# Title 20 — State Board of Dental Examiners

## Article 20-02 — Dentists

## Chapter 20-02-01 — General Requirements

### § 20-02-01-01. Advertising.

1. Advertising by dentists is permitted to disseminate information for the purpose of providing the
public a sufficient basis upon which to make an informed selection of dentists. In the interest
of protecting the public health, safety, and welfare, advertising which is false, deceptive, or
misleading is prohibited.
2. All advertising must contain the legal name of the dentist, or a reasonable variation thereof. In
the case of a partnership or corporation, the name used in the advertisement may be the true
name of the partnership or corporation. The advertisement must also contain the location, or
locations, of the dentist, partnership, or corporation. It is false or misleading for a dentist to
hold themselves out to the public as a specialist, or any variation of that term, in a practice
area unless the dentist meets the criteria of subsection 3.
3. A dentist engaged in general practice who wishes to announce the services available in the
dentist's practice is permitted to announce the availability of those services as long as the
dentist avoids using language that expresses or implies that the dentist is a specialist. If a
dentist, other than a specialist, wishes to advertise a limitation of practice, such advertisement
must state that the limited practice is being conducted by a general dentist. A dentist who is a
specialist may announce the dentist's bona fide specialty provided that the dentist has
successfully completed a qualifying postdoctoral educational program accredited by an
agency recognized by the United States department of education, of full-time study two or
more years in length, resulting in a master of science degree or certificate from an accredited
program or be a diplomate of a nationally recognized certifying board approved by this board.

Such a dentist may announce that the dentist's practice is limited to the special area of dental
practice in which the dentist has or wishes to announce. In determining whether an
organization is a qualifying specialty board or organization, the board shall consider the
following standards:
a. Whether the organization requires completion of an educational program with didactic,
clinical, and experiential requirements appropriate for the specialty or subspecialty field
of dentistry in which the dentist seeks certification, and the collective didactic, clinical,
and experiential requirements are similar in scope and complexity to a qualifying
postdoctoral educational program. Programs that require solely experiential training,
continuing education classes, on-the-job training, or payment to the specialty board shall
not constitute a qualifying specialty board or organization;
b. Whether the organization requires all dentists seeking certification to pass a written or
oral examination, or both, that tests the applicant's knowledge and skill in the specialty or
subspecialty area of dentistry and includes a psychometric evaluation for validation;
c. Whether the organization has written rules on maintenance of certification and requires
periodic recertification;
d. Whether the organization has written bylaws and a code of ethics to guide the practice of
its members;
e. Whether the organization has staff to respond to consumer and regulatory inquiries; and
f. Whether the organization is recognized by another entity whose primary purpose is to
evaluate and assess dental specialty boards and organizations.
4. A dentist who advertises on radio or television must retain a recorded copy of such advertising
for a period of one year following the termination of the use of such advertising, and is
responsible to make recorded copies of such advertising available to the North Dakota state
board of dental examiners within thirty days following a request from the board for such
copies.
5. No dentist may advertise the dentist, the dentist's staff, the dentist's services, or the dentist's
method or methods of delivery of dental services to be superior to those of any other licensed
dentist, unless such claim or claims can be substantiated by the advertiser, upon whom rests
the burden of proof.
6. This section may not be construed to prohibit a dentist who does not qualify to hold themself
out to the public as a specialist under subsection 3 from restricting the dental practice to one
or more specific areas of dentistry or from advertising the availability of dental services,
provided that such advertisements do not include the term "specialist", or any variation of that
term, and must state that the services advertised are to be provided by a general dentist. No
advertising by a dentist may contain representations or other information contrary to the
provisions of North Dakota Century Code section 43-28-18 or North Dakota Administrative
Code title 20.
History: Effective September 1, 1980; amended effective February 1, 1992; October 1, 1993; April 1,
2015; July 1, 2022.
General Authority: NDCC 43-28-06
Law Implemented: NDCC 43-28-06, 43-28-10, 43-28-10.1, 43-28-18

### § 20-02-01-02. Office emergency.

Every dentist, dental hygienist, dental assistant, qualified dental assistant, dental anesthesia
assistant, qualified dental assistant-limited radiology registrant, or registered dental assistant practicing
in North Dakota must have a current certificate of proficiency in cardiopulmonary resuscitation.
History: Effective February 1, 1992; amended effective October 1, 1993; May 1, 1996; August 1, 1998;
January 1, 2011; October 1, 2024.
General Authority: NDCC 43-20-10, 43-28-06
Law Implemented: NDCC 43-20-01.2, 43-20-01.3, 43-20-10, 43-20-13.2, 43-28-06, 43-28-10.1,
43-28-15
### § 20-02-01-03. Nitrous oxide.

Repealed effective July 1, 2022.
### § 20-02-01-03.1. Additional requirements for licensure by examination.

The board may grant a license to practice dentistry to an applicant who has met the requirements
of North Dakota Century Code section 43-28-10.1 and all the following requirements:
1. The applicant has passed the examination administered by the joint commission on national
dental examinations or the national dental examining board of Canada within five years of
application.
2. The applicant has passed, within five years of application, a clinical competency examination
approved by the board. Required components shall include a periodontal component,
posterior composite or amalgam restoration, a class three restorative procedure, and an
endodontic component, and after April 1, 2021, a fixed prosthetic component.
3. The applicant has successfully completed a cardiopulmonary resuscitation course within two
years of application.
4. The applicant has the physical health and visual acuity to enable the applicant to meet the
minimum standards of professional competence.
History: Effective January 1, 2011; amended effective April 1, 2015; July 1, 2017; April 1, 2021.
General Authority: NDCC 43-28-06
Law Implemented: NDCC 43-28-10.1
### § 20-02-01-03.2. Additional requirements for licensure by credential review.

The board may grant a license to practice dentistry to an applicant who has met the requirements
of North Dakota Century Code section 43-28-15 and all the following requirements:
1. The applicant has successfully completed a cardiopulmonary resuscitation course within two
years of application.
2. The applicant has the physical health and visual acuity to enable the applicant to meet the
minimum standards of professional competence.
3. The applicant has completed thirty-two hours of continuing education in accordance with
section 20-02-01-06 within two years of application.
History: Effective January 1, 2011.
General Authority: NDCC 43-28-06
Law Implemented: NDCC 43-28-15

### § 20-02-01-03.3. Additional requirements for applications.

Applications must be completed within six months of filing. The board may require an interview with
the applicant. In addition to the application requirements of North Dakota Century Code sections
43-28-11, 43-28-15, and 43-28-17, the board may require an application to include:
1. Proof of identity, including any name change.
2. An official transcript sent by an accredited dental school directly to the board.
3. Evidence demonstrating the applicant passed the examination administered by the joint
commission on national dental examinations within five years of application.
4. Evidence demonstrating the applicant passed a clinical competency examination, approved by
the board, within five years of application.
5. Anything necessary for a criminal history record check pursuant to North Dakota Century
Code section 43-28-11.2.
6. A certification, from the licensing board of every jurisdiction in which the applicant is licensed,
that the applicant is licensed in good standing.
7. Certification that the applicant has completed a cardiopulmonary resuscitation course within
two years of application.
8. Verification of physical health and visual acuity.
9. For applications for licensure by credential review, the law and rules stating the requirements
for licensure, when the applicant was licensed, of the jurisdiction in which the applicant is
licensed.
10. For applications for licensure by credential review and reinstatement from inactive status,
proof of completion of thirty-two hours of continuing education in accordance with section
11. Any information required by the application forms prescribed by the board.
History: Effective January 1, 2011; amended effective April 1, 2015; October 1, 2024.
General Authority: NDCC 43-28-06
Law Implemented: NDCC 43-28-10.1, 43-28-11, 43-28-11.2, 43-28-15, 43-28-17
### § 20-02-01-03.4. Clinical competency examination retakes.

