# Title 20 — State Board of Dental Examiners

## Article 20-01 — General Administration

## Chapter 20-01-02 — Definitions

### § 20-01-02-01. Definitions.

Unless specifically stated otherwise, the following definitions are applicable throughout this title:
1. "Advertising" means any public communication, made in any form or manner, about a
licensee's professional service or qualifications, for the purpose of soliciting business.
2. "Aldrete score" means a measurement of recovery after anesthesia that includes gauging
consciousness, activity, respiration, and blood pressure.
Aldrete Scoring Guidelines
Activity Respiration Circulation Consciousness Oxygenation
2 Able to move 2 Patient can 2 Blood pressure 2 Fully awake 2 Able to maintain
four extremities cough and deep and heart rate +/- (able to answer oxygen
voluntarily on breathe on 20 percent of questions) or at saturation
command command presedation level preprocedure greater than 92
and/or returned and/or and/or level percent or at
to respirations asymptomatic preprocedure
preprocedure unlabored, alteration level
level oxygen
saturation at Pink or normal
preprocedure skin color
level
1 Able to move 1 Dyspnea or 1 Blood pressure 1 Arousable on 1 Needs oxygen
two extremities limited breathing and heart rate +/- calling to maintain
voluntarily on or requires 20 to 50 percent (arousable only adequate
command oxygen greater of pre-anesthetic to calling) oxygenation
and/or moves than baseline level or mildly
weakly, unable level to maintain symptomatic Pale, dusky,
to stand adequate alteration that blotchy,
saturation requires fluid jaundiced, or
bolus other
intervention or
dopamine at less
than ten
micrograms per
kilogram per
minute for heart
failure patients
0 Unable to 0 Apneic or 0 Blood pressure 0 Unresponsive 0 Oxygen
move requires airway and heart rate saturation less
support greater than 50 than 90 percent
percent =/- adult, less than
presedation 92 percent peds
levels and/or even with
requires oxygen support.
pharmacological
intervention, or Cyanotic
dopamine at
greater than ten
micrograms per
kilogram per
minute for heart
failure patients
Target 2 Target 2 Target 1-2 Target 1-2 Target 2

A score of less than 8, re-evaluate q 15 minutes, greater than 8 discharge to recovery, or greater than or
equal to discharge home
3. "Analgesia" means the diminution or elimination of pain.
4. "Anesthesia" means the art and science of managing anxiety, pain, and awareness. It includes
analgesia, local anesthesia, minimal sedation, moderate sedation, deep sedation, and general
anesthesia.
5. "Basic full upper and lower denture" means replacement of all natural dentition with artificial
teeth. This replacement includes satisfactory tissue adaptation, satisfactory function, and
satisfactory aesthetics. Materials used in these replacements must be nonirritating in
character and meet all the standards set by the national institute of health and the bureau of
standards and testing agencies of the American dental association for materials to be used in
or in contact with the human body.
6. "Board certified" means the dentist has been certified in a specialty area in which there is a
certifying body approved by an agency recognized by the United States department of
education and is a diplomate of a nationally recognized certifying board that meets the criteria
as provided by section 20-02-01-01.
7. "Board eligible" means the dentist has successfully completed a duly accredited training
program or in the case of a dentist in practice at the time of the adoption of these rules has
experience equivalent to such a training program in an area of dental practice in which there is
a certifying body approved by an agency recognized by the United States department of
education and is a diplomate of a nationally recognized certifying board that meets the criteria
as provided by section 20-02-01-01.
8. "Bona fide specialties" means those specialties meeting the qualification as set forth in section
20-02-01-01.
9. "Capnography" means a process to determine the presence and percent of carbon dioxide in
a patient's breath through the use of a carbon dioxide monitor, the noninvasive measurement
of the partial pressure of carbon dioxide in exhaled breath expressed as carbon dioxide
concentration over time and is graphically represented. Carbon dioxide measured at the
airway can be displayed as a function of time (carbon dioxide concentration over time) or
exhaled tidal volume (carbon dioxide concentration over volume).
10. "Cardiopulmonary resuscitation course" means the American heart association's health care
provider course, the American red cross professional rescuer course, or an equivalent course.
11. "Certified dental assistant" means a dental assistant who meets the education or experience
prerequisites, or both, established by the dental assisting national board and passes the
dental assisting national board's certified dental assistant examination, is currently
cardiopulmonary resuscitation-certified, and continues to maintain the credential by meeting
the dental assisting national board requirements. A certified dental assistant must be
registered by the board as a qualified dental assistant or registered dental assistant to provide
any expanded duties.
12. "Code of ethics" means the November 2020 version of the American dental association's
principles of ethics and code of professional conduct.
13. "Complete evaluation" means an examination, review of medical and dental history, the
formulation of a diagnosis, and the establishment of a written treatment plan, documented in a
written record to be maintained in the dentist's office or other treatment facility or institution.

