(1)
Application. An applicant shall submit an accurate and
complete application on form(s) provided by the Board and accompanied by the
permit fee to be determined annually by the Executive Office of Administration
and Finance. The application shall, at a minimum, include the following:
(a) Applicant name and Massachusetts dental
license number;
(b) Name(s) of
dental establishment(s), owner(s) of said establishment, and address(es) of the
site(s) where anesthesia will be administered;
(c) Documentation of provision and
maintenance of equipment, materials, and drugs required for the administration
of moderate, minimal and nitrous oxide-oxygen sedation;
(d) A written request for an on-site
inspection conducted by the Board; and
(e) Other information as may be requested by
the Board.
(2)
Equipment Required for a Facility Permit D-B1. The
following equipment shall be required to be provided and maintained on-site:
(a) Alternative light source for use during
power failure;
(b) Automated or
manual external defibrillator;
(c)
Disposable syringes, assorted sizes;
(d) Disposable CPR masks (pediatric and
adult);
(e) Equipment suitable for
proper positioning of the patient for administration of cardiopulmonary
resuscitation, including a back board;
(f) Equipment and maintenance of an
intravenous infusion (if IV medications are to be administered by a qualified
dentist who is educated and trained commensurate with the ADA
Guidelines of Teaching Pain Control Sedation to Dentists and Dental Students
2007;
(g) Gas delivery
system capable of positive pressure ventilation, which must include:
1. Oxygen;
2. Safety-keyed hose attachments;
3. Capability to administer 100% oxygen in
all rooms (operatory, recovery, examination, and reception);
4. Gas storage in compliance with safety
codes;
5. Adequate waste gas
scavenging system; and
6. Nasal
hood or cannula.
(h)
Latex free tourniquet;
(i) Means of
monitoring vital signs (pediatric and adult);
(j) Oxygen (portable Cylinder E tank)
pediatric and adult masks capable of giving positive pressure ventilation
(including bag-valve-mask system);
(k) Pulse oximeter with battery
pack;
(l) Sphygmomanometer and
stethoscope (pediatric and adult);
(m) Suction;
(n) Supervised area for recovery;
and
(o) Any other equipment as may
be required by the Board.
(3)
Drugs Required for a Facility
Permit D-B 1 Permit. The following drugs and/or categories of
drugs shall be provided and maintained in accordance with the AHA/ACLS
Guidelines (
234 CMR 6.02) or as
determined by the Board for emergency use. All drugs shall be current and not
expired.
(a) Acetylsalicylic acid (readily
absorbable form);
(b) Ammonia
inhalants;
(c)
Anticonvulsant;
(d)
Antihistamine;
(e) Antihypoglycemic
agent;
(f)
Bronchodilator;
(g)
Corticosteroid;
(h) Epinephrine
preloaded syringes (pediatric and adult);
(i) Two epinephrine ampules;
(j) Oxygen;
(k) Vasodilator;
(l) Vasopressor;
(m) Reversal agents; and
(n) Any other drug or category of drugs as
may be required by the Board.
