Rule XIV.  Utilization of Anesthesia/Sedation
(Amended February 1, 1998, August 1, 2000; August 11, 2004; 
October 27, 2004; October 26, 2006)

This Rule specifically applies to each dentist (supervising dentist) utilizing general anesthesia, deep 
sedation, and conscious sedation under the statutory authority of the Dental Practice Law (C.R.S. 12-35-101 et seq).

A. “Induction and Administration” as those terms are used in Rule XIV, shall include any procedure or medication administered prior to attaining the proper level of anesthesia/sedation as determined by the supervising dentist.  All induction and administration procedures shall be the responsibility of the supervising dentist and shall not be delegated except to another dentist whose qualifications meet the education and training requirements of Rule XIV for the anesthesia to be administered, a qualified physician anesthesiologist, or a certified registered nurse anesthetist.  Induction and administration of anesthesia shall include, but not be limited to the following procedures:

1. Determination of the drugs, mode of administration, and dosage of the   
    anesthesia/sedation appropriate for the patient;

2. Observation of the patient until the appropriate and safe level of anesthesia/sedation 
    is attained.

B. 	“Monitoring”

		1.  “Monitoring” as used in Rule XIV refers to the continual observation of the 
           patient to ensure a stable physical condition of the patient and maintenance of a
           proper level of anesthesia or sedation as determined by the supervising dentist 
           during induction, maintenance, and recovery from the anesthesia/sedation
           procedure.

2. Monitoring of the patient during an anesthesia/sedation procedure may be delegated  
    under direct supervision to a dental hygienist or dental assistant; however, the 
    supervising dentist retains full accountability for the monitoring and dismissal of the 
    patient following completion of the anesthesia/sedation procedure.  Patient dismissal 
    must be specifically authorized by the supervising dentist.

C.	Any dentist administering parenteral or enteral conscious sedation pursuant to Rule XIV shall 
submit proof of current basic life support (BLS) knowledge and skills, including cardiopulmonary resuscitation (CPR).  Any dentist administering general anesthesia and/or deep sedation shall submit proof of current BLS and Advanced Cardiac Life Support certification.

D.	All personnel, including, but not limited to, dental hygienists and dental assistants, who render 
      	patient care services in a dental setting where anesthesia/sedation is administered shall have proof of current basic life support (BLS) knowledge and skills.

E.	All equipment, as provided for in this Rule XIV, subsections H.9 shall be functional and operative at 
	all times.

F.	Morbidity and Mortality Report ‑ A completed written report shall be submitted to the Board by the 
supervising dentist and any other person administering the anesthesia/sedation within fifteen (15) days of any anesthesia/sedation related incident resulting in patient morbidity or mortality which occurred while the patient was under the care of the dentist, and/or required or should have required hospitalization, emergency facility care, or emergency service response.

1.  Such report shall include all of the following items: 

a. 	Description of dental procedure;
b.	Description of preoperative physical condition of the patient; 
c.	List of the drugs and dosages administered with the time and route of each       
            	administration;
d.	Detailed description of techniques utilized in administering the drugs;
e.	Description of adverse occurrence to include:

1)	Detailed description of symptoms of any complications including, but not limited to, onset and type of symptoms in patient;
2)	Treatment instituted on patient; and,
3)	Response of the patient to treatment.

f.	Description of the patient's condition on termination of any procedure 
           	undertaken.

2.	All written records related to this incident shall be submitted to the Board with the 
report.

    3.	Pursuant to section 12‑35‑107(1)(d), C.R.S., the Board may request an on‑site 
evaluation of the dental facility related to this report.

G.	Prior to the induction and administration of anesthesia/sedation as provided for in this Rule XIV, a 
dentist licensed pursuant to the Colorado Dental Practice Law shall certify to the Board, on a form approved by the Board, compliance with all applicable requirements as specified in Rule XIV.  Required courses may be completed in an accredited dental school or in an advanced training program as approved by the Board.

H.	General anesthesia and/or deep sedation

1.	“General Anesthesia” is an induced state of unconsciousness accompanied by a partial 
or complete loss of protective reflexes, including the ability to maintain an airway independently and respond purposefully to physical stimulation or verbal command and is produced by a pharmacologic or non‑pharmacologic method or combination thereof.

2.	Deep sedation is an induced state of depressed consciousness accompanied by a 
partial loss of protective reflexes, including the occasional inability to independently maintain a patent airway and/or respond purposefully to verbal commands, and is produced by a pharmacologic or non‑pharmacologic method or combination thereof.