14. "Contiguous supervision" means that the dentist whose patient is being treated and has
personally authorized the procedures to be performed. The supervising dentist is continuously
onsite and physically present in the treatment facility while the procedures are performed by
the qualified dental staff member and capable of responding immediately in the event of an
emergency. The term does not require a supervising dentist to be physically present in the
operatory.
15. "Clinical continuing education" means information that relates to the assessment, diagnosis, or
treatment of patients.
16. "Coronal polishing" is the mechanical polishing of clinical crowns using a rubber cup or brush
only and not to include any instrumentation.
17. "Deep sedation" means a drug-induced depression of consciousness during which patients
cannot be easily aroused but respond purposefully following repeated or painful stimulation.
The ability to independently maintain ventilatory function may be impaired. Patients may
require assistance in maintaining a patent airway, and spontaneous ventilation may be
inadequate. Cardiovascular function is usually maintained.
18. "Dental anesthesia assistant" means an individual who possesses the expertise to provide
supportive anesthesia care in a safe and effective manner. The anesthesia assistant is
educated in the perioperative and emergent care management of patients undergoing dental
office sedation and anesthesia.
19. "Direct supervision" means the dentist is physically present in the dental office or treatment
facility, personally diagnoses the condition to be treated, personally authorizes the procedures
and remains in the dental office or treatment facility while the procedures are being performed
by the dental hygienist or dental assistant, and before dismissal of the patient, evaluates the
performance of the dental hygienist or dental assistant.
20. "Direct visual supervision" means the dentist is physically present to issue a verbal command
and under direct line of sight.
21. "Evaluation" means the act or process by a dentist of assessing and determining the patient's
oral health status, the progress of dental therapy, or the performance of the dental hygienist or
dental assistant.
22. "General anesthesia" means a drug-induced loss of consciousness during which patients are
not arousable, even by painful stimulation. The ability to maintain ventilatory function is often
impaired. Patients often require assistance in maintaining patent airway, and positive pressure
ventilation may be required because of depressed spontaneous ventilation or drug-induced
depression of neuromuscular function. Cardiovascular function may be impaired.
23. "General supervision" means the dentist has authorized the procedures and they are carried
out in accordance with the dentist's diagnosis, if necessary, and treatment plan. The dentist is
not required to be in the treatment facility. A new patient who has not been examined by the
authorizing dentist may be seen by a dental hygienist authorized to provide duties under
general supervision. Limitations are contained in North Dakota Century Code section
43-20-03.
24. "Host dentist" is a dentist authorized by permit who may provide a qualified dentist or
independently practicing qualified anesthesia health care provider administration of moderate,
or deep sedation, or general anesthesia. The host dentist is subject to site evaluations for the
level of sedation provided as per subsection 5 or 6 of section 20-02-01-05.

25. "Inactive status" means the licensee shall not engage in the practice of dentistry or dental
hygiene in the state of North Dakota. The license that is placed on inactive status remains on
that status until such time as the license is reinstated.
26. "Incremental dosing" means administration of multiple doses of a single drug until a desired
effect is reached, but not to exceed the maximum recommended dose at the recommended
interval.
27. "Indirect supervision" means that a dentist is in the dental office or treatment facility, has
personally diagnosed the condition to be treated, authorizes the procedures, and remains in
the dental office or treatment facility while the procedures are being performed by the dental
hygienist or dental assistant.
28. "Local anesthesia" means the elimination of sensations in one part of the body by regional
injection of drugs without causing the loss of consciousness.
29. "Maximum recommended dose" means the maximum recommended dose of a drug as printed
in the United States food and drug administration's approved labeling for unmonitored home
use.
30. "Minimal sedation" means a drug-induced state during which patients respond normally to
verbal commands. Although cognitive function and physical coordination may be impaired,
airway reflexes and ventilatory and cardiovascular are unaffected. Minimal sedation may be
achieved by the administration of a single drug administered in a single or divided dose not to
exceed the maximum recommended dose for unmonitored home use during a single
appointment. A permit is not required for minimal sedation.
31. "Moderate sedation" means a drug-induced depression of consciousness during which a
patient responds purposefully to verbal commands either alone or accompanied by light tactile
stimulation. No interventions are required to maintain a patent airway, and spontaneous
ventilation is adequate. Cardiovascular function is usually maintained. Administration of
sedative drugs exceeding the maximum recommended dose for unmonitored home use
during a single appointment or use of more than one enteral drug administered, with or
without concomitant use of nitrous oxide is considered moderate sedation.
32. "Nitrous oxide inhalation analgesia" means a technique in which the inhalation of nitrous oxide
enables treatment to be carried out and in which purposeful verbal contact with the patient can
be maintained or the patient responds appropriately to light tactile stimulation throughout the
administration of nitrous oxide inhalation analgesia, and the drugs and techniques used have
a margin of safety wide enough to render unintended loss of consciousness extremely
unlikely.
33. "Oral assessment" means the evaluation of data pertaining to the patient's condition to help
identify dental problems leading to a professional treatment plan. The final diagnosis of
disease or treatment plan is the sole responsibility of the supervising or collaborative dentist.
34. "Oral hygiene treatment planning" is a component of a comprehensive treatment plan
developed by the hygienist or dentist to provide the hygienist a framework for addressing the
preventative, educational, and clinical treatment needs of the patient.
35. "Parenteral moderate sedation" means the intravenous, intramuscular, intranasal,
subcutaneous, sublingual, submucosal, transdermal, or rectal administration of
pharmacological agents with the intent to obtain a depressed level of consciousness that
meets the definition of moderate sedation.
36. "Patient of record" means a patient who has undergone a complete dental evaluation, has had
a medical and dental history completed and evaluated by a dentist, or a patient who has been

