Authorization to Administer Sedation and General Anesthesia

Dentists must have authorization from the College to administer any level of sedation, including minimal sedation, in a dental facility.

Dentists applying for authorization must select: 1) a type of authorization*; and 2) a level/modality of sedation.

*Exception: Applicants for minimal sedation do not need to select a type of authorization. Practitioners with valid minimal sedation authorization can administer minimal sedation at any facility where they work.

Physicians must also register with the College before they administer any level of sedation in a dental facility

Types of Sedation Authorizations

1. Non-visiting authorization

Non-visiting sedation practitioners use the equipment, drugs and staff provided by the dental facility where they are administering sedation.

Non-visiting practitioners administering oral moderate sedation, parenteral conscious sedation, or deep sedation/general anesthesia can only administer sedation at dental facilities that have a Type A facility permit corresponding to the level/modality of sedation which they are administering or higher.

Note: The facility does not require a facility permit for practitioners to administer nitrous oxide and oxygen sedation or minimal oral sedation.

2. Visiting authorization

Visiting sedation practitioners are sedation practitioners that carry their own sedation equipment and drugs (i.e., visiting kit). Visiting sedation practitioners must pass an inspection of their visiting kit prior to being issued their provisional authorization.

Visiting sedation practitioners cannot share equipment with other visiting sedation practitioners or with a Type A facility.

Visiting sedation practitioners can administer sedation at any dental facility that has a Type B or Type A/B facility permit using their visiting kit.

They can also administer sedation at Type A dental facilities, but they must use the equipment and drugs at the Type A facility and can only administer the level/modality of sedation corresponding to the Type A facility permit.

Level/Modalities of Sedation Authorizations

The following levels/modality of sedation are defined in the Standard of Practice – Use of Sedation and General Anesthesia in Dental Practice. Refer to Appendix III (page 35) for more characteristics of each level of sedation.

1. Minimal sedation authorization

Practitioners with minimal sedation authorization are only permitted to administer minimal sedation using the modality or modalities corresponding to their authorization.

Minimal sedation is a minimally depressed level of consciousness, produced by a pharmacological method that retains the patient’s ability to independently and continuously maintain an airway and respond normally to tactile stimulation and verbal command. The maximum drug dose ranges for minimal sedation are on page 13 of Standard of Practice.

There are three types of minimal sedation authorization.

1. Nitrous Oxide/Oxygen Sedation Authorization
2. Oral Minimal Sedation Authorization
3. Nitrous Oxide/Oxygen or Oral Minimal Sedation Authorization (not in combination)

Practitioners with minimal sedation authorization cannot administer oral minimal sedation to patients under 12 years of age regardless of whether minimal sedation is intended or achieved. Practitioners must hold at least oral moderate authorization to administer any oral sedation to patients under the age of 12. 

2. Oral moderate sedation authorization

Practitioners with oral moderate sedation authorization are permitted to administer oral moderate sedation, nitrous oxide/oxygen sedation and oral minimal sedation.

Moderate sedation is a drug-induced depression of consciousness during which patients respond purposefully to verbal commands, either alone or accompanied by light tactile stimulation. The maximum drug dose ranges for oral moderate sedation are on pages 16-17 of the Standard of Practice.

3. Parenteral conscious sedation

Practitioners with parenteral conscious sedation authorization are permitted to administer parenteral conscious sedation, oral moderate sedation, nitrous oxide/oxygen sedation and oral minimal sedation.

Moderate sedation is a drug-induced depression of consciousness during which patients respond purposefully to verbal commands, either alone or accompanied by light tactile stimulation. The maximum drug dose ranges for oral moderate sedation are on pages 20-22 of Standard of Practice.

Practitioners with parental conscious sedation authorization cannot administer parenteral conscious sedation to patients under 12 years of age in out of hospital dental facilities. Practitioners must hold a deep sedation and general anesthesia authorization to administer any parenteral conscious sedation to patients under the age of 12 in out of hospital dental facilities. 

4. Deep Sedation & General Anesthesia

Deep sedation is a drug-induced depression of consciousness during which patients cannot be easily aroused but respond purposefully following repeated or painful stimulation.

General anesthesia is a drug-induced loss of consciousness during which patients are not arousable, even by painful stimulation.

Summary

Applying for Sedation Authorization

Dentists must apply for sedation authorization online through the RCDSO Portal. PDF applications will not be accepted after July 31, 2023.

