include a final assessment of competency of the didactic and clinical components of the program.
DE 15.06 Dentist responsibility for the administration of
nitrous oxide inhalation analgesia
.
A dental hygienist may administer nitrous oxide inhalation analgesia only if all of the following requirements are met:
(1)
The nitrous oxide inhalation analgesia is administered pursuant to a treatment plan approved by the dentist.
(2)
The dentist remains on the premises.
(3)
The dentist is available to the patient throughout the completion of the appointment.
Section 4.
EFFECTIVE DATE.
The rules adopted in this order shall take effect on the first day of the month following publication in the
Wisconsin
administrative register, pursuant to s.
227.22 (2) (intro.)
, Stats.
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(END OF TEXT OF RULE)
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