Code of Massachusetts Regulations › 234 CMR - BOARD OF REGISTRATION IN DENTISTRY › Title 234 CMR 6.00 - ADMINISTRATION OF ANESTHESIA AND SEDATION › Section 6.02 - Definitions

Current through Register 1525, July 5, 2024
ADA Sedation Guidelines
means the
American Dental Association Policy Statement: The Use of Sedation and
				General Anesthesia by Dentists
;
The Guidelines for Teaching
				Pain Control Sedation to Dentists and Dental Students 2007;
and
The Guidelines for the Use of Sedation and General Anesthesia by
				Dentists
.
AHA/ACLS Guidelines
means the
2005 American Heart Association Guidelines for Cardiopulmonary
				Resuscitation and Emergency Cardiovascular Care
.
Analgesia
means the diminution or
				elimination of pain. An analgesic (colloquially known as a "painkiller") is any
				member of the diverse group of drugs used to control pain.
Anesthesia
means an artificially
				induced insensibility to pain usually achieved by the administration of gases
				or the use of drugs.
ASA I, II, III, and IV
are
				classifications of patient physical status as determined by the American
				Society of Anesthesiologists (ASA).
Conscious Sedation
means sedation in
				which protective reflexes are normal or minimally altered. The patient remains
				conscious and maintains the ability to independently maintain an airway and
				respond appropriately to verbal command. Conscious sedation also includes the
				use of other sedative agents and/or pre-medication in combination with nitrous
				oxide-oxygen.
Continual
means repeated regularly
				and frequently in a steady succession.
Continuous
means prolonged without
				any interruption at any time.
Deep Sedation
means a drug-induced
				depression of consciousness during which patients cannot be easily aroused but
				respond purposefully following repeated or painful stimulation. The ability to
				independently maintain ventilatory function maybe impaired. Patients may
				require assistance in maintaining a patent airway, and spontaneous ventilation
				may be inadequate. Cardiovascular function is usually maintained. (American
				Society of Anesthesiologists, adopted October 2009)
Enteral
means any technique of
				administration in which the agent is absorbed through the gastrointestinal (GI)
				tract or oral mucosa (
i.e
., oral, rectal, sublingual).
Facility Permits
are issued by the
				Board before a qualified dentist licensed pursuant to M.G.L. c. 45 or a medical
				anesthesiologist licensed by the Massachusetts Board of Registration in
				Medicine may administer general anesthesia and/or deep sedation, moderate
				sedation, minimal sedation or nitrous oxide-oxygen in a dental office. A
				dentist owning or operating a dental facility or practice must obtain a
				Facility Permit in order to allow the administration of these categories of
				anesthesia services to be provided on the premises. The types of Facility
				Permits issued by the Board are:
(a)
Facility Permit D-A
authorizes the
				administration of general anesthesia, deep, moderate, minimal sedation, and
				nitrous oxide-oxygen sedation at the site named on the Permit, as performed by
				a qualified dentist licensed to practice under M.G.L. c. 112, § 45 or by a
				medically licensed anesthesiologist.
(b)
Facility Permit D-B1
authorizes
				the administration of moderate, minimal and nitrous oxide-oxygen sedation at
				the site named on the Permit, as performed by a qualified dentist licensed to
				practice under M.G.L. c. 112, § 45 or by a medically licensed
				anesthesiologist. (c)
Facility Permit D-B2
authorizes
				the administration of minimal sedation at the site named on the Permit, as
				performed by a qualified dentist licensed to practice under M.G.L. c. 112,
				§ 45, or by a medically licensed anesthesiologist.
(d)
Facility Permit D-C
authorizes the
				administration of nitrous oxide-oxygen sedation on the premises named on the
				permit by a qualified dentist licensed to practice dentistry in the
				Commonwealth under M.G.L. c. 112, § 45, or by a medically licensed
				anesthesiologist.
(e)
Facility Permit D-H
authorizes the
				dental facility or practice site named on the Permit to contract for or host a
				mobile or portable anesthesia service offered by a qualified dentist licensed
				under M.G.L. c. 112, § 45 who holds a Facility Permit D-P, or offered by a
				medically licensed anesthesiologist.
(f)
Facility Permit D-P
authorizes a
				qualified dentist to use his/her portable or mobile anesthesia equipment, drugs
				and personnel for the administration of general anesthesia, deep sedation,
				moderate sedation, minimal sedation, or nitrous oxide-oxygen sedation at a
				dental facility or dental practice that possesses a Facility Permit D-H.
General Anesthesia
means a
				drug-induced loss of consciousness during which patients are not arousable,
				even by painful stimulation. The ability to independently maintain ventilatory
				function is often impaired. Patients often require assistance in maintaining a
				patent airway, and positive pressure ventilation may be required because of
				depressed spontaneous ventilation or drug induced depression of neuromuscular
				function. Cardiovascular function may be impaired. (American Society of
				Anesthesiologists, adopted October 2009)
Immediately Available
means
				physically located in the facility and ready for immediate response or
				utilization.
Incremental Dosing
means
				administration of multiple doses of a drug until a desired effect is reached,
				but not to exceed the maximum recommended dose.
