NITROUS OXIDE
House Bill 4675
Sponsor: Rep. Barb Vander Veen
Committee: Health Policy
Complete to 6-23-03
A SUMMARY OF HOUSE BILL 4675 AS INTRODUCED 5-13-03
Currently, only a licensed dentist can administer nitrous oxide to a patient. The bill would amend the Public Health Code to allow a dental hygienist to also administer nitrous oxide, and to allow a dental assistant to monitor and assist in the administration of the drug.
Dental hygienist. Under a dentist’s direct supervision, a dental hygienist may currently administer intraoral block and infiltration anesthesia to a patient who is at least 18 years old. The bill would delete the age restriction, allowing a hygienist to administer anesthesia to all patients, and would expand the scope of practice for hygienists to include the administration of nitrous oxide analgesia.
In addition to the training course, examination, and certification now required for the administration of local anesthesia, a dental hygienist would have to complete a course containing at least four hours of didactic instruction and four hours of clinical experience in nitrous oxide analgesia. The course would have to include training in nitrous oxide analgesia medical emergencies, pharmacology of nitrous oxide, and nitrous oxide techniques. If available, a course in selection of pain control modalities should be taken by the hygienist intending to administer either local anesthesia or nitrous oxide analgesia.
A state or regional board-administered written examination would have to be successfully completed within 18 months of completing the course work in nitrous oxide analgesia, if such a course were available and approved by the Department of Community Health (DCH). As in the case of certification to administer local anesthesia, applying for certification in the administration of nitrous oxide would be at the discretion of the hygienist. The bill would specify that the certification for administering either local anesthesia or nitrous oxide would have to issued or documented by the DCH or its designee.
Dental assistants. The bill would expand the scope of practice for registered dental assistants by allowing them, under a dentist’s direct supervision, to monitor and assist the administration of nitrous oxide analgesia. “Assisting” would be defined as setting up equipment and placing the face mask. The term would not include titrating and turning on or off equipment. The nitrous oxide levels would have to be preset by the dentist or dental hygienist and could not be adjusted by the dental assistant. “Monitoring” would mean observing levels, admonishing, and reporting to the dentist or dental hygienist.
Under a dentist’s delegation and direct supervision, a registered dental assistant could assist and monitor the administration of nitrous oxide analgesia by the dentist or dental hygienist if the dental assistant had successfully completed a course in assisting and monitoring the
administration of the drug offered by a dental or dental assisting program accredited by the Commission on Dental Accreditation of the American Dental Association and approved by the DCH. The course would have to contain a minimum of five hours of didactic instruction and include the following content:
· Nitrous oxide analgesia medical emergencies techniques;
· pharmacology of nitrous oxide techniques; and,
· nitrous oxide techniques.
(The Public Health Code defines “direct supervision” of a dentist to mean that a dentist designates the patient upon whom the procedures are to be performed and describes the procedures to be performed; examines the patient both before prescribing the procedures and upon completion of the procedures; and is physically present in the office at the time the procedures are being performed.)
MCL 333.16611
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This analysis was prepared by nonpartisan House staff for use by House members in their deliberations, and does not constitute an official statement of legislative intent.