3.	Education/Training Requirements:  Prior to induction and administration of general 
anesthesia and/or deep sedation, a Colorado licensed dentist shall meet one of the following education/training requirements:

a.	Proof of successful completion of a residency program in general anesthesia of 
not less than two (2) calendar years that is approved by the Board of Directors of the American Dental Society of Anesthesiology for eligibility for the Fellowship in General Anesthesia; or

b.	Proof of successful completion of an accepted post-doctoral training program 
(e.g., oral and maxillofacial surgery) which affords comprehensive and appropriate training necessary to administer and manage general anesthesia and deep sedation commensurate with the American Dental Association Guidelines for teaching the comprehensive control of anxiety and pain in dentistry.

4.	The Board shall approve the authority to administer general anesthesia and/or deep sedation 
upon the Board’s finding that the applicant meets the requirements set forth in H.3.  
The permit shall be valid for a period of five (5) years after which it may be renewed subsequent to reapplication and completion of an anesthesia inspection as provided in Rule XV.

     5.	Examination:  Prior to administration of general anesthesia and/or deep sedation, a supervising 
dentist shall record the following information in the patient's chart:

a.	The patient's vital signs; and,

b.	The patient's pertinent medical history, pertinent physical findings and weight.

6.	Documentation:  The supervising dentist shall ensure that the dental treatment, the anesthesia 
treatment, and the patient's response to such treatment shall be recorded in the patient's record. The record shall include:

a.	A written and current medical history that is signed by the supervising 
dentist, and patient or guardian;

b.	A written examination chart that includes preoperative physical assessment 
performed by the practitioner administering the anesthesia with the proposed dental and anesthesia procedures clearly indicated and potential complications written on the records;

c.	A consent form signed by the patient or the patient's guardian for any 
anesthesia and for treatment;

d.	A fully documented record of each administered anesthesia, including a time-
lined record of vital signs, drugs and dosages, routes of administration, response to anesthesia and any complication or adverse reaction;

e.	Discharge criteria, condition on discharge, vital signs, and time of discharge; and,

f.	All prescriptions ordered.

7.	Monitoring.  The patient must be continually monitored through the procedure and recovery to 
the full extent as defined in Section B. above.

8.	Emergency Care:  Prior to the administration of general anesthesia and/or deep sedation, the 
supervising dentist and treatment team (dental hygienists and/or assistants) shall have appropriate knowledge and training to recognize the symptoms and reasonably treat the complications and emergencies incident thereto.

9.	Office Facilities and Equipment:  The supervising dentist shall submit an anesthesia inspection 
report in compliance with Rule XV, which must be approved by the Board prior to administering general anesthesia and/or deep sedation to a patient, and provide the following office facilities and equipment:

a.	An operating room; 

b.	An operating chair or table; 

c.	Back‑up suction equipment with fail-safe mechanism in the event of power loss;

d.	A back‑up lighting system, which provides light intensity adequate to permit completion   
      of any dental procedure in progress;

	e.	Oxygen and gas‑delivery systems, which shall include:

1)	Capability to deliver oxygen to a patient under positive pressure, including a 
back‑up oxygen system;

2)	Gas outlets that meet related state or federal standards that prevent 
accidental administration of inappropriate gases or gas mixture; 

3)	Fail‑safe mechanisms for inhalation of nitrous oxide analgesia; and,

4)	The equipment must have an appropriate scavenging system.

f.	A sterilization area;

g.	A recovery area, which shall include installed oxygen and suction systems or the 
capability to operate portable oxygen and suction systems;

h.	Gas storage facilities, which meet related state or federal standards;

i.	Emergency airway equipment and facilities, which shall include:

1)	A full-face mask and an ambu bag or equivalent with an oxygen hook-up;

2)	Oral and nasopharyngeal airways;

3)	Endotracheal tubes suitable for children and adults;

4)	A laryngoscope with reserve batteries and bulbs;

5)	Endotracheal tube forceps;

6)	Emergency drugs and or medications;

7)	An IV catheter with continuous drip; and,

8)	External defibrillator for general anesthesia.

j.	Equipment to monitor vital signs and assure an adequate airway, which shall include, 
but not be limited to:

1)	A pulse oximeter;

2)	A blood pressure cuff of appropriate size and stethoscope; or equivalent blood 
                                    	pressure monitoring devices; and,

3)	Electrocardiograph for general anesthesia.

10.	Personnel

a.	A minimum of 3 individuals must be present during the administration of general 
anesthesia and/or deep sedation.

b.	Those three individuals shall include the supervising dentist qualified to administer 
anesthesia and two individuals, at least one of whom is trained in patient monitoring.

