Washington Administrative Code

When anesthetic agents of any kind are administered, the dentist and staff must have access to an AED or defibrillator. The AED or defibrillator must be available and in reach within 60 seconds.[Statutory Authority: RCW 18.32.0365 and 18.32.640. WSR 24-01-033, § 246-817-722, file…

When anesthetic agents of any kind are administered, the dentist must comply with the requirements in this section.(1) The anesthesia provider or anesthesia monitor shall record the patient's condition. The record must include documentation of all medications administered with do…

Local anesthesia must only be administered by a provider qualified under this chapter and dental hygienists as provided in chapter 18.29 RCW.(1) "Local anesthesia" means the elimination of sensations, especially pain, in one part of the body by the topical application or regional…

(1) To administer minimal sedation with nitrous oxide, a licensed dentist shall successfully complete a minimum of 14 hours of education and training in one of the following:(a) Minimal sedation with nitrous oxide;(b) Moderate sedation with nitrous oxide;(c) Advanced education pr…

(1) To administer minimal sedation which is limited to a single dose of a single oral agent with or without nitrous oxide, a licensed dentist shall successfully complete a minimum of 16 hours of education and training in one of the following:(a) Minimal sedation; or(b) Moderate s…

(1) A licensed dentist is required to hold a permit of authorization to administer moderate sedation with enteral agents.(2) To obtain a moderate sedation with enteral agents permit, a licensed dentist shall:(a) Comply with the permitting and renewal requirements in WAC 246-817-7…

(1) A licensed dentist is required to hold a permit of authorization to administer moderate sedation with parenteral agents. A moderate sedation with parenteral agents permit allows the holder to deliver moderate sedation with enteral agents without obtaining a separate permit.(2…

A pediatric patient is physiologically and anatomically unlike an adult, and different sedation drugs and practices may be used for this population, it is necessary to ensure that adequately trained and skilled individuals are treating pediatric patients.(1) Effective January 1, …

(1) A licensed dentist is required to hold a permit of authorization to administer deep sedation or general anesthesia. A general anesthesia permit allows the holder to deliver moderate sedation with enteral or moderate sedation with parenteral agents without obtaining a separate…

(1) A dental anesthesia assistant shall be certified under chapter 18.350 RCW and WAC 246-817-205.(2) A dental anesthesia assistant may only accept delegation from an oral and maxillofacial surgeon or dental anesthesiologist who holds a valid Washington state general anesthesia p…

(1) When a licensed dentist is also administering moderate sedation with parenteral agents, deep sedation or general anesthesia, one additional appropriately trained team member must be designated for patient monitoring. The team member designated for patient monitoring when gene…

Continuing education must contribute to the professional knowledge and development of the licensed dentist to enhance sedation services provided to patients.(1) The continuing education reporting period for a licensed dentist that administers sedation in Washington before Decembe…

(1) To administer moderate sedation with enteral agents, moderate sedation with parenteral agents, or general anesthesia,including deep sedation, a licensed dentist shall:(a) Meet the requirements of this chapter;(b) Possess and maintain a valid dentist license pursuant to chapte…

(1) A licensed dentist shall conduct a self-assessment of their office preparedness for emergencies, proper emergency equipment, and emergency drugs annually. The annual self-assessment attestation must be maintained for five years.(2) A licensed dentist who holds a valid moderat…

The licensed dentist shall ensure an anesthesia provider assesses patient responsiveness using preoperative values as normal guidelines and discharge the patient only when the following criteria are met, except when their prior baseline is below the noted criteria:(1) Vital signs…

(1) A licensed dentist shall have a contract in place when working with a nondentist anesthesia provider. The contract must include:(a) That all facility, equipment, monitoring, and training requirements, for all personnel required in WAC 246-817-701 through 246-817-790 have been…

A licensed dentist shall submit a report of any patient death or other life-threatening incident or complication, permanent injury or admission to a hospital that results in a stay at the hospital for more than 24 hours, which is or may be a result of a dental procedure caused by…

