Definitions

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 mayrequire 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 oxide- oxygen 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.