# COMAR Title 10 — Maryland Department of Health

## Subtitle 44 — Board of Dental Examiners

### Chapter 04 — Practice of Dental Hygiene

#### Regulation .20 Board-Approved Course of Instruction for Administering Nitrous Oxide.

*COMAR 10.44.04.20*

The 6-hour Board-approved course of instruction shall include but not be limited to the following:

A. 4 hours of didactic classroom training, including at least the following:

  (1) The history, philosophy, and psychology of nitrous oxide minimal sedation;

  (2) The definition and descriptions of the physiological and psychological aspects of pain and anxiety;

  (3) Concepts and management of pain and anxiety;

  (4) Indications and contraindications for nitrous oxide sedation;

  (5) Anatomy and physiology of pediatric and adult respiration;

  (6) Medical assessment of a patient before administration of nitrous oxide;

  (7) Moderate sedation, deep sedation, and general anesthesia versus nitrous oxide;

  (8) Pharmacological and physiological effects of nitrous oxide including drug interactions;

  (9) A description of the stages of drug induced central nervous system depression through all levels of consciousness and unconsciousness with emphasis on the distinction between the conscious and unconscious state;

  (10) Administering and monitoring the flow of nitrous oxide, including the monitoring of a patient’s vital functions;

  (11) Recognition and management of complications and medical emergencies;

  (12) Occupational exposure; and

  (13) Preventing, recognizing, and managing possible complications of inhalation sedation; and

B. 2 hours of clinical training, including the direct observation of the performance of procedures.