The administration of anesthesia in dental offices across North Carolina is under heightened scrutiny. A series of tragic patient deaths, public advocacy, and legislative interest have prompted the North Carolina State Board of Dental Examiners (NCSBDE or Board) to re-evaluate its regulatory framework. This article explores the current rules, recent events, permit levels, professional distinctions, and the evolving debate around safety and oversight in dental anesthesia.
Impetus for Change
This issue has taken on new urgency in recent years due to a convergence of factors. High-profile patient deaths have drawn intense media scrutiny and public outcry, prompting families and advocacy groups to demand stronger safeguards. Simultaneously, advances in sedation techniques and the growing popularity of in-office procedures have expanded the use of anesthesia beyond oral surgery to general dentistry. These developments raise critical questions about training, oversight, and patient safety. With state regulators and lawmakers now actively reshaping the rules, the dental community finds itself at a pivotal moment: balancing innovation and accessibility with the imperative to protect patients from preventable harm.
Recent Changes to NCSBDE Rules on Dental Anesthesia
In response to multiple anesthesia-related deaths, the NCSBDE enacted several rule changes between 2022 and 2024.
- Mandatory Office Inspections: As of 2022, all dental offices administering moderate or deep sedation must undergo inspections at least once every five years. Previously, inspections could be conducted by third-party organizations like the American Association of Oral and Maxillofacial Surgeons, but this was discontinued following legal concerns about delegating regulatory authority.
- Permit Clarifications and Enforcement: The Board clarified the scope and requirements for each anesthesia permit level (Minimal, Moderate, and Deep Sedation/General Anesthesia), and began stricter enforcement of training and equipment standards.
- Emergency Preparedness Enhancements: Dentists are now required to maintain more robust emergency protocols, including updated resuscitation equipment and clearly documented emergency plans.
- Transparency in Disciplinary Actions: The Board has increased public access to disciplinary records and outcomes related to anesthesia violations, aiming to restore public trust.
High-Profile Cases and Public Reaction
Several high-profile deaths have intensified scrutiny. For instance, a patient died in 2021 after being over-sedated during a denture procedure. The dentist administered sedatives that “far exceeded the amounts appropriate and necessary,” leading to cardiac arrest. In 2020, a Wilmington-area cardiologist died following a dental procedure involving sedation. This case became a catalyst for reform for dental anesthesia and sedation, with proponents pushing for mandatory dual-provider anesthesia teams. These and other cases have galvanized public and legislative action.
Legislative Response: “Henry’s Law”
In 2023, the North Carolina Senate introduced “Henry’s Law,” a bill that would require a second licensed anesthesia provider (e.g., a Certified Registered Nurse Anesthetist (CRNA) or an anesthesiologist) to be present during deep sedation procedures. While the bill has not yet passed, it has significantly influenced public discourse and professional practices. Some dental groups, including large platform practices, have voluntarily adopted this model, employing CRNAs for moderate sedation even though not legally required.
The Debate Over Dual-Provider Models
Despite the safety benefits, the dual-provider model faces criticism and obstacles.
- Provider Shortages. A significant provider shortage presents a major challenge to implementation. With a limited supply of CRNAs and dental anesthesiologists, especially in rural areas, compliance with such a model may be difficult.
- Cost Implications. Employing a second provider increases operational costs, which may be passed on to patients, potentially reducing access to care.
- Professional Autonomy. Some dentists argue that with proper training and protocols, they can safely manage sedation without a second provider, especially for routine procedures.
Life Support Training: BLS and ALS in Dental Practices
The NCSBDE currently mandates Basic Life Support (BLS) for all dental staff involved in sedation and Advanced Life Support (ALS) for dentists administering moderate or deep sedation. There have been discussions about expanding these requirements to include Pediatric Advanced Life Support (PALS) for those treating children, though no formal rule change has been adopted yet.
Oversight by the NC State Board of Dental Examiners
The NCSBDE is the primary regulatory body overseeing dental anesthesia. Its responsibilities include:
- Issuing and renewing anesthesia permits;
- Conducting office inspections;
- Investigating complaints; and
- Enforcing disciplinary actions.
While the Board has faced criticism for perceived past oversight failures, it has since increased transparency and enforcement efforts.
Legislative Response: Restructuring the Board
In 2025, Senate Bill 599 was introduced to reform the structure of the NCSBDE. Key proposed changes include:
- Expanding the Board from 9 to 10 members;
- Adding a second dental hygienist;
- Reducing the Governor’s appointments;
- Adding appointments by the Commissioner of Labor; and
- Giving the Speaker of the House the authority to appoint both licensed dentists.
These changes aim to diversify representation and reduce potential conflicts of interest in regulatory decisions.
Looking Ahead: Future of Dental Anesthesia in North Carolina
North Carolina’s dental community is at a crossroads. While new rules and proposed laws aim to enhance patient safety, they also raise questions about access, cost, and feasibility. Dentists who proactively adopt best practices—such as enhanced training and collaboration with CRNAs—will be best positioned to adapt to this evolving landscape. Ongoing debates are expected around dual-provider mandates, expanded life support training requirements, and greater public involvement in dental board governance. By engaging with these changes constructively, dental professionals can help shape a safer, more transparent, and patient-centered future.
Note: The author of this article served as the Consumer Member of the NCSBDE from 2017 to early 2025. It is the opinion of this former Consumer Member of the NCSBDE that a vital legislative reform would be to make the Consumer Member position a full voting position. The Consumer Member is currently the only member of the general public on the Board, yet is unable to vote on various matters, including disciplinary hearings. Adding full voting rights to the position would, in this writer’s opinion, address certain antitrust and “active market participant” concerns and better empower and enable the Consumer Member to fulfill the position’s stated goal: protecting the public of NC.