If an applicant taking the clinical competency examination in the integrated format is unsuccessful
after having exhausted all allowable retake opportunities for the failed parts, one failure is recorded.
The applicant then shall retake all five parts of the examination in the traditional format. If the applicant
is unsuccessful in one or more parts, a second failure is recorded. If the failed parts are retaken and
failed again, a third failure shall be recorded. A dental applicant may take a clinical examination three
times before remedial training is required. After failing the examination for a third time, and prior to the
fourth attempt of the examination, an applicant shall:
1. Submit to the board a detailed plan for remedial training by an accredited dental school or a
dental testing agency. The proposed remedial training must be approved by the board.
2. Submit to the board proof of passing the remedial training within twenty-four months of its
approval by the board.

The board may grant or deny a fourth attempt of the clinical examination. A fourth attempt must occur
within twelve months of the date of the board's decision. If an applicant fails any part of the examination
after remedial training, additional retakes must be approved by the board.
History: Effective January 1, 2011; amended effective October 1, 2024.
General Authority: NDCC 43-28-06
Law Implemented: NDCC 43-28-06, 43-28-10.1, 43-28-17
### § 20-02-01-04. Temporary license to practice dentistry.

The board may grant a nonrenewable temporary license to practice dentistry in the state of North
Dakota for a period not to exceed one year. Between meetings of the board, the executive director of
the board may review the temporary license application and grant a provisional license if all
requirements are met.
1. A temporary license to practice dentistry in North Dakota may be granted to a dentist when the
dentist:
a. Has applied to the board as prescribed in North Dakota Century Code section 43-28-11.
b. Has paid the nonrefundable application and license fee that may be prescribed by the
board.
c. Holds an active dental license in another jurisdiction, has been a full-time student or
resident of a dental program accredited by the American dental association's commission
on dental accreditation within the last six months and provides evidence of a diploma
from a program accredited by the commission on dental accreditation of the American
dental association and meets any other requirements to receive a license to practice
dentistry under section 20-02-01-03.1, and 20-02-01-03.2, or has held a North Dakota
dental license within the previous five years.
d. Has provided a statement from the licensing authority of all the states in which the dentist
is licensed that the dentist's license is unencumbered, unrestricted, and that the dentist's
professional record is free of blemish for professional misconduct, substandard care, or
violations of the state's practice act.
e. Has certified that no disciplinary actions are pending in other states or jurisdictions.
f. Has authorized the board to seek information concerning the dentist's professional and
personal background and agrees to hold harmless those individuals who may provide
such information to the board.
g. The applicant has completed thirty-two hours of continuing education in accordance with
section 20-02-01-06.
h. The board shall require a criminal background check if the licensee anticipates practicing
for a period greater than ten days.
2. The board may apply such restrictions as it deems appropriate to limit the scope of the
practice of dentistry under the authority of the temporary license.
3. The board may restrict the licensee to engage in dental practice, as may be limited above,
only at certain and specifically defined practice locations.
4. The board may require the North Dakota jurisprudence examination.
History: Effective February 1, 1992; amended effective October 1, 2007; January 1, 2011; April 1,
2015; July 1, 2017.

General Authority: NDCC 43-28-06
Law Implemented: NDCC 43-28-06
### § 20-02-01-04.1. Restricted license to practice dentistry.

Repealed effective October 1, 2007.
### § 20-02-01-04.2. Volunteer license to practice dentistry.

A patient who is seen by a dentist who holds a volunteer license to practice dentistry shall not be
considered a patient of record of the volunteer dentist. The dentist is not obligated to treat the patient
outside of the volunteer practice setting. Between meetings of the board, the executive director of the
board may review the volunteer license application and grant a provisional license if all the
requirements are met. A volunteer license to practice dentistry in North Dakota, renewable annually by
application to the board, may be granted when the following conditions are met:
1. The applicant was formerly licensed and actively practicing in the state of North Dakota or
another jurisdiction for at least three of the five years immediately preceding application,
where the requirements are at least substantially equivalent to those of this state; or
a. The applicant is the resident of a board-approved specialty program; or
b. The board determines that the applicant is qualified and satisfies the criteria specified
under North Dakota Century Code section 43-28-10.1.
2. The applicant agrees to provide primary health services without remuneration directly or
indirectly in a board-approved setting.
3. The applicant holds a current cardiopulmonary resuscitation course certification.
4. The applicant has completed continuing education requirements of the board.
5. The applicant has made application for a volunteer dental license in a manner prescribed by
the board.
6. The board may collect from the applicant the nonrefundable application and license fee
prescribed by the board.
7. The board may apply such restrictions as it deems appropriate to limit the scope of the
practice of dentistry under the authority of the volunteer license.
History: Effective April 1, 2000; amended effective January 1, 2011; April 1, 2015; July 1, 2022.
General Authority: NDCC 43-28-06
Law Implemented: NDCC 43-28-06
### § 20-02-01-04.3. Inactive status - License reinstatement.

Upon payment of the fee determined by the board, a dentist may place the dentist's license on
inactive status. A dentist on inactive status is excused from the payment of renewal fees, except
inactive status renewal fees, and continuing education. A dentist on inactive status may not practice in
North Dakota. To reinstate a license on inactive status, the dentist shall apply on the form as prescribed
by the board, pay a reinstatement fee, and meet all of the following requirements:
1. The applicant has passed a clinical competency examination administered by a dental testing
service, approved by the board in section 20-02-01-03.1, within five years of application or
provides evidence of the clinical practice of dentistry within the previous five years. The board
may waive this requirement at the board's discretion.

2. The applicant has passed a written examination on the laws and rules governing the practice
of dentistry in this state administered by the board at a meeting.
3. The applicant has completed thirty-two hours of continuing education in accordance with
section 20-02-01-06 within two years of application.
4. The applicant successfully has completed a cardiopulmonary resuscitation course within two
years of application.
5. Grounds for denial of the application under North Dakota Century Code section 43-28-18 do
not exist.
History: Effective April 1, 2006; amended effective January 1, 2011; July 1, 2017; July 1, 2022;
October 1, 2024.
General Authority: NDCC 43-28-06
Law Implemented: NDCC 43-28-17
### § 20-02-01-05. Anesthesia and sedation permit requirements.

