General Anesthesia Permits to Administer or Order the Administration of Deep Sedation and General Anesthesia (Dentist)

On January 1, 2022, Senate Bill (SB) 501 (Glazer, Chapter 929, Statutes of 2018) changed how General Anesthesia (GA) permit holders will practice in California. For GA permits issued on or after January 1, 2022, GA permit holders may administer or order the administration of deep sedation or general anesthesia to patients 7 years of age and older. GA permit holders who wish to administer deep sedation or general anesthesia to pediatric patients under age 7 must apply to the Board for and maintain a Pediatric Endorsement. SB 501 also enacted new patient monitoring requirements for the administration of deep sedation and general anesthesia to patients under 13 years of age. Please review the information below.

“Deep sedation” means “a drug-induced depression of consciousness during which patients cannot be easily aroused but respond purposefully following repeated or painful stimulation. The ability to independently maintain ventilatory function may be impaired. Patients may require assistance in maintaining a patent airway, and spontaneous ventilation may be inadequate. Cardiovascular function is usually maintained.” (Business and Professions Code (BPC), § 1646.1, subd. (a).)

“General Anesthesia” means “a drug-induced loss of consciousness during which patients are not arousable, even by painful stimulation. The ability to independently maintain ventilatory function is often impaired. Patients often require assistance in maintaining a patent airway, and positive pressure ventilation may be required because of depressed spontaneous ventilation or drug-induced depression of neuromuscular function. Cardiovascular function may be impaired.” (BPC, § 1646.1, subd. (b).)

The following provide specific information regarding GA Permits:

Business and Professions Code, Division 2, Chapter 4, Article 2.75 (commencing with Section 1646)
Business and Professions Code Section 1680(z)
Business and Professions Code Section 1682

California Code of Regulations (CCR), Title 16, Division 10, Chapter 2, Article 5 (commencing with Section 1043)

Applying for a General Anesthesia Permit

The requirements for a permit to administer deep sedation and general anesthesia to a dental patient aged 7 years and older include:

  1. A completed Application for General Anesthesia Permit (GAP-1) form. (CCR, tit. 16, § 1043.1, subs. (b).)
  2. Non-refundable application fee of $524.00. (CCR, tit. 16, § 1021, subs. (q).) Check or money order made payable to the Dental Board of California.
  3. Current, active license to practice dentistry in this state, or a current permit issued pursuant to BPC section 1638 or 1640. (BPC, § 1646.1, subd. (a).)
  4. Documentation of one of the following:
    1. Certificate of completion or other documentary evidence showing completion of a residency program in general anesthesia accredited by the American Dental Association Commission on Dental Accreditation; or
    2. Certificate of completion or other documentary evidence showing completion of a residency program in oral and maxillofacial surgery accredited by the American Dental Association Commission on Dental Accreditation.

The completed Application for General Anesthesia Permit (GAP-1) form, documentation, and non-refundable application fee can be submitted by mail to:

Dental Board of California
2005 Evergreen St., Suite 1550
Sacramento, CA 95815

Applying for a Pediatric Endorsement

The requirements for a Pediatric Endorsement to administer deep sedation and general anesthesia to a dental patient under the age of 7 include:

  1. A completed Courtesy Application for Pediatric Endorsement for General Anesthesia Permit form. (CCR, tit. 16, §§ 1043.1, subs. (c), 1043.8.1, subs. (a).)
  2. A completed Documentation of Deep Sedation and General Anesthesia or Moderate Sedation Cases for Pediatric Endorsement (PE-1) form. (CCR, tit. 16, § 1043.8.1, subs. (a)(3).)
  3. Non-refundable application fee of $532.00. Check or money order made payable to the Dental Board of California. (CCR, tit. 16, § 1021, subs. (ag).)
  4. Documentation of completion of a Commission on Dental Accreditation program which provides competency in the administration of deep sedation or general anesthesia on pediatric patients. (BPC, § 1646.2, subd. (c)(1).)
  5. Documentation, such as patient records with identifying information redacted, of 20 cases of administration of deep sedation or general anesthesia to pediatric patients under 7 years of age within the 24 months directly preceding the application. (BPC, § 1646.2, sub(c)(2).)
  6. Certificate or other documentary evidence of current certification in Advanced Cardiac Life Support (ACLS) and Pediatric Advanced Life Support (PALS) as provided by the American Red Cross, American Heart Association, or American Safety and Health Institute. (BPC, § 1646.2, (c)(3); CCR, tit. 16, § 1043.8.1, subs. (a)(4).)

The completed Courtesy Application for Pediatric Endorsement for General Anesthesia Permit form, documentation, and non-refundable application fee can be submitted by mail to:

Dental Board of California
2005 Evergreen St., Suite 1550
Sacramento, CA 95815

New Monitoring Requirements for GA Permits Issued or Renewed after 01/01/2022 for Patient Under 13 Years of Age

SB 501 enacted new grounds for unprofessional conduct for (BPC, § 1682):

  1. Any dentist performing dental procedures to have more than one patient undergoing moderate sedation, deep sedation, or general anesthesia on an outpatient basis at any given time unless each patient is being continuously monitored on a one-to-one ratio while sedated by either the dentist or another licensed health professional authorized by law to administer moderate sedation, deep sedation, or general anesthesia.
  2. Any dentist with patients recovering from moderate sedation, deep sedation, or general anesthesia to fail to have the patients closely monitored by licensed health professionals experienced in the care and resuscitation of patients recovering from moderate sedation, deep sedation, or general anesthesia. If one licensed professional is responsible for the recovery care of more than one patient at a time, all of the patients shall be physically in the same room to allow continuous visual contact with all patients and the patient to recovery staff ratio should not exceed three to one.
  3. Any dentist with patients who are undergoing deep sedation, general anesthesia, or moderate sedation to fail to have these patients continuously monitored during the dental procedure with a pulse oximeter or similar or superior monitoring equipment and ventilation continuously monitored using at least two of the three following methods:
    1. Auscultation of breath sounds using a precordial stethoscope.
    2. Monitoring for the presence of exhaled carbon dioxide with capnography.
    3. Verbal communication with a patient under moderate sedation. This method shall not be used for a patient under deep sedation or general anesthesia.

