Do I need sedation authorization if I am writing the patient a prescription for a sedative?
Can I have a patient’s physician write them a prescription for a sedative or anti-anxiety medication?
There may be circumstances that warrant advising a patient to see their physician to discuss getting a prescription for a sedative or anti-anxiety medication. However, dentists cannot use this as a way to avoid having to obtain sedation authorization from the College. Dentists must still comply with all requirements and restrictions in the Standard of Practice – Use of Sedation and General Anesthesia in Dental Practice.
A dentist does need to have current sedation authorization to treat a patient who takes an anti-anxiety medication prescribed by a physician as needed or occasionally because the medication could potentially induce sedation in addition to anxiolysis. In these circumstances the dentist must comply with the Standard of Practice – Use of Sedation and General Anesthesia in Dental Practice.
A dentist does not need to have sedation authorization to treat a patient who regularly takes an anti-anxiety medication prescribed by a physician if:
- The patient is familiar with the effects of the medication; and
- does not appear to be more than minimally sedated at the time of the dental procedure.
Refer to the characteristics of sedation in appendix III of Standard of Practice – Use of Sedation and General Anesthesia in Dental Practice.
If the patient appears to be at a level of sedation that exceeds the dentist’s authorization and/or the level of sedation facility permit at the facility then the dentist should cancel the appointment.
It is highly recommended that oral sedatives are stored and dispensed in the facility due to the risk that the patient may take the sedative prior to arriving at the facility, or someone else may take the sedative.
The patient must be continuously monitored from the time they take the oral sedative. The Standard of Practice – Use of Sedation and General Anesthesia in Dental Practice outlines who can administer a sedative to the patient, who can monitor a patient after they have taken a sedative and how the patient must be monitored.
Patients must be continuously monitored starting when the sedative is administered. Vitals must be taken prior to administration of sedation and then for the duration of the sedation until the patient is fit for discharge.
- Access to a desktop or laptop computer with internet connection. Mobile devices (smartphones, tablets) are not recommended.
- Your RCDSO Member Resource Centre (MRC) password.
- Credit card payment information (Visa, MasterCard, American Express)
- A digital copy of your life support training certificate(s) (BLS at a minimum; ACLS, PALS, PEARS, if applicable).
- A digital copy of your sedation training certificate (CE or post-graduate) or letter from the program director.
The Standard of Practice – Use of Sedation and General Anesthesia in Dental Practice outlines the minimum training requirements for each level/modality of sedation authorization.
RCDSO no longer “approves” training programs or CE courses in advance of the dentist applying for authorization.
It is the responsibility of each dentist to use their professional judgement to assess:
- Whether the course they are selecting meets the education and training criteria outlined in the Standard of Practice – Use of Sedation and General Anesthesia in Dental Practice for the level and modality of sedation authorization they are requesting; and
- Whether the course they select incorporates the key elements of Standard of Practice – Use of Sedation and General Anesthesia in Dental Practice and addresses their individual learning needs.
The expectations and requirements in other jurisdictions may be different. We urge dentists who are taking training programs in other jurisdictions to review content carefully from that perspective.
If you require assistance interpreting the training requirements contact the Facility Inspection Program via sedation@rcdso.org.
Note: College staff will not recommend courses or guarantee that a particular training program will qualify a dentist for sedation authorization.
As of July 10, 2023, dentists applying for sedation authorization must demonstrate they have current training or experience.
There are two categories of applications:
- Dentists who have never administered sedation in a dental facility or who are applying for authorization to administer sedation at a higher level for the first time in a dental facility (i.e. upgrading their authorization).
These applicants must have completed their sedation training in the 1 year preceding the date they submit their application for authorization to the College.
These applicants are treated as initial sedation authorization applicants and must have completed their sedation training in the 1 year preceding the date they submit their application for authorization to the College.
- Dentists applying for sedation authorization after taking a break from administering sedation in practice or moving from another jurisdiction where they administered sedation in a dental facility.