11.	Discharge

a.	The professional administering the anesthesia/ or sedation must determine that the patient 
has met discharge criteria prior to the patient leaving the office.

I.  Parenteral Conscious Sedation

1.	Conscious sedation is a minimally depressed level of consciousness that retains the patient's 
ability to maintain a patent airway independently and continuously and respond appropriately to physical stimulation or verbal command and that is produced by a pharmacologic or non‑pharmacologic method or a combination thereof.

2.	Education/Training Requirements:  Prior to induction and administration of parenteral 
	conscious sedation, a Colorado licensed dentist shall meet one of the following education/training requirements:

a.	Completion of the education/training requirements specified under “General Anesthesia”, 
      subsection H.3.a. or H.3.b.; or

b.	Proof of successful completion of a specialty residency or general practice residency 
   	recognized by the Commission on Dental Accreditation that includes comprehensive 
      and appropriate training to administer and manage parenteral conscious sedation; or

c.	Proof of successful completion of a minimum of sixty (60) course hours within the past five (5) years that provides training in the administration and induction of parenteral conscious 
      sedation techniques and the potential problems and emergencies associated with such 
      administration, as well as documentation of twenty (20) treatment cases, which shall be   
      submitted to the Board for approval, as follows:

1).	The applicant must first provide an application with documentation of the training 
course(s) to include, but not limited to, a syllabus or course outline of the program and a certificate or other documentation from course sponsors or instructors indicating the number of course hours, content of such courses and date of successful completion.  

		A).	The course must consist of thirty (30) hours of classroom instruction as well as thirty (30) hours of supervised clinical training in parenteral conscious sedation.

                         	B).	   Course content leading to Basic Life Support and/or Advanced Cardiac Life     
              Support cannot be considered as part of the classroom and clinical    
              instruction.

		C).     All of the training course(s) must have been completed in the past five (5) 
                years.

2).	Upon Board approval of the training program, the applicant shall then submit
		documentation of twenty (20) treatment cases for Board approval, as follows.

	     A).	   Cases completed in the training program by the applicant as the provider of 
      			   conscious sedation may be submitted to the Board to meet the requirement     
               for part or all of twenty (20) treatment cases.

B).    At least ten (10) of the treatment cases must be under the on-site instruction 
        And supervision of a person qualified to administer parenteral conscious  
        sedation.

C).   The applicant must be the provider of parenteral conscious sedation in at least 
  ten (10) of the cases.

      D).  	 Cases must meet generally accepted standards for the provision of parenteral  
  conscious sedation and documentation.

E).  Cases must be completed by the licensee either within the course cited in 
       Rule XIV, subsection I.2.c.1. or during the one (1) year period immediately 
       after completion of the course.

       F).  If any of the required treatment cases are conducted in a Colorado dental 
	 office, the applicant must meet the following provisions:

i.  Prior to any parenteral conscious sedation services being provided in a   Colorado office or facility, the office or facility must first be inspected and the inspection approved by the Board as provided in Rule XV.

ii.  The first five (5) cases (or up to ten (10) cases if fewer than ten (10) cases were done in the training program) must be provided under the on-site instruction and supervision of a person qualified to administer parenteral conscious sedation.  The applicant shall submit the cases to the Board for approval.  

d.	The Board shall certify the authority to administer parenteral conscious sedation upon its determination that the applicant has met the requirements found in I. 2. a., b., or c., above, and Rule XV.  The permit shall be valid for a period of five (5) years after which it may be renewed subsequent to reapplication and completion of an anesthesia inspection as provided in Rule XV.

3.	Examination:  Prior to the administration of parenteral conscious sedation anesthesia, the 
dentist shall record all information in the patient's chart as specified under “General Anesthesia”, subsection H.5.a. and H.5.b.

4.	Documentation:  The dentist shall record in the patient's chart the treatment given and the 
patient's response to the treatment. The record shall include all information as provided for under ”General Anesthesia or Deep Sedation,” subsection H.6.

5.	Emergency Care:  Prior to the administration of conscious sedation anesthesia, the supervising 
dentist, dental hygienist, and assistants shall have appropriate training to recognize the symptoms and reasonably treat the complications and emergencies incident thereto.

6.	Office Facilities and Equipment:  Prior to administering conscious sedation anesthesia to a 
patient, the supervising dentist shall provide all office facilities and equipment as specified under “General Anesthesia or Deep Sedation”, subsection H.9., excepting the external defibrillator.

