Moderate Sedation Permits – Licensed Dentists

On January 1, 2022, Senate Bill (SB) 501 (Glazer, Chapter 929, Statutes of 2018) repealed the authority of the Dental Board of California (Board) to issue Conscious Sedation (CS) permits. Effective January 1, 2022, the Board will no longer renew existing CS permits or issue new CS permits. The CS permit has now been replaced with the new Moderate Sedation (MS) permit. MS permit holders may administer or order the administration of moderate sedation to patients 13 years of age and older. Considered as additional sub-permits to the MS permit, there are also two Pediatric Endorsements that are available for application. Both Pediatric Endorsements can be applied for at the same time as when applying for the MS permit, or the Pediatric Endorsement applications can be submitted after the initial issuance of the MS permit. The first Pediatric Endorsement allows MS permit holders to administer or order the administration of moderate sedation to patients ages 7-12. The second Pediatric Endorsement allows MS permit holders to administer moderate sedation to pediatric patients under age 7. SB 501 also enacted new patient monitoring requirements for the administration of moderate sedation to patients under 13 years of age. Please review the information below.

“Moderate sedation” means “a drug-induced depression of consciousness during which a patient responds purposefully to verbal commands, either alone or accompanied by light tactile stimulation, no interventions are required to maintain a patient’s airway, spontaneous ventilation is adequate, and cardiovascular function is usually maintained.” (Business and Professions Code (BPC), § 1647.1, subd. (a).) In addition, “[t]he drugs and techniques used in moderate sedation shall have a margin of safety wide enough to render unintended loss of consciousness unlikely. Further, patients whose only response is reflex withdrawal from painful stimuli shall not be considered to be in a state of moderate sedation.” (BPC, § 1647.1, subd. (b).)

The following provide specific information regarding MS permits:

Business and Professions Code, Division 2, Chapter 4, Article 2.84 (commencing with Section 1647)

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 Moderate Sedation Permit

The requirements for a permit to administer or order the administration of moderate sedation to a dental patient aged 13 years and older include:

  1. A completed online application via www.breeze.ca.gov or Application for Moderate Sedation Permit (MSP-1) (CCR, tit. 16, § 1043.1, subs. (d).)
  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, § 1647.2, subd. (a).)
  4. A completed Certification of Moderate Sedation Training (MSP-2) that documents the successful completion of training in moderate sedation that meets all the following (BPC, § 1647.3, subd. (c); CCR, tit. 16, §§ 1043.1, subs. (d)(1), 1043.8.1, subs. (b)(2).):
    • Consists of at least 60 hours of instruction.
    • Requires satisfactory completion of at least 20 cases of the administration of moderate sedation for a variety of dental procedures.
    • Complies with the requirements of the Guidelines for Teaching Pain Control and Sedation to Dentists and Dental Students of the American Dental Association, including, but not limited to, certification of competence in rescuing patients from a deeper level of sedation than intended, and managing the airway, intravascular or intraosseous access, and reversal medications.

The completed Application for Moderate Sedation Permit (MSP-1) form, non-refundable application fee, and the Certification of Moderate Sedation Training (MSP-2) form can be submitted by online application or by mail to:

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

Applying for a Pediatric Endorsement for Patients Ages 7 – 12

The requirements for a Pediatric Endorsement to administer moderate sedation to a dental patient age 7 - 12, include:

  1. A completed online application via www.breeze.ca.gov or Courtesy Application for Pediatric Endorsement for Moderate Sedation Permit (CCR, tit. 16, §§ 1043.1, subs. (e), 1043.8.1, subs. (b).)
  2. A completed Documentation of Deep Sedation and General Anesthesia or Moderate Sedation Cases for Pediatric Endorsement (PE-1) form. (BPC, § 3, subd. (d)(2); CCR, tit. 16, § 1043.8.1, subs. (b)(3).)
  3. Non-refundable application fee of $532.00. (CCR, tit. 16, § 1021, subs. (ah); 1043.8.1, subs. (b)(5).) Check or money order made payable to the Dental Board of California.
  4. Certificate of completion or other documentary evidence showing completion of residency in pediatric dentistry accredited by the Commission on Dental Accreditation (CODA).
  5. Documentation, such as patient records with identifying information redacted, of 20 cases of administration of moderate sedation to pediatric patients ages 7 – 12 within the 24 months immediately preceding the application. (BPC, § 3, subd. (d)(2).)
  6. Certificate or other documentary evidence of current certification in Pediatric Advanced Life Support (PALS) as provided by the American Red Cross, American Heart Association, or American Safety and Health Institute. (BPC, § 3, subd. (d)(4); CCR, tit. 16, § 1043.8.1, subs. (b)(4).)

