Local Anesthesia, Let’s Give it a Shot

In 2008, Indiana passed House Bill 1172, which allows properly trained and permitted dental hygienists to administer local anesthesia. Indiana joins 44 states that currently allow this delegation.

Thus far, this change has triggered much discussion and some confusion, but as of this writing, no consumer complaints. Dentists need to know what is allowed and what is not allowed, because violation of state statute can have significant consequences to your license, as well as that of the hygienist.

[su_pullquote align=”right”]Currently, all Indiana Dental Hygiene educational programs include administration of local anesthesia. [/su_pullquote]Currently, all Indiana Dental Hygiene educational programs include administration of local anesthesia. All hygiene graduates in Indiana are eligible to sit for the CDCA exam, and to then apply for a Hygiene Aesthetic Permit. This permit is separate from the hygiene license, and must be renewed every two years. If a hygienist graduated prior to the incorporation of this education component, he or she can enter a program that teaches these procedures separately. The required education for delivering local anesthesia in Indiana is 15 hours of didactic training, 14 hours of clinical training, and the CDCA exam. If you are a hygienist from a school outside of Indiana which included an anesthesia component, that education must meet the above Indiana Standards to qualify. If that program falls short of Indiana’s standards, additional training is required.

[su_pullquote align=”right”]Properly trained and permitted dental hygienist can administer anesthesia for his or her own procedures as well as other procedures being done in the office… No prescription supervision is allowed for this procedure. [/su_pullquote]A properly trained and permitted dental hygienist can administer anesthesia for his or her own procedures as well as other procedures being done in the office. In other words, there is nothing that would prohibit a dentist from employing a dental hygiene “nurse anesthetist” who would precede the dentist’s entry into the operatory by reviewing the planned procedure and delivering the appropriate injections. This could, in some cases, improve the efficiency of the dentist. Of course, local anesthesia administration in Indiana is only permitted under direct supervision of the dentist. The dentist must be present at the time of delivery. No prescription supervision is allowed for this procedure.

With this relatively new delegation of procedures, Indiana is positioned as one of the most conservative states when it comes to regulations that restrict the freedom of individual dentists. In Indiana, advanced procedures can be performed within the office by qualified auxiliary team members. We in Indiana allow a wide scope of expanded function restorative care to be done by dental assistants with appropriate education, including polishing and application of anti-cariogenic agents. We now have opened up the hygiene and dental law to allow much more latitude in delegated anesthesia procedures. It is important to understand that in the eyes of the state, all procedures permitted in your office will reflect as if they were performed by your hand. In a free society, all things legal are not necessarily safe.

As for me, I feel the delivery of local anesthetic to be a moment to form that important bond with my patients. But, hey, thankfully, we are each largely free to independently decide the best care for our patients. We all are always aware that above all else, it is about keeping our patients first.

In closing, the complete book of Statute and Rule is available at our website: www.pla.in.gov It is your responsibility as a dental professional to read and understand these regulations. Please visit this website, as you will find valuable information about all dental and hygiene regulation! Additionally, most find the minutes of previous meetings to be interesting reading material.  

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About Dr. Stetzel

Dr. Mark R. Stetzel is a general dentist practicing in Fort Wayne, IN. He served as the 2016-2017 President of the Indiana State Board of Dentistry. He can be reached at mstetzel@comcast.net.