These applicants must demonstrate they have experience administering sedation in a dental facility in the 3 years preceding the date they submit their application for authorization to the College. To meet the current experience requirement, applicants must demonstrate that at some point in the preceding 3 years:
- They held the required license and authorization to administer sedation, if applicable in the jurisdiction where they practiced; and
- They performed the minimum number of annual sedation cases required by the Standard of Practice – Use of Sedation and General Anesthesia in Dental Practice in a dental facility.
Dentists who do not meet the training or experience requirements must update their training prior to applying for sedation authorization by completing a training program that meets the requirements of the Standard of Practice – Use of Sedation and General Anesthesia in Dental Practice.
Requests for an exception to the requirement for current training or experience will only be considered in limited circumstances. For more information contact the Facility Inspection Program at sedation@rcdso.org
The College only accepts life support certificates from training courses that include a “hands on” component.
The “hands on” component refers to a practical element, which may be met through in-person and/or live-stream delivery.
The College does not accept life support training certificates from programs that are offered exclusively through on-demand or pre-recorded video.
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.
You will receive an email notification when your application is processed.
If your application is approved, your certificate will be available through the RCDSO Portal within 24-48hrs of approval.
The processing times for authorization applications varies depending on the number of applications received by the College and the time of year. Processing times are always longer in March and April due to sedation renewal.
Dentists should not pre-book any procedures that require the administration of sedation.
Your receipt will be available for download through the RCDSO Portal within 24- 48 hours of payment being received.
The receipt will be available in the “My Receipts” section of your RCDSO portal account.
Application fees are non-refundable.
Provisional Authorizations
- Provisional authorizations are valid for 3 months from the date they are issued by the College. Dentists who require additional time to submit sedation records for review by the College may be eligible for a one-time 3 month extension.
- FIP staff do not have the authority to grant additional extensions under any circumstances.
Annual Authorizations
- All annual authorizations expire annually on March 31st .
- Your annual authorization will expire the March 31st following the date it is issued by the College regardless of when you receive your annual authorization.
- The College does not prorate application fees and College staff do not have authority to waive the obligation to renew authorizations.
- To be maintained, authorizations have to be renewed annually.
Upgrading or downgrading the level/modality of sedation authorization
- Dentists cannot upgrade or downgrade their sedation authorization online at this time.
- Contact the Facility Inspection Program via sedation@rcdso.org to apply to upgrade or downgrade the level/modality of your sedation authorization. College staff will send you a pdf application.
- At this time, there is no charge to downgrade a sedation authorization.
- At this time, there is no charge to change modality of minimal sedation authorization.
- The application fee for all other sedation authorization upgrades is $150 and all dentists upgrading their sedation authorization will have to go through the provisional authorization phase.
Changing the type of sedation authorization
- Dentists cannot change from visiting to non-visiting sedation authorization, or vice versa, online at this time.
- Contact the Facility Inspection Program via sedation@rcdso.org to apply to change the type of your sedation authorization. College staff will send you a pdf application.
- At this time, there is no charge to change from visiting to a non-visiting sedation authorization.
- The application fee to change from a non-visiting to a visiting authorization is $600.
The College has created the following sample sedation and anesthesia records:
Note: Dentists with authorization to administer parenteral conscious sedation (2 drugs) must comply with the record keeping requirements for deep sedation and general anesthesia providers.
To file a tier report:
- Contact sedation@rcdso.org to advise College staff that you need to file a tier report. Staff will provide you a link to our secure encrypted email system.
- Download and complete the appropriate tier report form.
- Scan a copy of the corresponding sedation or anesthesia record and the patient health questionnaire.
- When you receive the encrypted email link, respond to the email attaching:
- The completed tier report form.
- The sedation or anesthesia record and the patient’s health questionnaire corresponding to the adverse event.
Caution: You should only transmit patient information via secure email.
You will be required to submit a minimum of 5 sedation records during the period of your provisional sedation authorization. The sedation records must correspond to the highest level of sedation that you are authorized to administer.
The College may request additional records if the first 5 sedation records were not fully compliant with the Standard of Practice – Use of Sedation and General Anesthesia in Dental Practice.