The rules in this chapter are adopted to define standards for the administration of anesthesia and
sedation by dentists or a dentist who collaborates with a qualified and licensed anesthesia or sedation
provider. A dentist may not use any form of sedation on any patient if the intent is beyond minimal
sedation unless such dentist has a permit, currently in effect, issued by the board, and renewable
biennially thereafter, authorizing the use of such general anesthesia, deep sedation, or moderate
sedation. With the administration of anesthesia, the qualified dentist must have the training, skills,
drugs, and equipment immediately available in order to rapidly identify and manage an adverse
occurrence until either emergency medical assistance arrives or the patient returns to the intended
level of sedation or full recovery without airway, respiratory, or cardiovascular complications.
1. Administration of nitrous oxide inhalation analgesia - Requirements. The following standards
apply to the administration of nitrous oxide inhalation analgesia:
a. Inhalation equipment must have a fail-safe system that is appropriately checked and
calibrated. The equipment also must have either a functioning device that prohibits the
delivery of less than thirty percent oxygen or an appropriately calibrated and functioning
in-line oxygen analyzer with audible alarm. A scavenging system must be available if
gases other than oxygen or air are used.
b. Patient dental records must include the concentration administered and duration of
administration.
c. A dentist may not delegate monitoring of nitrous oxide inhalation analgesia once the
patient has ingested an enteral drug for the purpose of minimal sedation.
d. Before authorizing a dental hygienist or registered dental assistant to administer nitrous
oxide inhalation analgesia, the dentist shall provide and document training in the proper
and safe operation of the nitrous oxide inhalation analgesia equipment.
e. A patient receiving nitrous oxide inhalation analgesia must be continually monitored by
authorized dental staff. A dental hygienist or a registered dental assistant may terminate
or reduce the amount of nitrous oxide previously administered by the authorized nitrous
oxide inhalation analgesia provider.
f. The board may issue a permit authorizing the administration of nitrous oxide inhalation to
a dentist, dental hygienist, or registered dental assistant if the dentist, dental hygienist, or
registered dental assistant provides:

(1) Evidence of successful completion of a twelve-hour, board-approved course of
training or course provided by a program accredited by an accrediting body
recognized by the United States department of education, and has either:
(a) Completed the course within thirteen months before application; or
(b) Completed the course more than thirteen months before application, legally
administered nitrous oxide inhalation analgesia for a period of time during the
three years preceding application, and provided written documentation from a
dentist that has employed or supervised the applicant, attesting to the current
clinical proficiency of the applicant to administer nitrous oxide inhalation
analgesia.
(2) Evidence of current certification in basic life support by the American heart
association for the health care provider, or an equivalent program approved by the
board.
2. Administration of minimal sedation. A dentist administering minimal sedation shall maintain
basic life support certification and comply with the following standards:
a. An appropriate sedative record must be maintained and must contain the names and
time of all drugs administered, including local anesthetics and nitrous oxide. The time and
condition of the patient at discharge from the treatment area and facility requires
documentation.
b. Medications used to produce minimal sedation are limited to a single enteral drug,
administered either singly or in divided doses, by the enteral route to achieve the desired
clinical effect, not to exceed the maximum food and drug administration recommended
dose for unmonitored home use in a single appointment. The administration of enteral
drugs exceeding the maximum recommended dose during a single appointment is
considered to be moderate sedation.
c. Drugs and techniques used must carry a margin of safety wide enough to render the
unintended loss of consciousness unlikely for minimal sedation, factoring in titration and
the patient's age, comorbidities, weight, body mass index, and ability to metabolize
drugs.
d. Combining two or more enteral drugs, excluding nitrous oxide, prescribing or
administering drugs that are not recommended for unmonitored home use, or
administering any parenteral drug constitutes moderate sedation and requires that the
dentist must hold a moderate sedation permit.
e. Facilities and equipment must include:
(1) Suction equipment capable of aspirating gastric contents from the mouth and
pharynx;
(2) Portable oxygen delivery system, including full face masks and a bag-valve-mask
combination with appropriate connectors capable of delivering positive pressure,
oxygen enriched ventilation to the patient;
(3) Blood pressure cuff (or sphygmomanometer) of appropriate size;
(4) Automated external defibrillator or defibrillator;
(5) Stethoscope or equivalent monitoring device; and

(6) The following emergency drugs must be available and maintained:
(a) Bronchodilator;
(b) Anti-hypoglycemic agent;
(c) Aspirin;
(d) Antihistaminic;
(e) Coronary artery vasodilator; and
(f) Anti-anaphylactic agent.
f. A dentist or qualified dental staff member responsible for patient monitoring must be
continuously in the presence of the patient in the office, operatory, and recovery area
before administration or, if the patient self-administered the sedative agent, immediately
upon arrival and throughout recovery until the patient is discharged by the dentist.
g. A dentist shall ensure any advertisements related to the availability of antianxiety
premedication, or minimal sedation clearly reflect the level of sedation provided and are
not misleading.
3. Administration of moderate sedation. Before administering moderate sedation, a dentist
licensed under North Dakota Century Code chapter 43-28 shall obtain a permit issued by the
board, renewable biennially thereafter. An applicant for an initial permit shall submit a
completed application and application fee on a form provided by the board and meet the
following requirements:
a. An applicant for an initial moderate sedation permit shall meet the following educational
requirements. This section does not apply to a dentist who has maintained a parenteral
sedation permit in North Dakota and has been administering parenteral sedation in a
dental office before July 1, 2022.
(1) The applicant successfully shall complete a comprehensive sixty-hour predoctoral
dental school, postgraduate education or continuing education in moderate sedation
with a participant-faculty ratio of not more than four-to-one. The course must include
courses in enteral and parenteral moderate sedation plus individual management of
twenty live patient clinical case experiences by the intravenous route and provide
certification of competence in rescuing patients from a deeper level of sedation than
intended, including managing the airway, intravascular or intraosseous access, and
reversal medications. The formal training program must be sponsored by or
affiliated with a university, teaching hospital, or other facility approved by the board
or provided by a curriculum of an accredited dental school and have a provision by
course director or faculty of additional clinical experience if participant competency
has not been achieved in allotted time.
(2) The course must be directed by a dentist or physician qualified by experience and
training with a minimum of three years of experience, including formal postdoctoral
training in anxiety and pain control. The course director must possess a current
permit or license to administer moderate or deep sedation and general anesthesia
in at least one state.
b. A dentist utilizing moderate sedation shall maintain current certification in basic life
support and advanced cardiac life support if treating adult patients or pediatric advanced
life support if treating pediatric patients and have present a staff of supervised personnel
capable of handling procedures, complications, and emergency incidents, including at

