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 that complies at a minimum with the ADA
Guidelines for Teaching Pain Control Sedation to Dentists and Dental Students,
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
inducing minimum sedation must have at least one additional individual trained
in BLS present during the administration of the anesthesia.
(3)
Patient Evaluation
Required. Patients considered for minimum sedation 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. 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
minimum sedation shall include:
(a) The
patient or legal representative shall be advised regarding the procedure
associated with the delivery of any sedative or anesthetic agents and a signed
informed consent shall be obtained pursuant to
234 CMR 5.15(3)(f)
for the proposed sedation/anesthesia
obtained prior to the administration of the anesthesia or sedative
agent(s);
(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 prohibits such determination, this must be documented in the patient
record;
(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;
and
(f) Pre-operative verbal and
written instructions must be given to the patient and responsible
person.
(5)
Patient Monitoring and Documentation Required.
(a) A qualified dentist administering minimum
sedation 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 Minimum sedation 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. Level of consciousness
(e.g. responsiveness to verbal command);
4. Chest excursions;
5. Ventilation either by auscultation of
breath sounds, monitoring end-tidal CO2 or by verbal
communication with the patient; and
6. ECG for patients with significant
cardiovascular disease (may be considered).
(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 anesthetic record including the names of all drugs administered,
including local anesthetics, dosages, and monitored physiologic
parameters;
2. Pulse oximetry,
heart rate, respiratory rate, and blood pressure;
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 Minimum sedation 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;
(d) Post-operative verbal and written
instructions provided; and
(e) If a
reversal agent is administered before discharge criteria have been met, the
patient must be monitored until recovery is assured.
(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, as may be
amended and republished 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 (
234 CMR 6.02
).
(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, providing
and maintaining the equipment, drugs and protocol for patient rescue, and
conducting and documenting emergency drills. 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.