The College will not issue your annual authorization if you do not provide the number of sedation records requested by the College during your provisional authorization.
The College may invite you to re-apply for sedation authorization if you are not successful in submitting the required number of cases in your first attempt.
You may be asked to submit sedation or anesthesia records to the College during your provisional authorization or following a re-inspection of a dental facility where you worked in the previous 36 months.
Follow this guide to submit sedation or anesthesia records to the College.
During the annual renewal you will be asked if you completed the required minimum number of cases. If you did not, you will be asked to provide an explanation.
If you do not complete the minimum number of cases in more than one consecutive year the College may cancel or downgrade your sedation authorization.
BLS/CPR (HCP)
- All sedation providers must maintain current life support training at all times. Current is defined as within two years from the date the course if completed or the expiry date listed on the certificate, whichever is less.
- All sedation providers must have at a minimum BLS, CPR (Health Care Practitioner) or its equivalent.
- If your BLS or CPR (Health Care Practitioner) has expired you must immediately stop administering sedation.
ACLS, PALS or PEARS
- You may also be required to have current ACLS, PALS or PEARS depending on your level/modality of sedation authorization, your patient demographic and your role on the sedation or anesthetic team.
- If your ACLS, PALS or PEARS is expired you may still be able to administer some levels of sedation to a particular patient demographic. It is your responsibility to review the life support training requirements in the Standard of Practice – Use of Sedation and General Anesthesia in Dental Practice and to comply at all times.
The same principles apply to all members of the sedation or anesthetic team.
All annual sedation authorizations expire annually on March 31
st. For more information on how to renew your sedation facility permit visit the
sedation renewal page.
The different types of sedation facility permits are explained on the sedation facility permit page. There is also a series of questions in the RCDSO Member Resource Centre (MRC) that were designed to guide the applicant to the right type of facility permit.
You can contact the Facility Inspection Program via sedation@rcdso.org if you are still unsure about the type of facility permit you require.
- Access to a desktop or laptop computer with internet connection. Mobile devices (smartphones, tablets) are not recommended.
- Your RCDSO Member Resource Centre (MRC) password.
- Credit card payment information (Visa, MasterCard, American Express)
- The full address of the facility, including postal code and unit number, if applicable.
- A list of all dentists who will be administering sedation at the facility (full name and RCDSO registration number), if known.
Facility Permits are non-transferrable. They cannot be transferred from one location to another, or from one owner to another.
The only exception is that a facility permit may be transferred from one existing co-owner to another co-owner. There must be continuity of ownership to qualify for this exception (i.e. the original Facility Permit Holder is remaining as a co-owner of the facility).
It is the obligation of the existing Facility Permit Holder to advise the Facility Inspection Program (sedation@rcdso.org) that the dental facility has moved or been sold.
If you believe you apply for an exception, contact the Facility Inspection Program via sedation@rcdso.org. Otherwise you can submit an application for a new facility permit.
Applications are processed in the order that they are received. Processing times may vary depending on the volume of applications in process.
The best way to ensure your permit application is processed in a timely manner is to verify your application is complete prior to submission and ensure you are prepared for the initial inspection.
If your application relates to a full practice sale or change of location you can submit the new facility permit application in advance and clearly indicate the date of the sale/relocation will be completed.
We will try to schedule an inspection soon after the date of sale/relocation to minimize the disruption of sedation services. However, it is impossible to completely avoid will be a disruption of services at the facility, we strongly advise against pre-booking patients who require sedation.
We only communicate with the Facility Permit Holder as they are the responsible individual.
Facility Permit applications – Initial Inspections
Before a sedation facility permit will be issued by the College, the College must inspect the dental facility to ensure that the facility is in compliance with the Standard of Practice – Use of Sedation and General Anesthesia in Dental Practice and the Facility Inspection Program facility requirements. This applies to all facilities, including those that just underwent a practice sale.
Once your application is approved, College staff will assign a facility inspector to your file. The Inspector will contact the facility permit holder via email to schedule a facility inspection.