least one qualified dental staff member as specified in subsection 40 of section
20-01-02-01.
c. A permitholder may not administer or employ any agents that have a narrow margin for
maintaining consciousness, including ultra-short acting barbiturates, propofol, ketamine,
or similarly acting drugs, agents, or techniques, or any combination thereof that likely
would render a patient deeply sedated, generally anesthetized, or otherwise not meeting
the conditions of moderate sedation.
d. During moderate sedation the adequacy of ventilation must be evaluated by continual
observation of qualitative clinical signs and monitoring for the presence of exhaled
carbon dioxide unless precluded or invalidated by the nature of the patient, procedure, or
equipment.
e. Successfully completed the moderate site evaluation required by this chapter. An initial
site evaluation must be completed within sixty days of the approval of the initial permit
application.
f. Administering intranasal versed or fentanyl, or both, is considered deep sedation. Rules
for deep sedation and general anesthesia site evaluations apply for administration of
intranasal versed or fentanyl, or both.
4. Administration of deep sedation and general anesthesia. Before administering deep sedation
or general anesthesia, a dentist licensed under North Dakota Century Code chapter 43-28
shall obtain a permit issued by the board and renewable biennially thereafter. An applicant for
an initial permit shall submit a completed application and application fee on a form provided by
the board and:
a. Within the three years before submitting the permit application, shall provide evidence
the applicant successfully has completed an advanced education program accredited by
the commission on dental accreditation that provides training in deep sedation and
general anesthesia and formal training in airway management, and completed a
minimum of five months of advanced training in anesthesiology and related academic
subjects beyond the undergraduate dental school level in a training program approved by
the board; or
b. Must be, within the three years before submitting the permit application, a diplomate of
the American board of oral and maxillofacial surgeons or eligible for examination by the
American board of oral and maxillofacial surgeons, a fellow of the American association
of oral and maxillofacial surgeons, a fellow of the American dental society of
anesthesiology, a diplomate of the national dental board of anesthesiology, or a
diplomate of the American dental board of anesthesiology or eligible for examination by
the American dental board of anesthesiology;
c. For an applicant who completed the requirements of subdivision a or b more than three
years before submitting the permit application, shall provide on a form provided by the
board a written affidavit affirming the applicant has administered general anesthesia to a
minimum of twenty-five patients within the year before submitting the permit application
or seventy-five patients within the last five years before submitting the permit application
and the following documentation:
(1) A copy of the deep sedation and general anesthesia permit in effect in another
jurisdiction or certification of military training in general anesthesia from the
applicant's commanding officer; and

(2) On a form provided by the board, a written affidavit affirming the completion of
thirty-two hours of continuing education pertaining to oral and maxillofacial surgery
or general anesthesia taken within three years before application.
d. Successfully shall complete the general anesthesia and deep sedation site evaluation
required by this chapter. An initial site evaluation must be completed within sixty days of
the approval of the initial permit application.
e. For a dentist utilizing deep sedation or general anesthesia shall maintain current
certification in basic life support and advanced cardiac life support if treating adult
patients or pediatric advanced life support if treating pediatric patients.
f. For a dentist authorized to provide deep sedation and general anesthesia, shall utilize
and have present a staff of supervised personnel capable of handling procedures,
complications, and emergency incidents, including at least two qualified dental staff
members as specified in subsection 40 of section 20-01-02-01.
5. Site evaluations for moderate sedation, deep sedation, and general anesthesia. A licensed
and permitted dentist or host dentist utilizing moderate sedation, deep sedation, or general
anesthesia is required to have an evaluation of the location where sedation or anesthesia
services are rendered initially and every three years thereafter and shall maintain a properly
equipped facility. A North Dakota licensed anesthesia or sedation provider authorized by the
board shall re-evaluate the credentials, facilities, equipment, personnel, and procedures of a
permitholder within every three years following a successful initial application or renewal. The
purpose of the evaluation is to assess the patient's anesthetic risk and assess a site's ability to
provide emergency care; therefore, the site evaluation emphasizes recognition and
management of emergencies and complications associated with office administration of
sedation and recordkeeping. Requirements of the site evaluation are as follows:
a. The applicant is responsible for scheduling a site evaluation with a board-appointed
anesthesia site evaluator. The host dentist must be present during the site evaluation and
submit the site evaluation form to the site evaluator no less than two weeks before the
scheduled site evaluation and must include the following:
(1) Life support credentials of any qualified dental staff or medical staff and anesthesia
provider or host dentist;
(2) Copy of license of qualified dental staff or other attending medical staff, or both;
(3) Copy of current permit to prescribe and administer controlled substances in this
state issued by the United States drug enforcement administration;
(4) Copy of patient consent agreement and health history forms;
(5) Copy of a blank sedation monitoring form;
(6) Preanesthesia sedation instructions; and
(7) Post care instructions.
b. The site evaluator shall submit a completed site evaluation form and documentation to
the board. The dentist's facility where anesthesia and sedation are provided must meet
the requirements of this chapter and maintain the following properly operating equipment
and supplies appropriate for the age and relative size of the patient during the provision
of anesthesia and sedation by the permitholder or physician anesthesiologist or certified
registered nurse anesthetist or other qualified sedation provider:

(1) Emergency drugs as required by the board, including:
(a) Vasopressor;
(b) Corticosteroid;
(c) Bronchodilator;
(d) Muscle relaxant;
(e) Intravenous medication for treatment of cardiopulmonary arrest;
(f) Narcotic antagonist;
(g) Benzodiazepine antagonist;
(h) Antihistamine;
(i) Antiarrhythmic;
(j) Anticholinergic;
(k) Coronary artery vasodilator;
(l) Antihypertensive;
(m) Antihypoglycemic agent;
(n) Antiemetic;
(o) Adenosine, for general anesthesia and deep sedation sites;
(p) Dantrolene, for general anesthesia and deep sedation sites, if volatile gases
are used; and
(q) Anticonvulsant;
(2) Positive pressure oxygen and supplemental oxygen delivery system;
(3) Stethoscope;
(4) Suction equipment, including tonsillar or pharyngeal and emergency backup
medical suction device;
(5) Oropharyngeal or nasopharyngeal airways, or both;
(6) Pulse oximeter;
(7) Auxiliary lighting;
(8) Blood pressure monitor with an automated time determined capability and method
for recording the data;
(9) Cardiac defibrillator or automated external defibrillator (AED);
(10) End-tidal carbon dioxide monitor;
(11) Electrocardiograph monitor;
(12) Laryngoscope multiple blades, backup batteries, and backup bulbs;

