Local Anesthesia, Nitrous Oxide-Oxygen Sedation, and Expanded-Function Certifications
This section covers expanded-function certifications; the exam tests the training, supervision, and documentation required for local anesthesia and nitrous oxide.
Local anesthesia certification
A Kentucky hygienist may administer local anesthesia only after completing a Board-approved course with didactic and supervised clinical training and obtaining the certification. The service is typically performed under direct supervision, meaning the dentist is on the premises and available. The hygienist must evaluate contraindications, obtain informed consent, use proper technique, monitor for complications, and document the agent, dose, and patient response. Emergency protocols and reversal agents must be available as required.
Nitrous oxide-oxygen sedation
Administration of nitrous oxide-oxygen also requires Board-approved training and certification. The dentist must evaluate the patient and remain available; the hygienist monitors vital signs and sedation level, ensures adequate oxygen delivery, and documents inspired and expired concentrations and recovery. Scavenging and ventilation are required. Nitrous oxide is not a substitute for local anesthesia authorization.
Other expanded functions
The Board recognizes additional expanded functions by regulation; each requires specific training and may carry supervision limits. Certification is an endorsement on the license, not a separate license, and must be maintained.
Worked example
A patient requests nitrous oxide for a hygiene visit. The hygienist completed a nitrous course but the dentist is off-site. The hygienist may not administer it: the expanded function requires the dentist's evaluation and on-premises availability as direct supervision. Reschedule or call the dentist in.
Traps
Assuming completion of a CE lecture certifies you. Assuming local anesthesia may be given under general supervision. Forgetting to document informed consent and monitoring. Using nitrous oxide without a scavenging system.