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

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

Applying for a Pediatric Endorsement for Patients Under the Age of 7

The requirements for a Pediatric Endorsement to administer moderate sedation to a dental patient under the age of 7 include:

  1. A completed online application via www.breeze.ca.gov or Courtesy Application for Pediatric Endorsement for Moderate Sedation Permit (CCR, tit. 16, §§ 1043.1, subs. (c), 1043.8.1, subs. (b).)
  2. A completed Documentation of Deep Sedation and General Anesthesia or Moderate Sedation Cases for Pediatric Endorsement (PE-1) form. (BPC, § 3, subd. (d)(3); CCR, tit. 16, § 1043.8.1, subs. (b)(3).)
  3. Non-refundable application fee of $532.00. (CCR, tit. 16, § 1021, subs. (ah).) Check or money order made payable to the Dental Board of California.
  4. Certificate of completion or other documentary evidence showing completion of residency in pediatric dentistry accredited by the Commission on Dental Accreditation (CODA)
  5. Documentation, such as patient records with identifying information redacted, of 20 cases of administration of moderate sedation to pediatric patients under the age of 7 within the 24 months immediately preceding the application. (BPC, § 3, subd. (d)(3).)
  6. Certificate or other documentary evidence of current certification in Pediatric Advanced Life Support (PALS) as provided by the American Red Cross, American Heart Association, or American Safety and Health Institute. (BPC, § 3, subd. (d)(4); CCR, tit. 16, § 1043.8.1, subs. (b)(4).)

The completed Courtesy Application for a Pediatric Endorsement for Moderate Sedation Permit form and non-refundable application fee must be submitted by mail by online application or to:

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

New Monitoring Requirements for Moderate Sedation Permits Issued After 01/01/2022 for Patients Under 13 Years of Age

SB 501 also enacted new patient monitoring requirements for the administration of moderate sedation to patients under 13 years of age, as follows:

  • A dentist who orders the administration of moderate sedation shall be physically present in the treatment facility while the patient is sedated. (BPC, 1647.2, subd. (c)(1).)
  • There shall be at least two support personnel in addition to the operating dentist present at all times during the procedure involving moderate sedation. (BPC, 1647.2, subd. (c)(2).)
  • The operating dentist and one personnel member 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. (BPC, 1647.2, subd. (c)(2).)
  • The personnel member with current certification in Pediatric Advanced Life Support (PALS) and airway management or other board-approved training in pediatric life support and airway management shall be dedicated to monitoring the patient during the procedure involving moderate sedation and may assist with interruptible patient-related tasks of short duration, such as holding an instrument. (BPC, 1647.2, subd. (c)(2).)
  • A dentist with a moderate sedation permit or a moderate sedation permit with a pediatric endorsement shall possess the training, equipment, and supplies to rescue a patient from an unintended deeper level of sedation. (BPC, 1647.2, subd. (d).)

In addition, SB 501 enacted new grounds for unprofessional conduct for:

  • Any dentist performing dental procedures to have more than one patient undergoing moderate sedation 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 (BPC, § 1682, subd. (a)).
  • Any dentist with patients recovering from moderate sedation to fail to have the patients closely monitored by licensed health professionals experienced in the care and resuscitation of patients recovering from moderate sedation. 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 (BPC, § 1682, subd. (b)).
  • Any dentist with patients who are undergoing 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 (BPC, § 1682, subd. (c)):
    • Auscultation of breath sounds using a precordial stethoscope.
    • Monitoring for the presence of exhaled carbon dioxide with capnography.
    • Verbal communication with a patient under moderate sedation. This method shall not be used for a patient under deep sedation or general anesthesia.

Renewal of Moderate Sedation Permit and Continuing Education Requirements

The MS permit is renewed biennially, and the renewal fee is $325.00. (BPC, § 1647.4; 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 MS permit renewal. Beginning with your second MS permit renewal, you are required to complete at least 15 hours of approved courses of study related to moderate sedation. (BPC, § 1647.5.) In addition, as a condition of renewal, a licensee who holds an MS permit with a Pediatric Endorsement must proof of current and continuous certification in Pediatric Advanced Life Support (PALS) and airway management or other board-approved training in pediatric life support and airway management. (BPC, § 1647.3, subd. (e).)

MS 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 Moderate Sedation Permit with Pediatric Endorsement Requirements

As a condition of renewal, a licensee who holds an MS permit with a Pediatric Endorsement must provide proof of current and continuous certification in Pediatric Advanced Life Support (PALS) and airway management or other board-approved training in pediatric life support and airway management. (BPC, § 1647.3, subd. (e).) The MS permit holder must also complete 20 cases of moderate sedation to pediatric patients ages 7-12 or those under the age of 7 within the 24 months immediately preceding the renewal and complete a self-certification at the time of the renewal. (BPC, § 1647.3, subd. (d)(2), (3); CCR, tit. 16, § 1017.1, subs. (b).)

MS 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, § 1647.3, subd. (d)(2), (3).)

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 six (6) years thereafter. (BPC, §, 1647.7, subd. (a).) Please take notice that refusal to submit to an inspection shall result in automatic denial or revocation of the MS 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.