Sedation and Anesthesia
Applying for a Facility Permit
Every dental facility where oral moderate sedation, parenteral conscious sedation, deep sedation and/or general anesthesia are administered must have a facility permit from the College. The College inspects facilities as part of the application process. There are two types of facility permits. It is possible to hold both a type A and B depending on your requirements.
- Type A Facility Permit is for a dental office or facility that provides and has present at all times all of the sedation equipment and emergency drugs. The permit will restrict the level of sedation permitted. The permit holder may request any or all of the modalities - oral moderate, parenteral conscious, deep sedation and/or general anesthesia.
- Type B Facility Permit is for a dental office or facility that uses the services of a College approved practitioner (dentist or physician) who brings all the sedation equipment and emergency drugs with them to the office (visiting dentist or visiting physician).
Dentists can access a list of approved practitioners (dentists or physicians) by logging in to their member resource centre account.
Facility Permits are non-transferable. If the ownership of the practice changes or the practice moves, the Facility Permit will be cancelled.
Initially, and then every three years, the College must inspect all dental offices that apply for/hold a facility permit to ensure that the facility is in compliance with the College’s Standard of Practice.
Checklists of required equipment and emergency drugs are available for each level of sedation along with sample sedation records.
Click to view/download checklists for inspection.
Any deficiencies noted during the inspection will be posted on the public register under the name of the facility permit holder (physician-related deficiencies are posted against the facility permit holder) or the name of the dentist authorized to administer sedation and/or general anesthesia. Postings will be removed from the public register once the College receives the appropriate documentation that the problems have been corrected.
Inspection Review Forms and Chart Review Forms
Inspectors use these forms when reviewing your facility and charts. Assess your facility and charts before your inspection to determine if they are in compliance with the Standard.
Inspection review forms
Chart review forms
Level of Sedation
It is your responsibility to maintain the level of sedation or GA for which you are registered and/or authorized to provide. Record patients' level of sedation experienced at regular intervals. As an example, the Ramsay Sedation Scale is one measure. Use any valid sedation scale and ensure you document the scale used on the sedation/GA record.
Sample Sedation/GA Records
Select the appropriate sedation/GA record that applies to your authorization and determine if you are documenting all that is required.
If you provide minimal sedation, it is strongly recommended that your documentation is consistent with the Sample Oral Moderate Sedation Record.
You must maintain a drug register to record and account for all narcotics, controlled drugs and targeted substances that are kept on-site. The register should contain the name and quantity of the drug purchased, the date and location of purchase, and the invoice number. Keep it in a secure area in the office, preferably with the drugs, and reconcile it on a routine basis, depending on the nature of the practice and reasonable clinical judgement.
Whenever drugs in the above-mentioned classes are used or dispensed, a record containing the name of the patient, the quantity used or dispensed, and the date should be entered in the register for each drug. Each entry should be initialed or attributable to the person who made the entry. Record this same information in the patient record, along with any instructions for use.
Applying for Authorization to Administer
Any dentist or physician who wishes to administer oral moderate sedation, parenteral conscious sedation, deep sedation and/or general anesthesia in a dental office or facility must apply to the College to have their training reviewed and approved.
The authorization expires on March 31st of each calendar year, regardless of when in the year it was initially issued.
- Member Authorization refers to dentists who will be using the sedation equipment and emergency drugs that are permanently kept onsite in the office/facility where the procedures will be performed. Dentists applying for a Member Authorization will only be permitted to administer sedation and/or general anesthesia in offices holding a Type A Facility Permit. Maintaining the equipment and drugs is the responsibility of the facility permit holder.
- Visiting Member Authorization refers to dentists who bring with them all the necessary sedation equipment and emergency drugs approved by the College to any office that holds a Type B Facility Permit. Dentists with a Visiting Member Authorization can also administer in a Type A facility, but are restricted to the level of sedation outlined on the Type A Facility Permit. They can only use the facility’s sedation equipment and emergency drugs maintained on-site. If the visiting dentist prefers to use their own equipment and drugs then they must ensure that the office has a Type B Facility Permit.
Physicians can apply for two types of privileges.
- “Physician” applies to physicians who use the sedation equipment and emergency drugs provided by the facility. Physicians applying for physician privileges will only be permitted to administer sedation and/or general anesthesia in offices holding a Type A Facility Permit.
- “Visiting Physician” applies to physicians who bring all the necessary sedation equipment and emergency drugs for which they have been granted privileges by the College to any office that holds a Type B Facility Permit. Visiting Physicians can also administer in a Type A facility, but are restricted to the level of sedation outlined on the Type A Facility Permit. They can only use the facility’s sedation equipment and emergency drugs maintained on-site. If the visiting physician prefers to use their own equipment and drugs then they must ensure that the office has been issued a Type B Facility Permit.
If you have any questions or concerns, please contact:
Standard of Practice or Training/Qualifications:
Dr. David Harper
Manager, Facility Inspection Program