The online application will ask the applicant dentist a series of eligibility questions intended to guide them to the type and level/modality of sedation authorization that meets their needs and training.

If you are unable to complete the application online, contact sedation@rcdso.org.

All sedation authorizations expire annually on March 31^st regardless of when the dentist applies for and receives their initial annual sedation authorization. Sedation authorizations must be renewed annually to remain valid.

Application Fees

All application fees collected by the College are non-refundable.

The application fee for non-visiting sedation authorization is $150. The application fee for visiting sedation authorization is $600.

Application fees cannot be pro-rated or waived for applicants applying close to the renewal deadline of March 31^st.

The annual renewal fee for non-visiting sedation authorization is $150. The annual renewal fee for visiting sedation authorization is $300.

Click here for more information on sedation renewal.

Processing times

The processing times for authorization applications varies depending on the number of applications received by the College. Processing times are longer in March and April annually due to sedation annual renewal.

Applications are processed in order that they are received. Dentists should not pre-book any procedures that require the administration of sedation. College staff will not prioritize applications for dentists who have pre-booked patients.

Sedation Training

Dentists applying for sedation authorization must meet the training requirements set out in the Standard of Practice. for the level/modality of sedation authorization they are applying for.

Current Training or Experience Requirement

Dentists applying for sedation authorization must demonstrate they have current training or experience. There are two categories of applications:

1. Initial sedation authorization applications and applications to upgrade to a higher level/modality of sedation authorization.
2. Dentists applying for sedation authorization after a break from that area of clinical practice, or moving from another jurisdiction where they administered sedation in clinical practice.

Dentists in category 1 must have completed their sedation training in the 1 year (12 months) preceding the date they submit their application for authorization to the College.

Dentists in category 2 must demonstrate they held the required license and authorization, if applicable, and administered sedation in clinical practice in the 3 years (36 months) preceding the date they submit their application for authorization to the College.

Provisional Authorization

Dentists applying for minimal sedation are not required to go through a provisional authorization. If they meet the eligibility requirements for minimum sedation they will be issued an annual authorization.

Provisional authorization is the first step in the authorization process for dentists applying to administer oral moderate sedation, parenteral conscious sedation or deep sedation and/or general anesthesia.

Dentists who meet the eligibility requirements for the level/modality of authorization they are applying for will be issued a three month provisional member authorization.

During the provisional authorization phase, the dentist will be required to submit sedation records for review by the College. The College will review the records to ensure they comply fully with the Standard of Practice.  

Dentists applying for oral moderate or parenteral conscious sedation authorization must submit a minimum of five sedation records.

Dentists applying for deep sedation and general anesthesia authorization must submit a minimum of 10 sedation/anesthesia records.

The College has created the following sample sedation and anesthesia records:

• Oral Moderate Sedation
• Parenteral Conscious Sedation (1 drug)
• Deep Sedation and General Anesthesia

Instructions on how to securely transmit sedation records to the College will be provided when the provisional member authorization is issued.

The dentist will only be issued an annual authorization if the sedation records submitted to the College are complete and in compliance with the Standard of Practice.

The College may grant a dentist one-time three month extension of their provisional authorization if they require additional time to submit compliant sedation records.  

If a dentist is unable to submit cases that comply with the Standard of Practice by the expiry of the extended provisional authorization, the dentist will not be issued an annual authorization. Dentists who are unsuccessful may have the option to re-apply for authorization.

Annual Authorizations

Dentists will be issued an annual sedation authorization if they are approved for minimal sedation authorization or successfully complete the requirements of the provisional authorization for oral moderate, parenteral conscious sedation or deep sedation and/or general anesthesia.

Annual authorizations expire annually on March 31^st. Annual authorizations must be renewed annually if the dentist wishes to maintain their authorization.

Authorization application fees will not be pro-rated or refunded if the dentist cancels their authorization mid-year.

Ongoing requirements for Sedation Authorized Dentists

Reporting Tier 1 and Tier 2 Events

A Tier 1 or Tier 2 event report must be filed if an adverse event, as defined by the Standard of Practice, occurs following the administration of sedation at a dental facility.

Facility Permit holders and sedation authorized practitioners are jointly responsible for ensuring the appropriate Tier 1 or Tier 2 form is filed with the College.