(13) Endotracheal tubes and appropriate connectors;
(14) Magill forceps;
(15) Appropriate intravenous setup, including appropriate supplies and fluids;
(16) Cricothyrotomy equipment;
(17) Thermometer; and
(18) Scale.
c. The operatory where moderate sedation, deep sedation, or general anesthesia is to be
administered must:
(1) Be of adequate size and design to permit physical access of emergency equipment
and personnel and to permit effective emergency management;
(2) Be equipped with a chair or table adequate for emergency treatment, including a
chair or cardiopulmonary resuscitation board suitable to administer cardiopulmonary
resuscitation;
(3) Be equipped with a lighting system to permit the evaluation of the patient's skin and
mucosal color with a backup system to permit the completion of any operation
underway at the time of a general power failure;
(4) Be equipped with suction and backup suction equipment also including suction
catheters and tonsil suction; and
(5) Be equipped with an oxygen delivery system and backup system complete with full-
face masks and appropriate connectors, capable of delivering oxygen to the patient
under positive pressure.
d. An operatory may double as a recovery location. A recovery room must be equipped with
the following:
(1) Suction and backup suction equipment;
(2) Positive pressure oxygen;
(3) Sufficient light to provide emergency treatment;
(4) Be of adequate size and design to allow emergency access and management; and
(5) Be situated to allow the patient to be observed by the dentist or a qualified staff
member at all times.
e. The applicant or permitholder shall provide the site evaluator with documentation
confirming that the applicant or permitholder maintains written emergency protocol and
conducts staff training on all patient emergencies listed below. The written documentation
must demonstrate that the applicant or permitholder conducted quarterly mock codes
with staff, and that each of the following clinical emergencies are included in a quarterly
mock code training at least once every two years:
(1) Laryngospasm;
(2) Bronchospasm;
(3) Emesis and aspiration;

(4) Airway blockage by foreign body;
(5) Angina pectoris;
(6) Myocardial infarction;
(7) Hypertension/hypotension;
(8) Hypertensive crisis;
(9) Hematoma;
(10) Extravasation;
(11) Phlebitis;
(12) Intra-arterial injection;
(13) Syncope;
(14) Hyperventilation/hypoventilation;
(15) Seizures;
(16) Allergic and toxicity reactions; and
(17) Malignant hypothermia, deep sedation and general anesthesia only.
f. Failure to successfully complete the anesthesia inspection results in an automatic
suspension of anesthesia and sedation privileges. The applicant shall have thirty days
from the date of inspection to correct documented deficiencies. Once the deficiencies are
corrected by the applicant and approved by the board, the board may reinstate the
sedation and anesthesia privileges.
g. Effective January 1, 2028, completion of a board-approved anesthesia simulation course
and the completion of anesthesia simulation training successfully every five years
thereafter as required by section 20-02-01-06.
6. Other anesthesia providers. Host dentists who intend to use the services of a certified
registered nurse anesthetist, anesthesiologist, or another dentist authorized by permit to
administer moderate sedation, deep sedation, or general anesthesia, shall notify the board
before sedation services are provided and arrange a site evaluation with the board appointed
anesthesia professional. The sedation provider is responsible for discharge assessment. The
host dentist shall run a mock code quarterly with the sedation team and maintain a record of
the mock code schedule and attendance. The anesthesia provider and the host dentist shall
remain at the facility until the sedated patient is discharged.
7. Renewal of permit and site evaluation. All sedation and anesthesia permits must be renewed
biennially, concurrent with the dentist's license renewal. The board of dental examiners may
renew such permit biennially provided:
a. Requirements of the permit have been met;
b. Application for renewal and renewal fee is received by the board before the date of
expiration of the permit. If the renewal application and renewal fee have not been
received by the expiration of the permit, late fees as determined by the board apply; and
c. The anesthesia site inspection is in good standing with the board of dental examiners.

8. Documentation. Dentists administering sedation or anesthesia shall maintain adequate
documentation.
a. For the administration of local anesthesia, minimal sedation, and analgesia, the following
documentation is required:
(1) Pertinent medical history, including weight and height;
(2) Medication administered and dosage; and
(3) Vital signs include heart rate and blood pressure.
b. For administration of moderate sedation, deep sedation, or general anesthesia the
following documentation is required:
(1) A current and comprehensive medical history, to include current medications;
(2) Informed consent of the patient for the administration of anesthesia;
(3) An anesthesia record, which includes documentation of the following:
(a) Height and weight of the patient to allow for the calculation of body mass index
and dosage of emergency medications;
(b) American society of anesthesiologist's physical status classification;
(c) Fasting or nothing by mouth status;
(d) Dental procedure performed on the patient;
(e) Time anesthesia commenced and ended;
(f) Parenteral access site and method, if utilized;
(g) Medication administered, including oxygen, dosage, route, and time given;
(h) Vital signs before and after anesthesia is utilized, to include heart rate, blood
pressure, respiratory rate, and oxygen saturation for all patients;
(i) Intravenous fluids, if utilized;
(j) Response to anesthesia, including any complications;
(k) Condition and Aldrete score of patient at discharge;
(l) Records showing continuous monitoring of blood pressure, heart rate, and
respiration using electrocardiographic monitoring and pulse oximetry recorded
every five minutes, if utilized;
(m) Emergency protocols followed in the instance of an adverse event; and
(n) Staff participating in the administration of anesthesia, treatment, and
monitoring.
9. Personnel.
a. During the administration of minimal sedation, the supervising dentist and at least one
other individual who is experienced in patient monitoring and documentation must be
present.

b. During the administration of moderate sedation, the anesthesia permit provider and at
least one other individual who is experienced in patient monitoring and documentation
must be present.
c. During the administration of deep sedation or general anesthesia, the anesthesia permit
provider and at least two other individuals meeting the following requirements must be
present:
(1) One individual to assist the host dentist as necessary.
(2) One qualified dental staff member solely responsible to assist with observation and
monitoring of the patient.
d. During any sedation or anesthesia procedure, the anesthesia permit provider retains full
accountability, but delegation to trained dental personnel may occur under:
(1) Direct, continuous, and visual supervision by the anesthesia permitholder if
medication, excluding local anesthetic, is being administered to a patient in the
intraoperative phase of surgery. A patient under general anesthesia, deep sedation,
and moderate sedation is in the intraoperative phase of surgery from the first
administration of anesthetic medication until:
(a) End of the surgical procedure;
(b) No additional anesthetic medication will be administered;
(c) Peak effect of the anesthesia medication has been reached; or
(d) The patient has regained consciousness with a full return of protective
reflexes, including the ability to respond purposely to physical and verbal
commands; or
(2) Direct supervision by the dentist and anesthesia permitholder if a patient is being
monitored in the postoperative phase of surgery.
e. All individuals assisting the anesthesia permitholder during sedation or anesthesia shall
maintain current basic life support, advanced cardiovascular life support, or pediatric
advanced life support and shall be appropriately trained in emergency procedures
through updates or drills that must be held at least quarterly and documented.
10. Standards for patient monitoring.
a. For the administration of local anesthesia and analgesia, patient monitoring must include
the general state of the patient.
b. For the administration of minimal sedation, patient monitoring must include the following:
(1) Pre- and post-procedure heart rate and respiratory rate;
(2) Pre- and post-procedure blood pressure; and
(3) Level of anesthesia or sedation.
c. For the administration of moderate sedation, patient monitoring must include the
following:
(1) Continuous heart rate, respiratory rate, and oxygen saturation;
(2) Intermittent blood pressure every five minutes or more frequently;

