Resolution 37 – What Does It Mean for My Patients and Me?

A FAQ Prepared by John P. Bitting, Esq., Regulatory Counsel, DOCS Education

Q1: I don't offer sedation currently, but I would like to. How does Resolution 37 affect me?

A1: If your state adopts the guidelines recommended by Resolution 37, as recently approved by the ADA House of Delegates, minimal sedation will have a new, lower dosage restriction, referred to as the “MRD.”

The MRD is the manufacturer’s maximum recommended dose a patient can take at home unmonitored by a doctor. This translates into 10mg of Valium, 0.5mg of Halcion, and 4mg of Ativan. These are the most common drugs and dosages administered by dentists who provide minimal sedation.

If these dosages are exceeded, 60 hours of sedation training will be required. However, if a moderate enteral permit is acquired in your state before the full incorporation of Resolution 37, a 24-hour sedation training course will grandfather you into a 60-hour moderate permit saving time and money.

Q2: I offer nitrous oxide analgesia. How does Resolution 37 affect me?

A2: Use of nitrous oxide is not affected unless you want to add an oral sedative per A1 above. Nitrous oxide is the most commonly administered analgesic for dental procedures.

Q3: I offer minimal sedation. How does Resolution 37 affect me?

A3: Same as A1 above, IF your state adopts the Resolution 37 guidelines as written.

The following states currently have unrestricted minimal sedation and allow all of the DOCS Education proven oral sedation protocols: Washington, Oregon, Utah, Colorado, Nebraska, Minnesota, Illinois, Indiana, Massachusetts, Rhode Island, Connecticut, and New York (eff. 1/1/18). Alaska, Hawaii, and Nevada are in the process of revising their sedation rules.

Minimal sedation (an oral sedative with or without nitrous oxide) is the second most commonly administered form of mild anesthesia for anxious and fearful dental patients in the United States. Be aware that some of these states may consider adopting the exact language of Resolution 37. If that occurs, it is best to acquire a moderate enteral permit immediately.

Also the following states have a moderate enteral permit that can be obtained with 24 hours of training which will place a practitioner in the best position to avoid a 60-hour course just to provide medication above the MRD, or if you administer two medications on the same day: Arkansas, Georgia, Idaho, Kentucky, Louisiana, Maine, Maryland, Missouri, New Hampshire, North Carolina, Tennessee, Texas, Virginia, and West Virginia.

Q4: I offer moderate oral sedation. How does Resolution 37 affect me?

A4: This modality is the one most affected by the Resolution 37 guidelines.

If adopted verbatim by your state, you could be grandfathered as a moderate sedation provider. However, if you let your permit slip due to not meeting the recertification requirements, you will be forced to take the complete 60-hours of sedation courses.

The following states allow moderate oral sedation under the current (2007) or earlier ADA guidelines: California, Idaho, Arizona, New Mexico, Texas, Wisconsin, Kansas, Arkansas, Louisiana, Mississippi, Tennessee, Kentucky, Alabama, Georgia, South Carolina, North Carolina, Virginia, Maryland, West Virginia, New Jersey, New Hampshire, and Maine.

Q5: I offer IV sedation. How does Resolution 37 affect me?

A5: This modality is largely unaffected by Resolution 37. If you are currently providing IV sedation, you should not expect any changes.

Q6: How soon will states begin considering updating their regulations to mirror the ADA guidelines? Do the guidelines immediately become law in any states?

A6: Some states have already begun (e.g. Alaska, Hawaii, Nevada, New York, North Carolina). Others will begin immediately (Indiana and Massachusetts). Yet others have different priorities (California and Washington). And still others won’t adopt the ADA guidelines or already have rules that mirror the guidelines recommended by Resolution 37 (Florida, Michigan and Pennsylvania).

Q7: What can we do at the state level to prevent our legislators and boards from embracing the ADA guidelines?

A7: Clearly, you could try getting on your dental board. Barring that, if you know a dental board member, talk to him/her. Talk or write to your legislators if you can. Certain specialists on state dental boards are more than happy to push for adoption of Resolution 37 in order to restrict your ability to continue providing oral sedation to your grateful and fearful patients who otherwise wouldn’t seek your care. Also, please participate in public comments to your dental board on this topic in writing and/or in person.

Q8: If I still have questions about Resolution 37 and its impact my patients and me, what should I do?

A8: DOCS Education members are always welcome to contact me with their regulatory questions and concerns. The most efficient method is by email. I’m reachable at If you aren’t currently a DOCS Education member, I encourage you to become one. We offer 52-week-a-year regulatory monitoring and alerts that in this highly regulated environment are essential for every dentist and dental practice. For membership information, or to learn more about our course offerings, phone: 888-406-2786.