SB 501 also enacted new patient monitoring requirements for the administration of deep sedation and general anesthesia to patients under 13 years of age, as follows (BPC, § 1646.1, subd. (d)):

  1. The operating dentist and at least two additional personnel shall be present throughout the procedure involving deep sedation or general anesthesia.
  2. If the operating dentist is the permitted anesthesia provider, then both of the following shall apply:
    1. The operating dentist and at least one of the additional personnel shall maintain current certification in Pediatric Advanced Life Support (PALS) or other board-approved training in pediatric life support and airway management, adopted pursuant to [BPC] Section 1601.8. The additional personnel who is certified in Pediatric Advanced Life Support (PALS) and airway management or other board-approved training in pediatric life support and airway management shall be solely dedicated to monitoring the patient and shall be trained to read and respond to monitoring equipment including, but not limited to, pulse oximeter, cardiac monitor, blood pressure, pulse, capnograph, and respiration monitoring devices.
    2. The operating dentist shall be responsible for initiating and administering any necessary emergency response.
  3. If a dedicated permitted anesthesia provider is monitoring the patient and administering deep sedation or general anesthesia, both of the following shall apply:
    1. The anesthesia provider and the operating dentist, or one other trained personnel, shall be present throughout the procedure and shall maintain current certification in Pediatric Advanced Life Support (PALS) and airway management or other board-approved training in pediatric life support and airway management, adopted pursuant to [BPC] Section 1601.8.
    2. The anesthesia provider shall be responsible for initiating and administering any necessary emergency response and the operating dentist, or other trained and designated personnel, shall assist the anesthesia provider in emergency response.

Renewal of Your GA Permit and Continuing Education Requirements

The GA permit is renewed biennially, and the renewal fee is $325.00.(BPC, § 1646.10; CCR, tit. 16, §§ 1021, subs. (s), 1043.8.) The renewal application and fee can be submitted online through the BreEZe system at www.breeze.ca.gov, and will be available approximately 90 days prior to the expiration date. If you do not have a BreEZe account, you can register as a new user to create an account. If you have an existing BreEZe account but do not know your username or password, you can follow the Forgot Password?, or Forgot Username? prompts.

Your first renewal may not be valid for a full two years. Your expiration date is based on your birth month and birth year. (BPC, § 1715.) If you were born in an even year, your permit will expire in an even year. If you were born in an odd year, your permit will expire in an odd year. From the issuance of your permit, your first permit will expire on the last day of your birth month, in the first odd or even year corresponding with your birth year.

After your first renewal, your permit will expire every two years on the last day of your birth month, either in an odd or even numbered year (as based on the year of your birth). (BPC, § 1715.)

You are exempt from the continuing education requirements for your first GA permit renewal. Beginning with your second GA permit renewal, you are required to complete at least 24 hours of approved courses of study related to general anesthesia, which must include either: (1) an advanced cardiac life support course approved by the American Heart Association and which includes an examination on the materials presented in the course; or (2) any other advanced cardiac life support course which is identical in all respects, except for the omission of materials that relate solely to hospital emergencies or neonatology, to the course published by the American Heart Association. (BPC, § 1646.5 ; CCR, tit. 16, §§ 1017, subs. (d), 1043.8.)

GA permit holders will complete a self-certification of completion of the required continuing education courses at the time of renewal. Permit holders are required to retain for certificates of course completions for at least three renewal periods. (CCR, tit. 16, §§ 1017, subs. (n), 1043.8.)

Renewal of Your GA Permit with a Pediatric Endorsement Requirements

As a condition of renewal, a licensee who holds a GA permit with a Pediatric Endorsement must provide proof of current certification in Advanced Cardiac Life Support (ACLS) and Pediatric Advanced Life Support (PALS) or other Board-approved training in pediatric life support and airway management. (BPC, § 1646.2, subd. (c)(3).) The GA permit holder must also complete 20 cases of deep sedation or general anesthesia to pediatric patients under the age of 7 within the 24 months directly preceding the renewal and complete a self-certification at the time of the renewal. (BPC, § 1646.2, subd. (c)(2); CCR, tit. 16, § 1017.1, subs. (a).)

GA permit holders with a Pediatric Endorsement shall maintain and be able to provide proof of these cases upon request by the Board for up to three permit renewal periods. (BPC, § 1646.2, subd. (c)(2).)

Required Onsite Inspection and Evaluation

The Board will conduct an onsite inspection and evaluation of you and your facility, equipment, personnel, and procedures utilized by you within one year of issuance of an initial permit, and every five years thereafter. (BPC, § 1646.4.) Please take notice that refusal to submit to an inspection shall result in automatic denial or revocation of the GA permit. (Ibid.)

The fee for the onsite inspection and evaluation is $2,000.00. (CCR, tit. 16, § 1021, subs. (u).) A notice will be sent to you by mail to your Address of Record, with instructions to schedule your onsite inspection and evaluation.