By Rose Dodson, M.S., CEO; Sedation Resource, Inc.

“Annie, Annie, are you okay?” For decades, that question has taken many back to their CPR training. Recognizing a life-threatening event, knowing the basic steps to save a life, and being comfortable performing rescue procedures are critical to emergency preparedness.

Texas regulations require emergency training and office preparedness.

Every dental practice is required to have a certain level of training for emergency preparedness. The training required varies depending on the permit level. (See the table at the end of this article. You can also find this information at

Whether the requirement is Basic Life Support (BLS) or Advanced Cardiac Life Support (ACLS), a core focus is airway management—rescuing a patient who is not breathing.

In addition to training requirements, Texas regulations clearly define some of the key components of preparing an office for an emergency. Yes, it’s important to have the appropriate equipment and an adequate supply of drugs. Making checklists and having an emergency plan documented are also key to emergency preparedness.

Unfortunately, having all this outlined in a 3-ring binder does not guarantee a state of readiness for a real crisis.

This is the most effective training for an actual emergency.

If an adverse event were to occur in your office, there will be many questions posed by many people, but the most important will be the ones you ask yourself. What could you have done differently? How could you have been better prepared?

Conducting simulated, realistic drills and exercises on a regular basis in spaces where scenarios are likely to occur is the most effective way to solidify emergency management training. This allows for weaknesses in the flow to be revealed and areas that need improvement to be identified.

To facilitate realistic and regular emergency management drills, creating a training center with a set of simulation tools is a logical strategy.

  • For Basic Life Support, this would be a CPR manikin, a bag valve mask, and an oral airway.
  • For those who are required to take ACLS/PALS, an intubation manikin would be needed, along with a few other airway adjuncts such as a laryngeal mask device and possibly a basic laryngoscope with endotracheal tubes.
  • It’s a good idea to include a mock emergency drug set with properly identified drugs.

With “Annie” in the chair ready for her procedure, every step of the emergency process can be rehearsed. There are various ways to practice emergencies in your office.

  • A simple way is to guide the team through common scenarios that could occur.
  • An advanced way could be having someone with a hi-fidelity simulation manikin come to your office and conduct scenarios and provide feedback to your team.

It’s essential to conduct emergency exercises incorporating mock drills relative to the type of patients who are typically treated and make time for debriefing afterwards.

Additionally, there are several resources that provide dental-related pre-prepared mock drills and at least one online video program that guides the team through the mock drill, demonstrating airway management with a CPR manikin and an intubation manikin.

The goal is to create a culture of safety in your practice, so the entire team is well-prepared for any emergency. Reacting to a crisis will be second nature, and your Annie will be okay.

Note: Patient safety resources can be accessed online at

Training Level Requirements

Refer to the Texas State Board of Dental Examiners continuing-education-for-dentists page on its website for more information.

Who Dentists w/o sedation permits Dentists w/ sedation permits
BLS CPR (hands on) Yes Yes
ACLS/PALS No Level 2–4 permit only
PALS Only No Levels 2–4 who provide anesthesia services to children 12 or younger

Sedation Levels

The CE requirements are in addition to any additional course required for licensure. ACLS and PALS courses may not be used to fulfill the CE renewal requirement.

Level 1: Minimal Sedation Six (6) hours on the administration of or medical emergencies associated with the permitted level of sedation.
Levels 2 & 3: Moderate Sedation Eight (8) hours on the administration of or medical emergencies associated with the permitted level of sedation.
Level 4: Deep Sedation/General Anesthesia Twelve (12) hours on the administration of or medical emergencies associated with the permitted level of sedation.

Texas Certification Requirements

Sedation Type Certification Requirement
Nitrous Oxide/Oxygen Inhalation Sedation Basic Life Support only
Level 1: Minimal Sedation Basic Life Support
Sedation Level 2, 3 & 4 Basic Life Support and ACLS or PALS if treating adults and children 13 years of age or older (Note: PALS is required if treating children under the age of 13 years old.)
Sedation Resource is a customer-focused company of integrity that carries an extensive line of sedation equipment and supplies at competitive prices. TDA members receive a 10% discount on all sedation supplies and year-round discounted pricing on equipment.

Anesthesia Research Foundation (2023). Ten minutes saves a life! American Dental Society of Anesthesiology,

Dental Anesthesia Online (2023). Hybrid SIMMAN team sedation training. Dental Anesthesia Online,