Current through Register 1531, September 27, 2024
(1)
Initial Application Requirements. An applicant shall
submit an accurate and complete application on forms provided by the Board and
accompanied by a fee established annually by the Executive Office of
Administration and Finance, and includes documentation that demonstrates proof
that the applicant:
(a) Is a dentist licensed
under M.G.L. c. 112, § 45 to practice in the Commonwealth;
(b) Has current certification in ACLS or
PALS;
(c) Has successfully
completed an education program accredited by the ADA Commission on Dental
Accreditation that provides comprehensive and appropriate training necessary to
administer and manage deep sedation or general anesthesia, commensurate with
Part III C of the ADA Guidelines for the Use of Sedation and General
Anesthesia, 2007 at the time training was commenced; or
(d) Is certified by the American Board of
Oral and Maxillofacial Surgery (ABOMS); or
(e) Is certified as a Fellow and/or has Board
certification in Anesthesia issued by the American Dental Board of
Anesthesiology.
(2)
Auxiliary Personnel Required. A qualified dentist
administering deep sedation and general anesthesia must have a minimum of three
individuals present during the procedure:
(a)
A dentist qualified in accordance with 234 CMR 6.11; and
(b) Two additional individuals who have been
appropriately trained to assist in anesthesia administration and have current
certification in BLS for the Healthcare Provider.
(c) When the same individual administering
the deep sedation or general anesthesia is performing the dental procedure, one
of the additional appropriately trained auxiliaries must be designated
specifically for patient monitoring.
(3) Patient Evaluation Required. Patients
considered for deep sedation or general anesthesia must be suitably evaluated
prior to the start of any sedative procedure. For healthy or medically stable
patients (ASA I, II), this must consist of a review of their current medical
history and medication use and NPO status. For patients with a significant
medical history (ASA III, IV), consultation with their primary care physician
or consulting medical specialist may be required.
(4)
Pre-operative Preparation
Required. Pre-operative preparation for the administration of deep
sedation or general anesthesia shall include:
(a) The patient shall be advised regarding
the procedure associated with the delivery of any sedative or anesthetic agents
and a signed informed consent (
234 CMR 5.15(3)(f)
) for the proposed sedation/anesthesia shall
be obtained prior to the administration of general anesthesia or deep
sedation;
(b) Determination of
adequate oxygen supply and equipment necessary to deliver oxygen under positive
pressure must be completed;
(c)
Baseline vital signs, including blood pressure, respiration, and heart rate,
must be obtained and documented in the patient record. If the patient's
behavior or condition prohibits such determination, this must be documented in
the patient record. The temperature of pediatric patients administered general
anesthesia/deep sedation must be monitored;
(d) A medical history must be completed and
problem-focused physical evaluation must be performed where deemed
appropriate;
(e) Specific dietary
instructions must be provided to the patient based upon the type of
sedative/anesthetic technique prescribed and patient's physical
status;
(f) Pre-operative verbal
and written instructions must be given to the patient; and
(g) An intravenous line, which is secured
throughout the procedure, must be established except as provided for pediatric
and/or special needs patients (see234 CMR 6.11(7)).
(5)
Patient Monitoring
and Documentation Required.
(a) A
qualified dentist administering deep sedation or general anesthesia must remain
in the room with the patient to monitor the patient continuously until the
patient meets the criteria for recovery and must not leave the facility until
the patient meets the criteria for discharge and is discharged from the
facility.
(b) Monitoring and
documentation of patient administered deep sedation or general anesthesia shall
include, but not be limited to, continuous monitoring and evaluation of :
1. Color of mucosa, skin or blood (monitoring
only);
2. Oxygenation saturation by
pulse oximetry;
3. For intubated
patient, end-tidal CO2;
4. For non-intubated patient, breath sounds
via auscultation and/or end-tidal CO2;
5. Respiration rate;
6. Heart rate and rhythm via ECG and pulse
oximetry;
7. Blood pressure (unless
the patient is unable to tolerate such monitoring which must be specifically
noted in the patient record);
8. A
device capable of measuring body temperature must be readily available;
and
9. Body temperature whenever
triggering agents associated with malignant hyperther-mia are
administered.
(c)
Anesthesia Chart. The Anesthesia Chart shall contain
documentation of all events related to the administration of the sedative or
anesthetic agents, including but not limited to the following:
1. Time-oriented anesthesia record including
the names of all drugs administered, including local anesthetics, and date,
dosage and method of administration;
2. Pulse oximetry and end-tidal
CO2 measurements (if taken), heart rate, respiratory
rate and blood pressure recorded at specific intervals during the
procedure;
3. The duration of the
procedure; and
4. The individuals
present during the procedure.
(6)
Requirements for Management
of Recovery and Discharge of Patients. The recovery and discharge
procedures for a patient administered deep sedation or general anesthesia,
shall include, but not be limited to:
(a)
Immediate availability of oxygen and suction equipment;
(b) Continuous monitoring and documentation
of the patient's blood pressure, heart rate, oxygenation and level of
consciousness;
(c) Determination
and documentation that the level of consciousness, oxygenation, ventilation,
and circulation are satisfactory for discharge; and
(d) Documentation that post-operative verbal
and written instructions have been provided to patient and responsible
person.
(7)
Requirements for Management of pediatric and Special Needs
Patients. The Board adopts the American Academy of
Pediatrics/American Academy of Pediatric Dentistry's Guidelines for Monitoring
and Management of Pediatric Patients During and After Sedation of Diagnostic
and Therapeutic Procedures, and the American Dental Association's
guidance on pediatric and special needs patients as contained in its
Policy Statement on The Use of Sedation and General Anesthesia by
Dentists (2007).
(8)
Requirements for Emergency Management. The qualified
dentist is responsible for the sedative management, adequacy of the facility
and staff, diagnosis and treatment of emergencies related to the administration
of sedation and providing and maintaining the equipment, drugs and protocol for
patient rescue. If a patient enters a deeper level of sedation than the
qualified dentist is permitted to provide, the dentist must stop the dental
procedure until the patient returns to the intended level of
sedation.