(3) Continuous electrocardiograph, if clinically indicated by patient history, medical
condition, or age;
(4) End-tidal carbon dioxide monitoring (capnography); and
(5) Level of anesthesia or sedation.
d. For the administration of deep sedation or general anesthesia, patient monitoring must
include the following:
(1) Continuous heart rate, respiratory rate, and oxygen saturation;
(2) Continuous ventilatory status (spontaneous, assisted, controlled) for the
administration of general anesthesia to a patient with an advanced airway in place
(e.g. endotracheal tube or laryngeal mask airway);
(3) Intermittent blood pressure every five minutes or more frequently;
(4) Continuous electrocardiograph;
(5) Continuous temperature for the administration of volatile anesthesia gases or
medications which are known triggers of malignant hyperthermia, otherwise the
ability to measure temperature should be readily available;
(6) End-tidal carbon dioxide monitoring; and
(7) Level of anesthesia or sedation.
e. Monitoring equipment must be checked and calibrated in accordance with the
manufacturer's recommendations and documented on an annual basis.
11. Patient evaluation required. The decision to administer controlled drugs for dental treatment
must be based on a documented evaluation of the health history and current medical
condition of the patient in accordance with the class I through V risk category classifications of
the American society of anesthesiologists. The findings of the evaluation, the American society
of anesthesiologists risk assessment class assigned, and any special considerations must be
recorded in the patient's record.
12. Informed written consent. Before administration of any level of sedation or general anesthesia,
the dentist shall discuss the nature and objectives of the planned level of sedation or general
anesthesia along with the risks, benefits, and alternatives and shall obtain informed, written
consent from the patient or other responsible party for the administration and for the treatment
to be provided. The written consent must be maintained in the patient record.
13. Pediatric patients. Sedating medication may not be prescribed for or administered to a patient
eight years of age or younger before the patient's arrival at the dentist office or treatment
facility.
14. Emergency management. The licensed dentist authorized by permit to administer sedation or
anesthesia and staff with patient care duties must be trained in emergency preparedness.
Written protocols must include training requirements and procedures specific to the
permitholder's equipment and drugs for responding to emergency situations involving sedation
or anesthesia, including information specific to respiratory emergencies. The permitholder
shall document this review of office training or mock codes. Protocols must include the
American heart association's basic life support or cardiopulmonary resuscitation and
advanced cardiac life support, or pediatric advanced life support for any practitioner
administering moderate sedation, deep sedation, or general anesthesia.

a. If a patient enters a deeper level of sedation than the dentist is qualified and prepared to
provide, the dentist shall stop the dental procedure until the patient returns to and is
stable at the intended level of sedation.
b. Quarterly mock codes to simulate office medical emergencies must be documented and
available during a site evaluation.
c. Authorization of duties. A dentist who authorizes the administration of general
anesthesia, deep sedation, or moderate sedation in the dentist's dental office is
responsible for assuring that:
(1) The equipment for administration and monitoring is readily available and in good
working order before performing dental treatment with anesthesia or sedation. The
equipment either must be maintained by the dentist in the dentist's office or provided
by the anesthesia or sedation provider;
(2) The person administering the anesthesia or sedation is appropriately licensed;
(3) The individual authorized to monitor the patient is qualified;
(4) A physical evaluation and medical history is taken before administration of general
anesthesia or sedation. A dentist holding a permit shall maintain records of the
physical evaluation, medical history, and general anesthesia or sedation
procedures; and
(5) Administration of sedation by another qualified provider requires the operating
dentist to maintain advanced cardiac life support if the patient is nine years of age or
older and pediatric advanced life support if the patient is eight years old or younger.
d. Reporting. All licensed dentists in the practice of dentistry in this state shall submit a
report within a period of seven days to the board office of any mortality or other incident
which results in temporary or permanent physical or mental injury requiring
hospitalization of the patient during, or as a result of, minimal sedation, nitrous oxide
inhalation analgesia, moderate sedation, deep sedation, or general anesthesia.
(1) The report must include responses to at least the following:
(a) Description of dental procedure;
(b) Description of preoperative physical condition of patient;
(c) List of drugs and dosage administered;
(d) Description, in detail, of techniques utilized in administering the drugs utilized;
(e) Description of adverse occurrence:
[1] Description, in detail, of symptoms of any complications, to include onset
and type of symptoms in patient.
[2] Treatment instituted on the patient.
[3] Response of the patient to the treatment.
(f) Description of the patient's condition on termination of any procedures
undertaken; and

(g) The unique reporting identification issued by the dental anesthesia incident
reporting system, indicating a report has been submitted to the national
database.
(2) Violations. A violation of any provision of this article constitutes unprofessional
conduct and is grounds for the revocation or suspension of the dentist's permit,
license, or both, or the dentist may be reprimanded or placed on probation.
15. Controlled pharmaceuticals.
a. A dentist shall secure and maintain controlled pharmaceuticals in accordance with the
state and federal guidelines.
b. Used controlled pharmaceuticals or medications must be discarded immediately with
documentation of disposal in conformance with drug enforcement administration
guidelines.
History: Effective October 1, 1993; amended effective May 1, 1996; June 1, 2002; July 1, 2004; April 1,
2006; October 1, 2007; January 1, 2011; April 1, 2015; July 1, 2017; July 1, 2022; October 1, 2024.
General Authority: NDCC 43-28-06
Law Implemented: NDCC 43-28-01, 43-28-06, 43-28-15, 43-28-18.1
### § 20-02-01-06. Continuing dental education for dentists.

Each dentist shall maintain documentation of attendance or participation in continuing clinical
dental education in accordance with the following conditions:
1. Continuing education activities include publications, seminars, symposiums, lectures, college
courses, and online education.
2. The continuing dental education hours accumulate on the basis of one hour of credit for each
hour spent in education. Subject matter directly related to clinical dentistry will be accepted by
the board without limit.
3. The minimum number of hours required within a two-year cycle for dentists is thirty-two. Of
these hours, a dentist may earn no more than sixteen hours from self-study. Self-study is an
educational process designed to permit a participant to learn a given subject without
involvement of a proctor or without the opportunity to interact in real-time with the proctor. A
qualified professional may act as a proctor who oversees a clinical continuing education
course which may be used for classroom style continuing education credits. Cardiopulmonary
resuscitation courses must provide hands-on training. All other continuing education
requirements may be satisfied from online education that allows for real-time interaction
between attendees and the proctor. The continuing education must include:
a. At least two hours of ethics or jurisprudence. Passing the laws and rules examination is
the equivalent of two hours of ethics or jurisprudence.
b. At least two hours of infection control.
c. A cardiopulmonary resuscitation course.
d. For sedation and anesthesia permitholders:
(1) At least six hours related to sedation or anesthesia; and
(2) At least two hours related to anesthesia emergencies that are based on actual
adverse anesthesia events or actual closed insurance claims. Content offered by
insurance providers or licensees of the board may be approved by the board.