7.	Personnel:  During administration of parenteral conscious sedation, the dentist and at least 
one other individual must be present.

8.	Nitrous oxide analgesia may be used in conjunction with parenteral conscious sedation 
provided that:

a.	All requirements of Rule XVII have been met; and,

	b.	The level of sedation does not exceed conscious sedation.

J.  Enteral conscious sedation

1.	Enteral conscious sedation is a controlled state of depressed consciousness that retains the 
patient’s ability to maintain a patent airway independently and continuously and to respond appropriately to physical stimulation and verbal command and is produced by a pharmacologic or non-pharmacologic method or a combination thereof which is administered by way of the gastro-intestinal tract (i.e. oral, rectal and/or sublingual routes).  Oral premedication prescribed/administered for the relief of anxiety and apprehension does not fall within these provisions. However, if the agents/medications are given in dosages such that the patient is placed in a state of conscious sedation then the dentist must have met the requirements and be approved pursuant to this Rule XIV.

2.	Educational/Professional Requirements.  Prior to the use of enteral conscious sedation, a 
	Colorado licensed dentist shall meet one of the following education/training requirements:

a.	Completion of the education/training requirements specified under “General Anesthesia”, 
subsection H.3.a. or H.3.b.; or

b.  Completion of the education/training requirements specified under “Parenteral Conscious
     Sedation” subsection I.2.a., I.2.b., or I.2.c; or

c.	Proof of successful completion of a Commission on Dental Accreditation accredited post-
doctoral training program which affords comprehensive and appropriate training necessary to administer and manage enteral conscious sedation as determined by the Board, with documented administration of enteral conscious sedation in a minimum of five (5) such cases.  The cases shall be completed as a component of the course, under the on-site instruction of a person qualified to administer conscious sedation, and are subject to Board approval; or

d.	Proof of successful completion of a course consistent with those described in Parts II and III 
of the American Dental Association (ADA) Guidelines for Teaching the Comprehensive Control of Pain and Anxiety in Dentistry, within the past five (5) years, that provides training in the use of enteral conscious sedation techniques and the potential problems and emergencies associated with such administration with documented administration of enteral conscious sedation in a minimum of five (5) such cases.  The cases shall be completed as a component of the course or completed after the course, under the on-site instruction and supervision of a person qualified to administer enteral conscious sedation.  All cases are subject to Board approval.  The applicant shall submit documentation of the five (5) cases completed as a component of the training course or completed after the course for approval by the Board.  Cases must meet generally accepted standards for the provision of enteral conscious sedation and documentation.

3.	Examination:  Prior to the administration of enteral conscious sedation, the dentist shall record all 
information in the patient’s chart as provided for under “General Anesthesia,” subsection H.5.a. and H.5.b.

4.	Documentation:  The dentist shall record, in the patient's chart, the treatment given and the 
patient's response to the treatment. The record shall include all information as provided for under ”General Anesthesia and/or Deep Sedation,” subsection H.6.

5.	Emergency Care:  Prior to the administration of enteral conscious sedation anesthesia, the 
supervising dentist, dental hygienists, and assistants shall have appropriate training to recognize the symptoms and reasonably treat any complications and emergencies incident thereto.

6.	Office Facilities and Equipment:  Prior to administering enteral conscious sedation anesthesia 
to a patient, the supervising dentist shall provide all office facilities and equipment as specified under “General Anesthesia and/or Deep Sedation”, subsection H.9., excepting the external defibrillator.   An IV catheter with continuous drip is not required but must be available for use in case emergency care is required.

7. 	Personnel:  During administration of enteral conscious sedation, the supervising dentist and at 
least one other individual must be present.

8.	Prior to any enteral conscious sedation services being provided in a Colorado office or facility, 
the office or facility must first be inspected and the inspection approved by the Board as set forth in Rule XV.

9.	The Board shall certify the authority to administer enteral conscious sedation upon its 
determination that the applicant has met the requirements found in J.2. and Rule XV.  The permit shall be valid for a period of five (5) years after which it may be renewed subsequent to reapplication and completion of an anesthesia inspection as set forth in Rule XV.

10.	Nitrous oxide analgesia may be used in conjunction with enteral conscious sedation provided   that: 

	a.	All requirements of Rule XVII have been met; and,

		b.	The level of sedation does not exceed conscious sedation.

K.	Upon reasonable cause, including an incident of patient morbidity or mortality, and/or for any violation or non-compliance with this Rule, the Board may temporarily suspend or revoke the permit granted by the Board to administer anesthesia.  Upon a specific finding of violation of this Rule, as set forth in section 12-35-129 (1), C.R.S., the Board may order that a suspension or revocation of permit be permanent.

