Section 313-14-VII - USE OF MINIMUM AND MODERATE SEDATION; PERMIT REQUIREMENTSA.Minimal Sedation(1)General. No dentist shall be required to obtain a permit in order to administer minimal sedation as defined by the "ADA Guidelines."(2)Exception. Dentists who administer minimal sedation to patients age 12 and under must first obtain a Permit for Moderate Sedation if: (a) The dentist prescribes a preoperative sedative to be administered to the child (Level I - Enteral); or(b) The dentist administers a combination of minimal sedation methods (e.g. oral sedative and nitrous oxide) (Level I - Enteral).B.Moderate Sedation Permit(1)General. No dentist may administer moderate sedation without first obtaining a permit from by the board.(2)Types of Permits for Moderate Sedation: The Board may issue one of the following types of permits for moderate sedation:(a) Permit for Moderate Sedation Level I (Enteral); and(b) Permit for Moderate Sedation Level II (Parenteral).(3)Qualifications for Initial Permits for Moderate Sedation: In order to qualify, dentist applicants must submit an application, pay the required fees, and meet each of the following: (a)Permit for Moderate Sedation Level I (Enteral). Dentist applicants for this type of permit must satisfy each of the following:(i) Have successfully completed a Board-approved comprehensive training program of a minimum of twenty-four (24) hours duration, plus management of at least ten (10) adult case experiences by the enteral and/or enteral-nitrous oxide/oxygen route as described in the "ADA Teaching Guidelines." The ten (10) cases must include at least three live clinical dental experiences managed by participants in groups no larger than five (5). The remaining cases may include simulations and/or video presentations, but must include one experience in returning (rescuing) a patient from deep to moderate sedation. Participants should be provided supervised opportunities for clinical experience to demonstrate competence in airway management. Clinical experience will be provided in managing healthy adult patients. This course in moderate enteral sedation is not designed for the management of children (aged 12 and under). Additional supervised clinical experience is necessary to prepare participants to manage medically compromised adults and special needs patients. This course in moderate enteral sedation does not result in competency in moderate parenteral sedation;(ii) Possess current life support certifications in accordance with Section V(H)(1)(b);(iii) Have submitted to the Board a completed, signed certification form that attests to adhering to the equipment, personnel, procedures, techniques and documents as outlined in the "ADA Sedation Guidelines" and requirements in this chapter; and(iv) If providing sedation services to an operating dentist, agree to comply with the notification requirements in this chapter that requires the sedation provider to submit to the Board, fourteen (14) days prior to delivering services in this chapter, a signed, written agreement between the operating dentist and sedation provider identifying the location of which sedation services are to be administered and demonstrating compliance with the equipment, personnel, procedures, techniques and documents as outlined in the "ADA Sedation Guidelines" and requirements in this chapter. The agreement, at a minimum, must describe how emergency response training and protocols will be developed and practiced, procedures for verifying qualifications of personnel who assist in the care and monitoring of the patient, responsibilities for pre-operative, inter-operative, and post- operative patient assessment and monitoring, responsibilities for obtaining informed consent, and how compliance with applicable board statutes and regulations will be achieved and maintained at the site.(b)Permit for Moderate Sedation Level II (Parenteral). Dentist applicants for this type of permit must satisfy each of the following:(i) Have successfully completed a Board-approved comprehensive training program of a minimum of sixty (60) hours of instruction, plus management of at least 20 patients by the intravenous route per participant as described in the "ADA Teaching Guidelines." Clinical experience in managing a compromised airway is critical to the prevention of emergencies. Participants should be provided supervised opportunities for clinical experience to demonstrate competence in management of the airway. Typically, clinical experience will be provided in managing healthy adult patients. Additional supervised clinical experience is necessary to prepare participants to manage children (aged 12 and under) and medically compromised adults;(ii) Possess current life support certifications in accordance with Section V(H)(1)(b);(iii) Have submitted to the Board a completed, signed certification form that attests to adhering to the equipment, personnel, procedures, techniques and documents as outlined in the "ADA Sedation Guidelines" and requirements in this chapter; and(iv) If providing sedation services to an operating dentist, agree to comply with the notification requirements in this chapter that requires the sedation provider to submit to the Board, fourteen (14) days prior to delivering services in this chapter, a signed, written agreement between the operating dentist and sedation provider identifying the location of which sedation services are to be administered and demonstrating compliance with the equipment, personnel, procedures, techniques and documents as outlined in the "ADA Sedation Guidelines" and requirements in this chapter. The agreement, at a minimum, must describe how emergency response training and protocols will be developed and practiced, procedures for verifying qualifications of personnel who assist in the care and monitoring of the patient, responsibilities for pre-operative, inter-operative, and post- operative patient assessment and monitoring, responsibilities for obtaining informed consent, and how compliance with applicable board statutes and regulations will be achieved and maintained at the site.02-313 C.M.R. ch. 14, § VII