e. No more than two hours related to practice management or administrative aspects of
dentistry.
4. Mere registration at a dental convention without specific attendance at continuing education
presentations is not creditable toward the continuing dental education requirement.
Certificates awarded for continuing education must indicate the name of the continuing
education provider, date, and number of hours of continuing education. Certificates obtained
from webinar courses must indicate the course was a webinar. For continuing education
courses utilizing a proctor, the certificate of attendance must be signed by the proctor.
5. All dentists must hold a current cardiopulmonary resuscitation certificate. General anesthesia,
deep sedation, and moderate sedation providers shall maintain current advanced cardiac life
support or pediatric advanced life support certification as determined by the age of the
patients treated. A dentist who utilizes minimal sedation shall maintain basic life support
certification.
6. Effective January 1, 2028, all dentists who administer general anesthesia, deep sedation, and
moderate sedation shall successfully complete an approved anesthesia simulation training
course and complete anesthesia simulation training successfully every five years thereafter.
Proof of completion of this requirement must be submitted to the anesthesia inspector as
required in subsection 5 of section 20-02-01-05.
7. The board may audit the continuing education credits of a dentist. Each licensee shall
maintain certificates or records of continuing education activities from the previous renewal
cycle. Upon receiving notice of an audit from the board, a licensee shall provide satisfactory
documentation of attendance at, or participation in the continuing education activities. Failure
to comply with the audit is grounds for nonrenewal of or disciplinary action against the license.
8. A dentist who maintains a license on inactive status is not subject to continuing education
requirements.
History: Effective October 1, 1993; amended effective May 1, 1996; August 1, 1998; June 1, 2002;
April 1, 2006; October 1, 2007; January 1, 2011; April 1, 2015; July 1, 2017; July 1, 2022; October 1,
2024.
General Authority: NDCC 43-28-06
Law Implemented: NDCC 43-28-06, 43-28-16.2
### § 20-02-01-07. Removable dental prostheses owner identification.

1. Every complete upper and lower denture or removable dental prosthesis fabricated by a
dentist or fabricated pursuant to the dentist's work order must be marked with the name of the
patient for whom the prosthesis is intended. The markings must be done during the fabrication
process and must be permanent, and cosmetically acceptable. The exact location of the
markings and methods used to apply or implant them shall be determined by the dentist or
dental laboratory fabricating the prosthesis. If in the professional judgment of the dentist or
dental laboratory this identification is not practical, identification must be provided as follows:
a. The initials of the patient may be used if the entire name is not practical.
b. The identification marks may be omitted in their entirety if no form of identification is
practical or clinically safe.
2. Failure of any dentist to comply with this section shall be deemed to be a violation of the rules
of the board and the dentist may be liable to penalty as permitted under statute.
History: Effective October 1, 1993; amended effective April 1, 2006.
General Authority: NDCC 43-28-06

Law Implemented: NDCC 43-28-06
### § 20-02-01-08. Discontinuance of practice - Retirement - Discontinuance of treatment.

These rules are adopted for the purpose of avoiding practice abandonment. A licensed dentist shall
maintain patient records in a manner consistent with the protection of the welfare of the patient. Upon
request of the patient or patient's legal guardian, the dentist shall furnish the dental records or copies of
the records, including dental radiographs or copies of the radiographs. The dentist may charge a
nominal fee for duplication of records as provided by North Dakota Century Code section 23-12-14, but
may not refuse to transfer records for nonpayment of any fees.
1. A licensee, upon retirement, or upon discontinuation of the practice of dentistry, or upon
moving from a community, shall notify all active patients in writing and by publication once a
week for three consecutive weeks in a newspaper of general circulation in the community that
the licensee intends to discontinue the practice of dentistry. The licensee shall make
reasonable arrangements with active patients for the transfer of patient records, or copies
thereof, to the succeeding licensee. In the event of a transfer of patient records to another
licensee assuming the practice, written notice must be furnished to all patients as
hereinbefore specified. For the purpose of this section, "active patient" is defined as a person
whom the licensee has examined, treated, cared for, or otherwise consulted with during the
two-year period prior to the discontinuation of the practice of dentistry by the licensee. In the
event of a nontransfer of records, a licensee shall have the ongoing obligation of at least two
years to afford the licensee's prior patients access to those records not previously provided to
the patient.
2. In the event of termination of a dentist-patient relationship by a licensee, notice of the
termination must be provided to the patient. A dentist-patient relationship exists if a dentist has
provided treatment to a patient on at least one occasion within the preceding year. The dentist
who is the owner or custodian of the patient's dental records shall mail notice of the
termination of the dentist's relationship to the patient, which shall provide the following:
a. The date that the termination becomes effective, and the date on which the dentist and
patient relationship may resume, if applicable;
b. A location at which the patient may receive emergency dental care for at least thirty days
following the termination of the dentist and patient relationship;
c. A statement of further dental treatment required, if any; and
d. The dentist shall respond to a written request to examine or copy a patient's record within
ten working days after receipt. A dentist shall comply with North Dakota Century Code
section 23-12-14 for all patient record requests.
3. If a licensee dies or becomes unable to practice dentistry due to disability, for the purpose of
selling or otherwise disposing of the deceased or disabled licensee's dental practice, a person
who is not licensed to practice dentistry but who is the personal representative of the estate of
a deceased dentist or the personal representative of a disabled dentist may contract with a
dentist to manage the dental practice for a period not to exceed twenty-four months.
4. If a dentist agrees to provide dental care without remuneration to underserved patients in the
absence of a public health setting, the patient may not be considered a patient of record of the
dentist providing the donated dental service.
5. If a licensee retires from a group practice and continuity of patient dental care will not be
interrupted, the dentist is exempt from notifying active patients in writing. The licensee shall
notify patients by publication once a week for three consecutive weeks in a newspaper of

general circulation in the community that the licensee intends to discontinue the practice of
dentistry.
History: Effective April 1, 2006; amended effective April 1, 2015; July 1, 2022.
General Authority: NDCC 43-28-06
Law Implemented: NDCC 43-28-06, 43-28-18
### § 20-02-01-09. Patient records.

Dental records must be legible and include a chronology of the patient's progress throughout the
course of all treatment and postoperative visits. All entries in the patient record must be dated, initialed,
and handwritten in ink or computer printed. Digital radiographs must be transferred by compact or
optical disc, electronic communication, or printing on high quality photographic paper. All transferred
film or digital radiographs must reveal images of diagnostic quality using proper exposure settings and
processing procedures. For purposes of this section:
1. "Patient" means an individual who has received dental care services from a provider for
treatment of a dental condition.
2. "Dental record" or "patient's chart" means the detailed history of the physical examination,
diagnosis, treatment, patient-related communications, and management of a patient
documented in chronological order. The dental record must contain the following components:
a. Personal date to include name, address, date of birth, name of patient's parent or
guardian, name and telephone number of a person to contact in case of an emergency,
and patient's insurance information.
b. Patient's reason for visit or chief complaint.
c. Dental and physical health history.
d. Clinical examination must include record of existing oral health status, radiographs used,
and any other diagnostic aids used.
e. Diagnosis.
f. Dated treatment plan except for routine dental care, such as preventive services.
g. Informed consent must include notation of treatment options discussed with the patient,
including prognosis of the treatment plan, benefits and risks of each treatment, and
documentation of the treatment the patient has chosen.
h. Corrections of records must be legible, unless electronic and written in ink, and contain
no erasures or use of "white-outs". If incorrect information is placed in the record, it must
be crossed out with one single line and initialed by the dental health care worker.
i. Progress notes must include a chronology of the patient's progress throughout the
course of all treatment and postoperative visits of treatment provided; medications used
and materials placed; the treatment provider by name or initials; name of collaborating
dentist; administration information of nitrous oxide inhalation or any medication
dispensed before, during, or after discharge, and patient status at discharge.
j. Each patient shall have access to health provider information as it pertains to their
treating doctor or potential doctors. Any entity utilizing telehealth shall provide upon
request of a patient the name of the dentist, telephone number, practice address, and
state license number of any dentist who was involved with the provision of services to a
patient before or during the rendering of dental services.