L.	Current Experience.  It is required that the supervising dentist maintain competency and recent experience.  If a supervising dentist has not regularly provided general anesthesia or conscious sedation services within the three (3) years prior to certificate renewal, the dentist must provide evidence to the Board of competency in these procedures.  The Board may in turn require additional training or supervision and/or deny issuance of a permit until competency is demonstrated.

M.   A dentist with general anesthesia/deep sedation authority may also administer conscious sedation (enteral or parenteral and nitrous oxide sedation).  A dentist with parenteral sedation authority may also administer enteral conscious sedation and nitrous oxide sedation in accordance with Rule XIV  I., but may not administer general anesthesia, or deep sedation.  A dentist with enteral conscious sedation authority may utilize nitrous oxide sedation in accordance with Rule XIV J., but may not administer general anesthesia, deep sedation or parenteral conscious sedation.

N.	A dentist utilizing a combination of more than one anxiolytic or sedation agents for a patient encounter (e.g. titrating oral anxiolytic agents or utilizing an oral anxiolytic agent, plus nitrous oxide) must hold at least enteral sedation authority.

O.	Practitioners utilizing anesthesia/sedation without approval, with an expired approval, without a permit or with an expired permit may be censured and/or disciplined under section 12-35-129(1), C.R.S.

Rule XV.  Anesthesia Inspection
(In Compliance With HB 95-1060)
(Amended February 1, 1998, May 15, 1998; August 11, 2004; October 26, 2006)

This Rule does not apply if the dentist is not the person administering general anesthesia and/or conscious/deep sedation.
		
A.   All dentists qualified by training and education to administer general anesthesia and/or
conscious/deep sedation must undergo a facility anesthesia inspection and a practitioner/team anesthesia inspection as described in this Rule XV to obtain a permit to perform such services in Colorado. Board approval of training and education is required prior to obtaining an anesthesia inspection.  

B.	The permit shall be effective for five (5) years and expire at the end of the month of the date of the       
inspection.  There shall be a sixty (60) day grace period from the date of the end of the expiration
month to comply with this Rule.

C.	Dentists who receive a permit pursuant to this Rule XV and travel to other office locations to administer anesthesia and dentists who engage the services of another properly licensed and certified individual to provide anesthesia/sedation services shall be responsible for ensuring that the office location has equipment required by Rule XIV and that the staff is properly trained to handle anesthesia related emergencies.

D.	The dentist requiring the anesthesia inspection is responsible for all fees associated with the 
	inspection.

E.	The fee for the anesthesia inspection shall not exceed $400.00.  In addition to the $400.00, the 
inspector may charge and be reimbursed for reasonable out-of-pocket expenses for travel, meals,
and lodging.

F.	The anesthesia inspection shall consist of four (4) parts:

Part I - Review of the office equipment, records, and emergency medications required by Rule XIV.

Part II - Simulated emergencies -The dentist and his/her team must perform an actual demonstration of their method for managing the following emergencies:

Laryngospasm
Bronchospasm
Emesis & Aspiration of Vomitus
Foreign Bodies in the Airway 
Angina Pectoris 
Myocardial Infarction
Cardiopulmonary Resuscitation
Hypotension
Hypertensive Crisis
Allergic Reaction
Seizure
Hypoglycemia
Asthma
Respiratory Depression
Local Anesthesia Allergy or Overdose.
Hyperventilation Syndrome
Convulsion of Unknown Etiology

The simulated emergency procedures are to be demonstrated in the surgery area with full 
participation of the office staff.  An exact simulation of the emergency situation should be demonstrated.  The type of emergencies selected by examiners should be based on the emergencies likely to be seen in the type of practice in which the dentist is engaged.  The “patient” should be positioned and draped, and all equipment that may be used should be demonstrated.  A simulated intravenous line should be taped into position and all emergency equipment should be present, including syringes, medications, etc.

The inspector shall review with the dentist and his/her office staff a minimum of eight (8) of the 
previously listed simulated emergencies and cardiopulmonary resuscitation must be one of the eight (8) simulated emergencies.  The dentist and his/her office staff must be proficient in all eight (8) of the simulated emergencies.  

If the dentist is not considered by the inspector to be proficient in all eight (8) simulated emergencies this shall be immediately reported to the Board for immediate action, including but not limited to loss of privilege to administer anesthesia or sedation.   