Re-inspections
All dental facilities are re-inspected on a 36 month cycle.
Clinic staff that are part of the sedation or anesthetic team administering parenteral conscious sedation, deep sedation or general anesthesia are required to have life support training. The type of training required depends on level of sedation being administered to the patient and the sedation/anesthetic team format that the facility uses. For more information refer to the Standard of Practice – Use of Sedation and General Anesthesia in Dental Practice and the facility inspection checklists.
The sedation facility permit application and visiting provider application fees cover the cost of the initial inspection.
The sedation renewal fees cover the cost of 1 re-inspection every 36 months for each dental facility and visiting provider.
If additional inspections are required due to the facility or visiting provider’s failure to comply with the inspection process or failure to comply with the Standard of Practice – Use of Sedation and General Anesthesia in Dental Practice, then the College may require the facility permit holder or visiting provider cover the cost of the additional inspection. The dentist would be notified of this requirement and cost in advance.
The facility permit holder must establish written protocols for emergency procedures and review them with their staff regularly. This includes a fire protocol that contemplates evacuation of patients under sedation/anesthesia.
The College does not have template or sample emergency protocols.
As part of the facility permit re-inspection, you will be required to submit a minimum of 3 sedation/anesthesia records for each provider who administered sedation at the facility in the preceding 36 months.
Follow this guide to submit sedation or anesthesia records to the College.
Facility Permit applications
- If the dental facility is not in compliance during the initial facility inspection then the College will not issue the sedation facility permit.
- The Facility Inspection Program will communicate the deficiencies to the facility permit holder.
- The facility permit holder will be asked to submit proof that all deficiencies have been rectified to the Facility Inspection Program via inspections@rcdso.org. It is important that the facility permit number is included in the email subject line.
Re-inspections
- If the dental facility is not in compliance during a facility re-inspection then the College will direct the facility permit holder to ensure all practitioners immediately cease administration of sedation at the facility until the deficiencies are rectified to the satisfaction of the College. This communication will come from the Facility Inspection Program staff, not the College Inspector.
- College Inspectors have limited discretion to permit the facility permit holder to address the deficiencies after the inspection. They may give the facility permit holder 24-48hrs to provide outstanding documentation at their discretion.
- The Facility Inspection Program will communicate the deficiencies to the facility permit holder. This may take 1-2 weeks after the inspection report is received from the College Inspector.
- The facility permit holder will be asked to submit proof that all deficiencies have been rectified to the Facility Inspection Program via inspections@rcdso.org. It is important that the facility permit number is included in the email subject line.
- Practitioners may not resume administration of sedation at the facility until the Facility Inspection Program staff send the facility permit holder official correspondence advising them they may resume sedation. This may take 2 weeks after all proof of corrections are received by the College.
The Facility Inspection Program will not permit facilities to continue to administer sedation if they do not have all the required sedation equipment or emergency drugs.
Exceptions
Exceptions are only made in limited circumstances.
A dental facility may request permission to administer a lower level/modality of sedation for which they have all the required equipment and emergency drugs only if the required equipment or emergency drugs for the higher level/modality of sedation are not available.
For example, a dental facility with a deep sedation/general anesthesia permit may request an exception to provide oral moderate sedation if the deficiencies only relate to equipment or emergency drugs that are only required for deep sedation/general anesthesia.
Exceptions are only considered:
- Upon receipt of a request in writing from the facility permit holder; and
- With proof that the items that are missing for the higher level/modality of sedation are not available from any suppliers in their region (including online providers).
The Facility Inspection Program will not make an exception if the facility has just not ordered or received the required equipment or emergency drugs.
Drug shortages
The College recognizes that dental facilities may occasionally be impacted by drug shortages. The College will not permit a dental facility to continue to administer sedation if the required emergency drugs are expired.
Exceptions will only be made if Health Canada has issued a public notice that the expiry date for that particular drug has been extended. This information may be posted on the Canadian Pharmacist Association website.
All sedation facility permits expire annually on March 31st. For more information on how to renew your sedation facility permit visit the sedation renewal page.