The provisions of the Uniform Disciplinary Act, chapter 18.130 RCW, apply to the permits and endorsements of authorization that may be issued and renewed under this chapter.[Statutory Authority: RCW 18.32.0365 and 18.32.640. WSR 24-01-033, § 246-817-790, filed 12/11/23, effective…

It is the intent of the legislature that the DQAC seek ways to identify and support the rehabilitation of dentists where practice or competency may be impaired due to an applicable impairing or potentially impairing health condition. The legislature intends that these dentists be…

"Aftercare" is that period of time after intensive treatment that provides the dentist or the dentist's family with group or individual counseling sessions, discussions with other families, ongoing contact and participation in self-help groups, and ongoing continued support of tr…

The DQAC will approve the physician health program or substance use disorder monitoring program(s) which will participate in the recovery of dentists. The DQAC will enter into a contract with the approved physician health program or substance use disorder monitoring program(s) on…

(1) In lieu of disciplinary action, the dentist may accept DQAC referral into an approved physician health program or substance use disorder monitoring program.(a) The dentist shall undergo a complete physical and psychosocial evaluation before entering the approved physician hea…

WAC 246-817-901 through 246-817-980 govern the prescribing of opioids in the treatment of pain.[Statutory Authority: RCW 18.32.002, 18.32.0365, 18.32.800 and 2017 c 297. WSR 19-02-043, § 246-817-901, filed 12/26/18, effective 1/26/19. Statutory Authority: RCW 18.32.785 and 18.32.…

WAC 246-817-901 through 246-817-980 do not apply to:(1) The treatment of patients with cancer-related pain. Cancer-related pain means pain that is unpleasant, persistent, subjective sensory and emotional experience associated with actual or potential tissue injury or damage or de…

The definitions in this section apply to WAC 246-817-901 through 246-817-980 unless the context clearly requires otherwise:(1) "Aberrant behavior" means behavior that indicates misuse, diversion or substance use disorder. This includes, but is not limited to, multiple early refil…

(1) The dentist shall discuss with the patient educating them of risks associated with the use of opioids, including the risk of dependence and overdose. The dentist shall document such notification in the patient record.(2) Patient notification must occur, at a minimum, at the f…

The dentist shall consider multimodal pharmacologic and nonpharmacologic therapy for pain rather than defaulting to the use of opioid therapy alone whenever reasonable, evidence-based, clinically appropriate alternatives exist.[Statutory Authority: RCW 18.32.002, 18.32.0365, 18.3…

(1) In order to prescribe an opioid in Washington state, a dentist licensed to prescribe opioids shall complete a one-time continuing education requirement regarding best practices in the prescribing of opioids and the rules in this chapter. The continuing education must be at le…

The practitioner shall include the diagnosis, indication for use, or the International Classification of Diseases (ICD) code on all opioid prescriptions.[Statutory Authority: RCW 18.32.002, 18.32.0365, 18.32.800 and 2017 c 297. WSR 19-02-043, § 246-817-911, filed 12/26/18, effect…

The dentist shall comply with the requirements in this section when prescribing opioid analgesics for acute nonoperative pain or acute perioperative pain and shall document completion of these requirements in the patient record:(1) The dentist shall consider prescribing nonopioid…

The dentist shall comply with the requirements in this section when prescribing opioid analgesics for subacute pain, and shall document completion of these requirements in the patient record:(1) Prior to prescribing an opioid for subacute pain, the dentist shall:(a) Conduct an ap…

(1) The dentist shall recognize the progression of a patient from the acute nonoperative or acute perioperative phase to the subacute phase and take into consideration the risks and benefits of continued opioid prescribing for the patient.(2) If tapering has not begun prior to th…

The dentist shall evaluate and document the patient's health history and physical examination in the patient record prior to treating for chronic pain.(1) History. The patient's health history must include:(a) The nature and intensity of the pain;(b) The effect of pain on physica…