Part III - Discussion Period - This part of the evaluation should be conducted in private away from
the staff and patients.  The inspector may note deficiencies and make positive suggestions to the dentist for improving the office facility and patient management.  It is appropriate to discuss management of risk patients if this has not been covered during the earlier phase.

Part IV - Surgical/Anesthetic Techniques - The inspector shall observe at least one (1) case while the dentist administers general anesthesia and/or conscious/deep sedation.  The authority will be granted at the demonstrated level of anesthesia or sedation observed.  The inspector is authorized to observe additional cases at his/her discretion.

G.	The dentist requiring the inspection shall obtain his/her own inspector.  The inspector must be an 
Oral Surgeon, Certified Registered Nurse Anesthetist, Physician Anesthesiologist, or a Dental Anesthesiologist, and must be authorized at or above the level of anesthesia and/or sedation being inspected.   The inspector must have a current, unrestricted Colorado dental, medical, or nursing license.  If the inspector is a Colorado dentist, he/she must also have a valid, current permit to administer general anesthesia/deep sedation.   

H.	There shall not be reciprocal agreements between the inspector and the dentist.

I.	The inspector shall not have had a previous, current, or intended working relationship with the 
dentist he/she is inspecting.

J.   The Board shall accept anesthesia inspections conducted by the Dentist’s Professional Liability
Trust and the American Association of Oral and Maxillofacial Surgeons as meeting the
requirements of the Board, so long as all the requirements of Rule XV have been met.  Inspections 
conducted by one of the above entities will be effective for five (5) years from the date of issuance 
by the entity, with a sixty (60) day grace period from the end of the expiration month.

K.	Pursuant to section 12-35-109(3), C.R.S., inspectors shall be considered consultants for the Board 
and shall be immune from liability in any civil action brought against him or her occurring while acting in this capacity.  

L.   The documentation of the anesthesia inspection must be competed on forms approved by the
      Board.

Rule XVII.  Administration of Nitrous Oxide/Oxygen Inhalation
(Amended February 1, 1998; August 11, 2004; October 26, 2006) 