3. "Retention of records" means a dentist shall retain a patient's dental record for a minimum of
six years after the patient's last examination, prescription, or treatment. Records for minors
shall be retained for a minimum of either one year after the patient reaches the age of
eighteen or six years after the patient's last examination, prescription, or treatment, whichever
is longer. Proper safeguards shall be maintained to ensure safety of records from destructive
elements. The requirements of this rule apply to electronic records as well as to records kept
by any other means.
History: Effective April 1, 2006; amended effective January 1, 2011; July 1, 2022.
General Authority: NDCC 43-28-06
Law Implemented: NDCC 43-28-06, 43-28-18
### § 20-02-01-10. Authorization of laboratory services.

A dentist using the services of any person, not licensed to practice dentistry in this state, to
construct, alter, repair, or duplicate any orthodontic or prosthetic device, must furnish the unlicensed
person a written prescription which shall include all of the following:
1. The name and address of the unlicensed person.
2. The patient's name or patient number.
3. The date on which the prescription was written.
4. The description of the work to be done, with a diagram, if necessary.
5. A specification of the materials to be used if necessary.
6. The signature of the dentist and the number of the dentist's North Dakota license.
The dentist shall retain a duplicate copy of the prescription for inspection by the board or the board's
agent for two years.
History: Effective January 1, 2011.
General Authority: NDCC 43-28-06
Law Implemented: NDCC 43-28-02, 43-28-06, 43-28-18, 43-28-25
### § 20-02-01-11. Permit for the use of dermal fillers and botulinum toxin for dental use.

The rules in this chapter are adopted to define standards for the administration of dermal fillers and
botulinum toxin by a dentist if the use is limited to the practice of dentistry as defined in subsection 7 of
North Dakota Century Code section 43-28-01. Notwithstanding a dentist who specializes in oral and
maxillofacial surgery, the board may issue a permit to a dentist who applies on forms prescribed by the
board and pays the initial fee or biennial renewal fee as required by subsection 1 of section
and aesthetic dental treatment purposes under the following conditions if the dentist provides evidence
demonstrating one of the following:
1. The applicant has completed a course and received satisfactory training in a residency or
other educational program accredited by the commission on dental accreditation of the
American dental association;
2. The applicant successfully has completed a board-approved continuing education course of
instruction within the previous three months of application which includes neurophysiology,
including facial tissues, parasympathetic, sympathetic, and peripheral nervous systems
relative to the peri-oral tissue, and facial architecture, and:
a. Patient assessment and consultation for botox and dermal fillers;

b. Indications and contraindications for techniques;
c. Proper preparation and delivery techniques for desired outcomes;
d. Enhancing and finishing esthetic dentistry cases with dermal fillers;
e. Botulinum neurotoxin treatment of temporomandibular joint syndrome and bruxism;
f. Knowledge of adverse reactions and management and treatment of possible
complications;
g. Patient evaluation for best esthetic and therapeutic outcomes;
h. Integrating botulinum neurotoxin and dermal filler therapy into dental therapeutic and
esthetic treatment plans; and
i. Live patient hands-on training, including diagnosis, treatment planning, and proper
dosing and delivery of botox and dermal fillers; or
3. The applicant successfully has completed a continuing education course of instruction
substantially equivalent to the requirements of this state and provides evidence from another
state or jurisdiction where the applicant legally is or was authorized to administer dermal fillers
and botulinum toxin.
History: Effective April 1, 2015; amended effective July 1, 2017; July 1, 2022; October 1, 2024.
General Authority: NDCC 43-28-06
Law Implemented: NDCC 43-28-01, 43-28-06
### § 20-02-01-12. Dental prescribers and use of the prescription drug monitoring program.

Subject to the exceptions described in section 20-02-01-13, prior to the initial prescribing of any
controlled substance, including samples, a dentist authorized by the drug enforcement administration to
prescribe, administer, sign for, dispense, or procure pharmaceuticals shall authorize an employee to
review or personally request and review the prescription drug monitoring program report for all
available prescription drug monitoring program data on the patient within the previous twelve months,
and shall do all of the following:
1. Assess a patient's drug monitoring program data every twelve months during the patient's
treatment with a controlled substance.
2. Review the patient's prescription drug monitoring program data if the patient requests early
refills or demonstrates a pattern of taking more than the prescribed dosage.
3. Review the patient's prescription drug monitoring program data if there is a suspicion of or a
known drug overuse, diversion, or abuse by the patient.
4. Document the assessment of the patient's prescription drug monitoring program data.
5. Discuss the risks and benefits of the use of controlled substances with the patient, the
patient's parent if the patient is an unemancipated minor child, or the patient's legal guardian
or health care surrogate, including the risk of tolerance and drug dependence.
6. Request and review prescription drug monitoring program data on the patient if the
practitioner becomes aware that a patient is receiving controlled substances from multiple
prescribers.

7. Request and review the patient's prescription drug monitoring program data if the prescriber
has a reasonable belief that the patient may be seeking the controlled substance, in whole or
in part, for any reason other than the treatment of an existing medical condition.
History: Effective July 1, 2017.
General Authority: NDCC 19-03.5-09, 43-28-01(7), 43-28-06
Law Implemented: NDCC 19-03.5-09, 43-28-06
### § 20-02-01-13. Exceptions to the review requirement.

A practitioner may not be required to review a patient's prescription drug monitoring program data if
any of the following apply:
1. The controlled substance is prescribed or dispensed for a patient who is currently receiving
hospice care.
2. The controlled substance is prescribed or dispensed to a patient of record as a nonrefillable
prescription as part of treatment for a surgical procedure.
3. The dentist prescribes a controlled substance after the performance of oral surgery and no
more than a seventy-two hour supply of the controlled substance is prescribed.
4. The dentist prescribes pre-appointment medication for the treatment of procedure anxiety.
5. The dentist obtains a report through a board-approved risk assessment tool for health care
providers that accesses patient prescription information from prescription drug monitoring
program databases, analyzes the data, and provides a risk-based score that includes
prescription drug monitoring program data.
History: Effective July 1, 2017.
General Authority: NDCC 43-28-01(7), 43-28-06
Law Implemented: NDCC 19-03.5-09, 43-28-06(1)
