Apply for an anesthesia & sedation facility permit - for dental offices or practice locations

To administer any type of anesthesia or sedation other than local anesthesia, your dental facility must be properly permitted. You can apply here for the permit you need.

Board of Registration in Dentistry

The Details of Apply for an anesthesia & sedation facility permit - for dental offices or practice locations

What you need for Apply for an anesthesia & sedation facility permit - for dental offices or practice locations

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 - for dental offices or practice locations

  • 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 staple payment to the application
  • Please don't send cash
Name Fee Unit
Dental Facility Permit $180 per permit

How to apply Apply for an anesthesia & sedation facility permit - for dental offices or practice locations

  1. Select and download the permit application(s) you need. You can find them listed below.
  2. Fill out the permit application(s)
    • Include all required attachments, including the fee(s)
    • If you submit multiple applications, include a fee payment for each one
  3. Mail the completed application(s) and all attachments to:

The Massachusetts Board of Registration in Dentistry
239 Causeway St.
Suite 500
Boston, MA 02114

Downloads for Apply for an anesthesia & sedation facility permit - for dental offices or practice locations

Contact for Apply for an anesthesia & sedation facility permit - for dental offices or practice locations

Feedback

Did you find what you were looking for on this webpage? * required
We use your feedback to help us improve this site but we are not able to respond directly. Please do not include personal or contact information. If you need a response, please locate the contact information elsewhere on this page or in the footer.
We use your feedback to help us improve this site but we are not able to respond directly. Please do not include personal or contact information. If you need a response, please locate the contact information elsewhere on this page or in the footer.

If you need to report child abuse, any other kind of abuse, or need urgent assistance, please click here.

Feedback