A.   When conscious sedation is accomplished solely by means of nitrous oxide/oxygen inhalation 
       techniques, then this Rule shall apply.
  B.   The administration of nitrous oxide may be delegated to another dentist whose qualifications meet the education and training requirements of Rule XIV, a qualified physician anesthesiologist, or a certified registered nurse anesthetist.
C.   Education/Training Requirements:
	1.    In order to administer and induce conscious analgesia solely by means of nitrous   oxide/oxygen inhalation techniques, a dentist shall complete a course(s)                                    conducted at an institution accredited by the Commission on Dental Accreditation or certified by the Colorado Department of Higher Education Division of Private Occupational Schools. The course(s) must have a minimum of sixteen (16) hours, including four (4) patient contact hours. As of January 1, 1994, the Board required all dentists who did not meet the requirements of subsection 2. below to submit an application and documentation of training in nitrous oxide/oxygen administration.
2.   A Colorado licensed dentist who has safely administered conscious analgesia solely by means of nitrous oxide/oxygen inhalation techniques within the State of Colorado for the three (3) years prior to October 30, 1987, should be deemed to have satisfied, the education/training specified under this Rule in making a determination on safe administration and inducement of conscious analgesia accomplished solely by means of nitrous oxide/oxygen inhalation techniques, the Board shall consider any and all anesthesia/analgesia related incidents, accidents or complaints filed against the licensee.
	3.   The dentist and all personnel, including but not limited to, dental hygienists and dental auxiliaries, who render patient care services in a dental setting where nitrous oxide/oxygen is administered shall have proof of current basic life support (BLS) knowledge and skills.
             D.   Examination: Upon the effective date of this Rule, prior to administration of nitrous oxide/oxygen, the dentist, dental hygienist, or auxiliary shall record, in the patient’s chart, the patient’s medical and pertinent physical findings.
E.   Documentation: Upon the effective date of this Rule, when administering nitrous oxide/oxygen, the dentist, dental hygienist, or auxiliary shall record, in the patient's chart, the treatment given, the dosage administered and the patient's response to treatment.
F.   Emergency Care: Prior to the administration of nitrous oxide/oxygen, the supervising dentist, dental hygienist, and auxiliaries shall have appropriate training to recognize the symptoms and reasonably treat the complications and emergencies incident thereto.
G.   Office Facilities and Equipment: If conscious analgesia is accomplished solely by means of nitrous oxide/oxygen inhalation techniques, then the supervising dentist shall provide and ensure the following:
1.        Fail safe mechanisms in the delivery system and an appropriate scavenging system;
2.	The inhalation equipment must be evaluated for proper operation and delivery of inhalation agents prior to use on each patient;
3.       Determination of adequate oxygen supply must be completed prior to use with each     patient;
4.       Baseline vital signs may be obtained at the discretion of the operator depending on the medical status of the patient and the nature of the procedure to be performed; and,
5.       Appropriate equipment to monitor vital signs and maintain an adequate airway including but not limited to a blood pressure cuff, stethoscope and a method for administering positive pressure oxygen.
H.         Delegating under direct supervision the monitoring and administration of nitrous oxide/oxygen to appropriately trained personnel pursuant to section 12-35-113 (1) (q), C.R.S.:
     1.      The supervising dentist is responsible for determining the maximum dosage of nitrous     oxide/oxygen analgesia and must record the dosage in the patient's dental chart prior to delegation;   
	2.       The supervising dentist delegating must be approved by the Board under this Rule to administer nitrous oxide/oxygen;  
3.       The dental hygienist or dental auxiliary accepting the delegation of the administration and monitoring of nitrous oxide/oxygen under direct supervision shall ensure that the dentist is approved by the Board to administer nitrous oxide/oxygen; and, 
4.        Education/Training Requirements for dental hygienists and auxiliaries administering and monitoring nitrous oxide/oxygen under direct supervision;
a.	In order to administer and induce conscious analgesia solely by means of nitrous oxide/oxygen inhalation techniques, a dental hygienist or a dental auxiliary shall complete a course(s) conducted at an institution accredited by the American Dental Association Commission on Dental Education or certified by the Colorado Department of Higher Education Division of Private Occupational Schools. The course(s) must have a minimum of sixteen (16) hours, including four (4) patient contact hours. The dental hygienist and dental auxiliary shall certify to the Board, on a form approved by the Board, compliance with the educational requirement.
I. 	 “Monitoring”, as that term is used in Rule XVII means:
1.   The continual observation of the patient to ensure the stable physical condition of the patient and maintenance of a proper level of nitrous oxide/oxygen inhalation as determined by the supervising dentist; or
2.   The continual observation of the patient to ensure stable physical condition of the patient during recovery from the nitrous oxide/oxygen inhalation.
  3.	Unless a dental hygienist or dental auxiliary has received the training to administer nitrous
oxide/oxygen inhalation, they may only monitor (observe) a patient during the use of nitrous oxide/oxygen inhalation. Monitoring may only be delegated under the direct supervision of a dentist approved/authorized to administer nitrous oxide/oxygen inhalation.
J.  	All equipment, as provided for in this Rule XVII shall be functional and operative at all times.
K.         Morbidity and Mortality Report - A completed written report shall be submitted to the Board by the    supervising dentist and any other person administering the nitrous oxide/oxygen inhalation within fifteen (15) days of any nitrous oxide/oxygen inhalation related incident resulting in patient morbidity or mortality which occurred while the patient was under the care of the dentist, and required hospitalization, emergency facility care, or emergency service response.
	1.  Such report shall include all of the following items:
	a.  Description of dental procedure;
	b.  Description of preoperative physical condition of the patient;
	c.  List of the drugs and dosages administered;
	d.  Detailed description of techniques utilized in administering the nitrous oxide;
	e.  Description of adverse occurrence to include:
	1)  Detailed description of symptoms of any complications including, but 
     not limited to, onset and type of symptoms in patient;
	2)  Treatment instituted on patient; and, 
	3)  Response of the patient to treatment.
                  f.   Description of the patient's condition on termination of any procedure    undertaken.
	2.  The Board may request inspection of any written records related to this report.
3.  Pursuant to section 12-35-107(1)(d), C.R.S., the Board may request an on-site    evaluation of the dental facility related to this report.

        Rule XXVI – Advertising                               
(Effective August 1, 2000; Temporarily Expired December 2, 2002; Effective July 1, 2003; Amended October 27, 2004; October 26, 2006)
This Rule applies to advertising in all types of media, including, but not limited to, print, radio, television and the Internet for dentists and dental hygienists.
1.   “Misleading, deceptive, or false advertising” includes, but is not limited to, the following and may be a violation of section 12-35-129(1), C.R.S.:

A.	An unsubstantiated claim that the services performed, personnel employed, education and/or  
      materials or office equipment used are professionally superior to that which is ordinarily 
      performed, employed, and/or used or that the licensee possesses superior abilities over 
      other licensees.  

B.	The false, deceptive, or misleading use of a claim regarding board certification, registration, listing, or education, or an unearned degree/certificate.  An unearned degree/certificate is one that is awarded by an educational institution not accredited by the Commission on Dental Accreditation.