Individual Anesthesia Permits
are
				permits authorizing qualified dentists to administer deep sedation and general
				anesthesia, moderate sedation, minimal sedation, and/or nitrous oxideoxygen
				sedation that may be issued by the Board to a dentist licensed to practice
				pursuant to M.G.L. c. 112, § 45 who meets the qualifications specified in
				234
				CMR 6.10,
				6.11,
				6.12,
				6.13,
				and/or 6.14. The following individual anesthesia permits may be issued:
(a)
Individual Permit A
authorizes a
				qualified dentist to administer general anesthesia, deep sedation, moderate
				sedation, minimal sedation, and nitrous oxide-oxygen in a dental facility that
				has the required Facility Permit for the type of anesthesia being administered
				by said dentist.
(b)
Individual Permit B-1
authorizes a
				qualified dentist to administer moderate sedation and nitrous oxide-oxygen in
				conjunction with any other anesthestic or enteral sedative agents dispensed or
				administered in the dental facility that has the required Facility Permit for
				the type of anesthesia being administered by said dentist.
(c)
Individual Permit B-2
authorizes a
				qualified dentist to administer minimal sedation and/or nitrous oxide-oxygen in
				conjunction with an enteral agent dispensed or administered in the dental
				facility that has the required Facility Permit for the type of anesthesia being
				administered by said dentist.
(d)
Individual Permit C
authorizes a
				qualified dentist to administer nitrous oxide-oxygen alone, or in conjunction
				with a local anesthetic in a dental facility that has the required Facility
				Permit for the type of anesthesia being administered by said dentist.
Inhalation
means a technique of
				administration in which a gaseous or volatile agent is introduced into the
				lungs and whose primary effect is due to absorption through the gas/blood
				interface.
Local Anesthesia
means the
				elimination of sensation, especially pain, in one part of the body by the
				topical application or regional injection of a drug. Administration of local
				anesthesia requires awareness of the maximum, safe dosage limits for each
				patient.
Maximum Recommended Dose
means the
				maximum FDA-recommended dose of a drug as printed in FDA approved labeling for
				unmonitored home use.
Minimal Sedation (Anxiolysis)
is a
				drug-induced state during which patients respond normally to verbal commands.
				Although cognitive function and physical coordination may be impaired, airway
				reflexes, and ventilatory and cardiovascular functions are unaffected.
				(American Society of Anesthesiologists, adopted October 2009).
Mobile Anesthesia Permit P
means a
				permit issued by the Board to a qualified dentist anesthesiologist who travels
				to a dental office(s) bringing equipment, supplies, drugs and qualified staff
				for the purpose of providing mobile or portable anesthesia or sedation services
				at a dental office which has the required Facility Permit D-H to contract or
				host an anesthesia service that uses portable or mobile dental anesthesia
				equipment, drugs, and personnel.
Moderate Sedation
is a drug-induced
				depression of consciousness during which patients respond purposefully to
				verbal commands, either alone or accompanied by light tactile stimulation. No
				interventions are required to maintain a patent airway, and spontaneous
				ventilation is adequate. Cardiovascular function is usually maintained.
American Society of Anesthesiologists
, adopted October 2009.
				Administration of moderate sedation includes parenteral, enteral and/or
				combination inhalation-enteral conscious sedation.
Nitrous Oxide-oxygen Sedation
means
				conscious sedation accomplished solely by the use of nitrous
				oxide-oxygen.
Operating Dentist
means a dentist
				licensed pursuant to M.G.L. c. 112, § 45 to practice dentistry in the
				Commonwealth who provides treatment to the patient.
Parenteral
means a technique of
				administration in which drugs bypass the gastrointestinal (GI) tract,
e.g
. through intramuscular (IM), intravenous (IV), intranasal
				(IN), sub mucosal (SM), subcutaneous (SC), or intraosseous (IO)
				administration.
Pediatric Advanced Life Support (PALS)
				Certification
means that an individual has successfully completed
				a pediatric advanced life support course offered by the American Heart
				Association or other entity approved by the Board.
Permit L
means a permit issued by the
				Board to a dental hygienist who is qualified to administer local anesthesia
				under the direct supervision of a dentist licensed to practice pursuant to
				M.G.L. c. 112, § 45.
Qualified Dentist
means a dentist
				licensed pursuant to M.G.L. c. 112, § 45 to practice dentistry in the
				Commonwealth who has completed the appropriate education and training and holds
				a current permit to administer deep sedation and general anesthesia, moderate
				sedation, minimal sedation, and/or nitrous oxide-oxygen pursuant to
				234 CMR 6.00.
Routes of Administration
include
				parenteral, enteral, and inhalation-enteral methods.
Supplemental Dosing
means the
				administration of a single additional dose of the initial drug administered
				during sedation.
Time-oriented Anesthesia Record
means
				documentation of drugs, doses, and physiologic data obtained during patient
				monitoring at appropriate time intervals.
Titration
means the administration of
				incremental doses of a drug until the desired effect is reached, and applies to
				achieving moderate and deeper levels of sedation.
Transdermal
means a technique of
				administration in which a drug is administered by patch or iontophoresis
				through the skin.
Transmucosal
means a technique of
				administration in which the drug is administered across mucosa such as
				intranasal, sublingual, or rectal.