Apply for an anesthesia & sedation facility permit

To administer any type of anesthesia or sedation other than local anesthesia, your dental facility must be properly permitted. You can apply here for dental office or practice location permits.

Board of Registration in Dentistry

The Details   of Apply for an anesthesia & sedation facility permit

What you need   for Apply for an anesthesia & sedation facility permit

Things to know

  • Each practice location must have a separate permit
  • Select the correct application for your practice location(s) below

Application attachments

We must have these attachments to process your application(s).

Required Equipment and Emergency Drugs form

Complete this form, as applicable. It's attached with the application.

Schedule and log of inspection

A copy of the schedule and log showing your regular inspection of all emergency drugs and equipment for the administration of anesthesia, sedation, and/or nitrous oxide-oxygen. Include the date(s) and name of the person who last checked the drugs and equipment, and the results of the checks. Include a statement that the condition of equipment meets manufacturers’ specifications.

Some applications also need these attachments

Proof of certifications

For each person in the facility administering anesthesia & sedation or assisting in the administration of anesthesia & sedation, we need copies of the following certifications:

  • Advanced Cardiac Life Support (ACLS), or
  • Pediatric Advanced Life Support (PALS), or
  • Basic Life Support for Healthcare Providers (BLS)
Copies of forms and paperwork

Depending on the application, you may need to submit copies of the following:

  • Your office’s medical history form to be completed by each patient
  • Your office’s anesthesia monitoring chart
  • Your office’s anesthesia consent form to be completed by each patient
  • Your written protocol for the management of medical emergencies
  • Your schedule and content of regular and routine office emergency drills
  • Weekly spore testing results for the 3 months prior to your application
    • If your office has been open less than 3 months, submit:
      • The protocols and procedures for spore testing at the site
      • Any and all weekly spore testing results to date
  • Your Federal DEA Controlled Substance Certificate
  • Your MA Controlled Substance Registration
  • Your request for an on-site inspection of the site by the Board
    • For permit D-A only:
      • You may submit instead a copy of the certificate of an on-site inspection conducted by the Massachusetts Society of Oral and Maxillofacial Surgeons (MSOMS members only). This must be from the past 5 years.
  • Your DPH Radiation Control Program Certification (M.G. L. c. 111 §5N)
  • All current individual anesthesia permits of your staff

Fees   for Apply for an anesthesia & sedation facility permit

  • We accept personal checks, business checks, or money orders. Make it payable to the Commonwealth of Massachusetts.
  • All fees are non-refundable and non-transferable
  • Please don't send cash
Name Fee Unit
Dental Facility Permit $180 per permit

How to apply   Apply for an anesthesia & sedation facility permit

Go to the Health Professions Licensing Portal  and create an account, or log into your existing account. If this is your first time using this new portal, please visit Health Professions Licensing System User Guide.

Contact   for Apply for an anesthesia & sedation facility permit

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