examined, and has had oral conditions diagnosed and a written plan developed by the dentist
or dental hygiene treatment authorized by a dentist, and the patient has compensated the
dentist or dental facility for a procedure.
37. "Pediatric patient" means a dental patient ten years of age or younger.
38. "Primary practice site" means the office location that is to be considered the main location of
the dental practice. This office location would be listed first on the biennial registration.
39. "Qualified dental assistant" means a dental assistant who has been employed and trained as
a dental assistant and has received at least three hundred hours of on-the-job training, has
successfully completed the national entry level dental assistant certification administered by
the dental assisting national board or a board-approved course, and has applied to the board
and paid the certificate fee and met any other requirements of section 20-03-01-05.
40. "Qualified dental staff member" means an individual trained and competent in the use of
monitoring and emergency equipment, capable of assisting with procedures and emergency
incidents that may occur as a result of the sedation or secondary to the unexpected medical
complication, and who has received documented training acquired directly by an employer-
dentist or by a planned sequence of instruction in an educational institution and holds a
current basic life support registration.
41. "Registered dental assistant" means a dental assistant who is a graduate of a dental assistant
program accredited by the commission on dental accreditation of the American dental
association or a substantially equivalent curriculum approved by the board or has been
certified by the dental assistant national board, and has applied to the board and paid the
registration fee and met any other requirements of section 20-03-01-05.
42. "Remedial education" means an educational intervention prescribed by the board that is
designed to restore an identified practice deficiency of a licensee. Remediation may include
successful demonstration by the licensee that the learned knowledge and skills have been
incorporated into the licensee's practice.
43. "Satellite office" means an office, building, or location used at any time by a dentist for the
practice of dentistry other than the office listed on the dentist's biennial registration certificate.
44. "Screening" means an inspection used for the early identification of individuals at potentially
high risk for a specific condition or disorder and can indicate a need for further evaluation or
preliminary intervention. A screening is neither diagnostic nor a definitive indication of a
specific condition and does not involve making diagnoses that lead to treatment plans.
45. "Self-study", for the purposes of continuing education requirements, means the licensee
engages in obtaining education without direct supervision, without attendance in a classroom
setting, or without a proctor during online education. A certificate of completion must be
obtained as proof of education.
46. "Time-oriented anesthesia record" means documentation at appropriate intervals of drugs,
doses, and physiologic data obtained during patient monitoring.
47. "Titration" means administration of incremental doses of an intravenous or inhalation drug until
a desired effect is reached.
48. "Topical anesthesia" means the elimination of sensation, especially pain, in one part of the
body by skin or mucous membrane surface application of a drug.
49. "Webinar", for the purposes of continuing education requirements, means the licensee
engages in a live web-based seminar or presentation using video conferencing software. A

webinar is interactive and has the ability to give, receive, and discuss information in real-time.
A certificate of completion indicating "webinar" or other evidence of attendance must be
maintained as proof of continuing education.
History: Effective September 1, 1980; amended effective February 1, 1992; October 1, 1993; May 1,
1996; August 1, 1998; April 1, 2000; June 1, 2002; July 1, 2004; April 1, 2006; October 1, 2007;
January 1, 2011; April 1, 2015; July 1, 2017; July 1, 2022.
General Authority: NDCC 43-20-10, 43-28-06
Law Implemented: NDCC 43-20-01.1, 43-20-03, 43-20-10, 43-20-12, 43-20-13, 43-28-06
