2020 State Board Proposed Rule Changes
On November 18, 2019, pursuant to their rule-making authority, the New Jersey State Board of Dentistry proposed changes to the New Jersey Administrative Code. These proposals, published to the public on November 25, 2019, were open for public comment until January 17, 2020. Some of these changes were minor, and others are significant. With your feedback and the guidance of NJAGD Board Members we drafted the attached letter to the New Jersey State Board of Dentistry to voice our concerns. It is our mission to represent our members as well as all general dentists in New Jersey.
The NJAGD will always fully consider all of our members’ concerns before we take a position as an organization. The AGD and NJAGD represents the interests of and advocates on behalf of general dentists. The professional organization committed to providing general dentists with representation before state and federal legislatures as well as regulatory agencies while
continuing to provide the perspective of general dentists to all the professional communities of interest.
Therefore, it is critical that you support the NJAGD as members. We can’t do this without you! Membership in the Academy of General Dentistry shows your commitment to professional development, and continuing education. The AGD acts as a full-service organization to assist you in remaining current with advances in the profession. NJAGD members must be members of national AGD.
Please consider renewing or becoming a new member today! Please click on the link below and together we will stand united!
If you need any assistance please do not hesitate to contact me.
New Jersey Academy of General Dentistry
1(866) GO NJAGD (466-5243) | www.NJAGD.org
Below is the aforementioned letter.
New Jersey State Board of Dentistry
124 Halsey Street
Newark, New Jersey 07102
Re: Proposed Rule Changes
Honorable Members of the Board:
On behalf of the New Jersey Academy of General Dentistry (NJAGD), please accept the following comments on the proposed New Jersey State Board of Dentistry rule changes. Each numbered item is the proposed change, followed by the NJAGD’s comment regarding that proposal.
These comments have been voted on and approved by the NJAGD Board on January 15th, 2020.
1) Proposal: Requiring both basic life support (BLS) and advanced cardiac life support (ACLS) for licensed dentists and two personnel who are present in the operation room during PCS.
NJAGD Comment: The NJAGD suggests an amendment to this proposed change. We agree that ACLS is important training for any dentist administering PCS, especially because PCS may progress into deep sedation. However, we submit that requiring that two personnel (dental assistants) also be trained in ACLS is too onerous a burden on assistants. This would require the assistants to be able to read an EKG, and to use and administer medications. Adding this requirement will reduce patient access to care, because providers would be less likely to renew their PCS permits. The NJAGD suggests that The New Jersey State Board of Dentistry have the same guidelines for PCS that the ADA has for General Anesthesia: “two additional individuals who have current certification of successfully completing a Basic Life Support Course for the Healthcare Provider” present in the operating room.
2) Proposal: Amending the formal training for PCS permits from a combined 80 hours to 40 hours in didactic instruction and 40 hours in supervised clinical training, including certification in capnography competency.
NJAGD Comment: The NJAGD suggests three amendments to this proposed change. First, we would like to request more specific training requirements, including 20 live patient case experiences. ADA guidelines require 60 hours of instruction and 20 case experiences with all 20 being live case experiences. Nationally, the AGD has fought to maintain the old requirement that
dentists who wish to practice IV sedation have had training providing IV sedation to at least 20 live patients.
Second, we ask that a distinction be made between minimal and moderate sedation. The AAPD/AAP and ADA differentiate between the two, and the practitioner must be prepared for both situations. See “AAPD/AAP definitions”, PEDIATRICS, Volume 138, number 1, p. e9-e10 (July 2016).
Defining the level of sedation, the category of medications (ie. propofol should not be used for mild or moderate sedation), prohibiting multidrug cocktails (i.e. fentanyl and propofol) and guidelines specific for children vs adults (specifically certification in PALS) will create a safer environment for the public.
Lastly, the NJAGD proposes eliminating requiring certification in capnography, because the use of precordial/pretracheal stethoscope is just as accurate. In the recent past, the AGD has opposed the 2016 ADA Guidelines that mandated capnography and support the AAP/AAPD guideline/position that dentists should have a choice of capnography or precordial/pretracheal stethoscope to monitor breather during PCS. AAP/AAPD guidelines do not require preclusions or invalidations to apply for a dentist to select stethoscope instead of capnography. Similarly, the NJAGD would like to suggest that the practitioner have a choice between capnography and the use of precordial/pretracheal stethoscope.
3) Proposal: Requirements regarding IV administration sets and tubing; syringes, needles, IV catheters, and tape scissors; laryngoscopes, assorted size blades, and spare batteries; endotracheal tubes (adult and pediatric sizes); magil forceps; yankauer type suction tips and catheter suction; and a capnometer. The Board is also proposing to amend the requirement for suction to specify suction equipment capable of aspirating gastric contents from the mouth and pharynx.
NJAGD Comment: The NJAGD suggests two amendments to this proposed change. First, the NJAGD proposes removing the requirement of laryngoscopes and endotracheal tubes, and instead suggests that LMA’s (Laryngeal Mask Airway) be the required equipment to serve the same purpose. It is safer and easier to operate for a dentist not intubating regularly. Intubations and the
use of a laryngoscope require a high skill level that needs regular use to be effectively maintained.
Moreover, unsuccessful attempts to use a laryngoscope can put the patient at risk. Requiring it in every office would encourage use by practitioners who might not be confident enough in the equipment to use it safely.
Second, the NJAGD suggests that the list of medication categories be more consistent with what is needed for PCS. For example, cardio drugs and dantrolene are excessive for PCS.
Proposal: Requiring all Treatment plans to be signed by the patient, and in the event of significant changes, must be amended and re-signed.
NJAGD Comment: The NJAGD proposes an amendment to this suggested change, to
establish a threshold requirements before it applies. Specifically, the NJAGD proposes that the change only
apply to those treatment plans which are over $2,500.
We believe we need to respond to this change because we represent general dentists. We understand that most hospital based facilities require this on all treatment plans. For a general dentist in a smaller practice, this creates an undue burden for small procedures performed on a daily basis. We do believe that for larger treatment plans a signed treatment plan is necessary.
However we think for a simple filling diagnosed in hygiene having a patient sign a form would slow down patient care and create additional clerical work, without providing any significant benefit to the patient.
4) Proposal: Requiring that, in addition to the existing equipment required to maintain adult and pediatric airways, all offices must have an AED and contain back up battery operated equipment consisting of at least lighting, suction and a pulse oximeter.
NJAGD Comment: The NJAGD suggests an amendment to this proposed change, eliminating battery back up suction and pulse oximeter. These are excessive for anyone not doing PCS. The NJAGD proposes that this be suggested equipment for the general dentist and required for those with PCS permits.
Thank you for your attention to our concerns, which we offer in the spirit of achieving the
same goals as this Honorable Board: the best and safest patient care.
The New Jersey Academy of General Dentistry
Dr. Narpat Ja