C.   An advertisement that uses a patient testimonial but is not in compliance with Section 6 of 
this Rule.

D.	Advertising that makes an unsubstantiated medical claim.

E.	Advertising that is outside the scope of dentistry, unless within the scope authorized by licensing or registration in another profession.

F.	Advertising that makes an unsubstantiated promise or claim that the patient will be cured.

G.   The use of “bait and switch” in advertisements.  “Bait and switch” is defined as advertising    that switches consumers from buying or receiving the advertised merchandise or services in order to sell or provide something else, usually at a higher fee or on a basis more advantageous to the advertiser.

H.  The use of any unsubstantiated testimonials attesting to the technical quality or technical 
competence of a service or treatment by a licensee.

I.    Claims that state or imply a specialty practice by a dentist or dental hygienist in violation of Section 4 of this Rule.  For example, a general dentist or hygienist who advertises in any medium under a specialty heading or section.  Claims that state or imply a specialty practice by a dental specialist in a specialty other than the specialty degree they have earned.

J    Failure to disclose endorsement by a third party in which there is compensation, 
      remuneration, fee paid, or benefit of any kind, that the dentist or dental hygienist has paid for         the endorsement.  Any advertisement containing such endorsement must include the phrase:  “This advertisement is a paid endorsement.”

K.   Inferring or giving the appearance that an advertisement is a news item without using the 
phrase “paid advertisement.”

L.  Advertising that claims to provide services at a specific rate and fails to disclose that the 
patient’s insurance will provide payment for all or part of the services.

2.   At the time any type of advertisement is placed, the dentist or dental hygienist must in good faith
possess information that would substantiate the truthfulness of any assertion, omission, or claim set forth in the advertisement.	

3.   A licensed dentist or dental hygienist shall be responsible for any advertisement made by a corporate 
dental or dental hygiene practice.  A licensed dentist or dental hygienist shall approve and be responsible for claims made in any such advertisement and the corporate dental or dental hygiene practice shall maintain a list stating the name and license number of the dentist(s) or dental hygienist(s) who approves and is responsible for the advertisement.  This list must be maintained for a minimum of five (5) years.

4.   Specialty practice and advertising

A.   A licensed dentist has the legal authority to practice in any and all areas of dentistry and also 
the authority to confine the areas in which he or she chooses to practice.
	
	B.   Dental specialties are recognized as only those defined by the American Dental Association 
and dental specialists are those dentists who have successfully completed a Commission on Dental Accreditation specialty program.

	C.   Practitioners who have successfully completed a Commission on Dental Accreditation 
  accredited specialty program may advertise the practice of that specialty.  Practitioners who have not completed an accredited specialty program, and have limited their practice to a specific Commission on Dental Accreditation defined specialty, must clearly state in all advertising and/or public promotions, that he/she is a general dentist who has limited his/her practice to that field of dentistry.

	D.   It is misleading, deceptive or false for general practitioners to list their names, advertise, or 
      promote him or her in any area or location that implies a specialty.  A general practitioner       who advertises in any medium under a specialty heading or section may be considered as having engaged in misleading, deceptive or false advertising and may be in violation of section 12-35-129(1), C.R.S.

5.   Practitioners who advertise dentistry or dental hygiene shall not make any misleading, deceptive, or false claims to a patient or the general public in any advertisement, business card, letterhead, or envelope, of any recognition, accomplishments, levels of attainment, diplomate status, fellowship status, teaching credentials, or any other form of recognition from an unaccredited school or organization or continuing education program relating to dentistry and dental hygiene.  Any advertisement stating recognition from an unaccredited school, organization or continuing education program must include a disclaimer that the Commission on Dental Accreditation does not accredit the school, organization, or continuing education program.  

6.   Patient testimonials may be used if they do not violate Rule 1 G. above and the following conditions  
are met:
	
A.	The patient’s current name, address and telephone number at the time treatment was rendered, must be maintained by the dentist or dental hygienist and shall be made available to the Board within ten (10) days of any request for that information.

B.	Practitioners who advertise dental or dental hygiene services, which are the subject of the   
testimonial, must have actually provided these services to the patient.

C.	No compensation, remuneration, fee or benefit of any kind shall be provided to the person in 
exchange for or consideration of the testimonial.

	D.   The dentist or dental hygienist must obtain a specific release and consent for the testimonial 
from the patient which shall be made available to the Board within ten (10) days of the request for that information.

	E.   The following statements must follow any testimonial: “Results may vary in individual cases.”