(1) When the patient enters the chronic pain phase, the dentist shall reevaluate the patient by treating the situation as a new disease.(2) The chronic pain treatment plan must state the objectives that will be used to determine treatment success and must include, at a minimum:(a…

The dentist shall use a written agreement for treatment with the patient who requires long-term opioid therapy for chronic pain that outlines the patient's responsibilities. This written agreement for treatment must include:(1) The patient's agreement to provide biological sample…

(1) The dentist shall periodically review the course of treatment for chronic pain. The frequency of visits, biological testing, and PMP queries must be determined based on the patient's risk category:(a) For a high-risk patient, at least quarterly;(b) For a moderate-risk patient…

(1) The dentist shall consider referring the patient for additional evaluation and treatment as needed to achieve treatment objectives. Special attention should be given to those chronic pain patients who are under eighteen years of age or who are potential high-risk patients. Th…

A dentist is not required to consult with a pain management specialist as described in WAC 246-817-965 when the dentist has documented adherence to all standards of practice as defined in WAC 246-817-919 through 246-817-967 and when one or more of the following conditions are met…

The dentist is exempt from the consultation requirement in WAC 246-817-950 if one or more of the following qualifications are met:(1) The dentist is a pain management specialist under WAC 246-817-965;(2) The dentist has successfully completed every four years a minimum of twelve …

A pain management specialist shall meet the following qualifications:(1) A dentist shall be board certified or board eligible in oral medicine or orofacial pain by the American Board of Oral Medicine or the American Board of Orofacial Pain.(2) An allopathic physician shall meet r…

(1) The dentist shall assess and document the appropriateness of continued use of the current treatment plan if the patient's response to or compliance with the current treatment plan is unsatisfactory.(2) The dentist shall consider tapering, changing, discontinuing treatment, or…

(1) When a patient receiving chronic opioid pain medications changes to a new dentist, it is normally appropriate for the new dentist to initially maintain the patient's current opioid doses. Over time, the dentist may evaluate if any tapering or other adjustments in the treatmen…

(1) Patients twenty-four years of age or under. In the treatment of pain for patients twenty-four years of age or under, the dentist shall treat pain in a manner equal with that of an adult but must account for the weight of the patient and adjust the dosage prescribed accordingl…

(1) When providing episodic care for a patient who the dentist knows is being treated with opioids for chronic pain, such as for emergency or urgent care, the dentist shall review the PMP to identify any Schedule II-V or drugs of concern received by the patient and document in th…

(1) The dentist shall not knowingly prescribe opioids in combination with the following Schedule II-IV medications without documentation of clinical judgment and discussion of risks with patient:(a) Benzodiazepines;(b) Barbiturates;(c) Sedatives;(d) Carisoprodol; or(e) Sleeping m…

(1) Where practicable, the dentist providing acute nonoperative pain or acute perioperative pain treatment to a patient known to be receiving MAT shall prescribe opioids for pain relief either in consultation with the MAT prescribing practitioner or a pain specialist.(2) A dentis…

The dentist shall confirm or provide a current prescription for naloxone or refer the patient to a pharmacist for further counseling and evaluation when opioids are prescribed to a high-risk patient.[Statutory Authority: RCW 18.32.002, 18.32.0365, 18.32.800 and 2017 c 297. WSR 19…

(1) The dentist shall register to access the PMP or demonstrate proof of having assured access to the PMP if they prescribe opioids in Washington state.(2) The dentist is permitted to delegate performance of a required PMP query to an authorized designee.(3) At a minimum, the den…

(1) Licenses must be renewed every year on the practitioner's birthday as provided in chapter 246-12 WAC, except faculty and resident licenses.(2) Faculty and resident licenses must be renewed every year on July 1 as provided in chapter 246-12 WAC.(3) The following nonrefundable …

(1) Credentials must be renewed every year on the practitioner's birthday as provided in chapter 246-12 WAC.(2) The following nonrefundable fees will be charged for dental assistant, dental anesthesia assistant, and expanded function dental auxiliary credentials:Title of Fee - De…