(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 minimal and nitrous oxide-oxygen
sedation;
(d) A written request for
an on-site inspection conducted by the Board; and
(e) Any other information as may be requested
by the Board.
(2)
Equipment Required for a Facility Permit D-B2. 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 CPR masks (pediatric and adult);
(d) Disposable syringes, assorted
sizes
(e) Equipment suitable for
proper positioning of the patient for administration of cardiopulmonary
resuscitation, including a back board;
(f) 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;
and
6. Nasal hood or
cannula.
(g) Latex free
tourniquet;
(h) Means of monitoring
vital signs (pediatric and adult);
(i) Oxygen (portable Cylinder E tank)
pediatric and adult masks capable of giving positive pressure ventilation
(including bag-valve-mask system);
(j) Pulse oximeter with battery
pack;
(k) Sphygmomanometer and
stethoscope (pediatric and adult);
(l) Suction;
(m) Supervised area for recovery;
and
(n) Any other equipment as may
be required by the Board.
(3)
Drugs Required for a Facility
Permit D B-2. 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) Oxygen;
(j) Reversal agents;
(k) Two epinephrine ampules;
(l) Vasodilator;
(m) Vasopressor; and
(n) Any other drugs or categories of drugs as
may be required by the Board.