Tier report must be filed through the College’s encrypted email system. To file a Tier report contact eventreports@rcdso.org to request an encrypted email link, then complete one of the forms below.

Tier 1 Events

Tier 1 events must be report within 24 hours of knowledge of the event. Tier 1 events are:

• Death of a patient within the facility.
• Death of a patient within 10 days of a procedure performed at the facility.
• Transfer of a patient from the facility directly to a hospital for care.

Download the Tier 1 event report form. 

Tier 2 Events

Tier 2 events must be reported within 10 days of knowledge of the event. Tier 2 events are:

• Unscheduled treatment of a patient in a hospital within 10 days of a procedure performed with sedation or general anesthesia.
• Any use of a benzodiazepine or opioid antagonist.
• Any serious cardiac or respiratory adverse event requiring administration of a medication for its management.

Download the Tier 2 event report form.

College staff may request additional information to support the event report form, including but not limited to, the sedation/anesthesia record.

Life Support Training

The Standard of Practice sets ongoing obligations for all sedation authorized dentists and staff of the dental facility who act as a member of the sedation/anesthesia team.

Sedation authorized dentists must maintain current basic life support training (BLS) and may be required to maintain additional life support training depending on:

1. Their level/modality of authorization;
2. The format of their sedation/anesthetic team; and
3. Their patient demographic.

Additional life support training includes ACLS, PALS or PEARS.

Current is defined as the lesser of 2 years or the period of validity of the certificate obtained by the practitioner.

Minimum Annual Case Counts and Continuing Education

Sedation authorized dentists must also complete the minimum number of continuing education (CE) points related to sedation and anesthesia that must be completed in a 3-year period and the annual minimum cases that an authorized dentist must complete in a year as outlined in the Standard of Practice.

Summary of life support training, CE and annual case count requirements 

Current*

• For the purposes of fulfilling this requirement, “current” is defined as within two years or the expiry date listed on the certificate, whichever is less.

Basic Life Support (BLS) Training*

• CPR at the Level of Health Care Practitioner or its equivalent with training that includes a “hands on” component.

The “hands on” component refers to a practical element, and may be met through in-person and/or live-stream delivery.

It is the responsibility of the course provider to effectively deliver practical elements, and of the dentist fulfilling that requirement to assess whether the delivery method proposed by the provider meets their learning style.

Advance Life Support Training*

Adult Patients

• Advanced Cardiac Life Support (PALS) with training that includes a hands on component (see explanation under Basic Life Support Training).

Pediatric Patients

• Pediatric Advanced Life Support (PALS) with training that includes a hands on component  (see explanation under Basic Life Support Training) OR
• Pediatric Emergency Assessment Recognition (PEARS) with training that includes a hands on component (see explanation under Basic Life Support Training)

Continuing Education*

• This 3-year period for sedation and anesthesia related CE will match your general CE cycle.
• CE points for sedation and anesthesia can be acquired in any category.
• Log your CE points for sedation and anesthesia in your e-Portfolio in the appropriate category.
• For the purposes of fulfilling this requirement, courses in the management of medical emergencies are accepted. Courses to acquire or maintain life-support certification (BLS, ACLS, PALS and PEARS) are NOT accepted.
• All CE cycles require the sedation CE points as set out by the Standard of Practice.
• As with all other CE activities, you must keep your original CE documents. These documents must be retained for five years from the end of each three-year CE cycle and submitted to the College on request.

Minimum Number of Cases Required

• For the purposes of fulfilling this requirement, the calendar year during which the minimum number of cases is completed starts April 1^st and runs to March 31^st of the following year.

Physician Sedation Registration

A physician who wants to administer sedation above the minimal level in a dental facility must register with the College using the following form: Application for a physician to administer sedation and general anesthesia in a dental office.

Physicians can apply for two types of privileges:

• Physician authorizations are for physicians who will be using the sedation equipment and emergency drugs provided by the dental facility. This corresponds to a Type A facility permit.

Visiting physician authorizations are for physicians who bring all the necessary sedation equipment and emergency drugs the dental facility. This corresponds to a Type B facility permit. Visiting physicians can also administer sedation in a Type A facility, but are restricted to the level of sedation on the Type A facility permit and they can only use the facility’s sedation equipment and emergency drugs.

Questions?

Visit the sedation FAQ page or contact the Facility Inspection Program at sedation@rcdso.org or by phone at 1-800-565-4591/416-934-4331.