Section 6.16 - Permit L: Administration of Local Anesthesia by a Dental Hygienist(1) No licensed dental hygienist shall administer local anesthesia unless he or she has been issued a Permit L by the Board. A dental hygienist who has been issued a Permit L may only administer local anesthesia under the direct supervision of a licensed dentist.(2)Application for Permit L by Examination. Application for a Permit L shall be on forms provided by the Board and shall be accompanied by the permit fee, to be determined annually by the Secretary of Administration and Finance, and documentation demonstrating proof of: (a) Licensure as a dental hygienist in the Commonwealth;(b) Current Basic Life Support (BLS) certification;(c) Successful completion of a training program or course of study, no more than two years prior to application for the permit, in a formal program in the administration of local anesthesia, which shall be a minimum of 35 hours of instruction, including no less than 12 hours of clinical training, and be conducted by an educational institution accredited by the Commission on Dental Accreditation of the American Dental Association; and(d) Successful completion of a written examination in the administration of local anesthesia administered by the Northeast Regional Board of Dental Examiners (NERB) or any successor agency approved by the Board.(3)Application for Permit L by Credentials. Application for local anesthesia permit by a dental hygienist qualified in another jurisdiction by virtue of successful completion of an examination to administer local anesthesia shall, at a minimum, be accompanied by the permit fee, to be determined annually by the Secretary of Administration and Finance and documentation demonstrating proof of: (a) Licensure as a dental hygienist in the Commonwealth;(b) Current BLS certification;(c) Documentation of successful completion of a training program or course of study in a formal program in the administration of local anesthesia accredited by the American Dental Association and equivalent to the course of study described in 234 CMR 6.14(4); and(d) A letter from a dentist who directly supervised the hygienist attesting to the hygienist's experience in administering local anesthesia within the previous two years.(4)Requirements for Course of Study for Permit L.(a) An applicant for a Permit L-Administration of Local Anesthesia shall have completed a minimum of 35 hours of instruction, which must include, but is not limited to:1. Medical history evaluation procedures;2. Physical evaluation of the dental patient;3. Pharmacology of local anesthesia and vasoconstrictors; and4. Local anesthesia, didactic and clinical courses, including the following:a. Anatomy of head, neck, and oral cavity as it relates to administering local anesthetic agents;b. Indications and contraindications for administration of local anesthesia;c. Selection and preparation of the armamentaria and record-keeping for administering various local agents;d. Medical and legal management of complication;e. Recognition and management of post-injection complications;f. Proper infection control techniques with regard to local anesthesia and proper disposal of sharps;g. Methods of administering local anesthetic agents with emphasis on technique and minimum effective dosage; andh. Management of diagnosis, prevention and treatment of medical emergencies.(b) Instructors preparing students for certification to administer local anesthesia in Massachusetts shall be licensed to practice dentistry or dental hygiene in the Commonwealth.(5)Renewal of Permit L. A permit to administer Local Anesthesia shall be renewed biennially at the same time the applicant's license to practice dental hygiene is renewed. The application for renewal of Permit L shall be accompanied by the permit fee, to be determined annually by the Executive Office of Administration and Finance; and an attestation confirming current BLS certification.(6)Recording of Anesthesia Required.(a) The dental hygienist shall obtain the local anesthesia only from the licensed dentist who is exercising direct supervision of the dental hygienist administering the local anesthesia.(b) The dental hygienist shall sign and document in the patient record the date, type and amount of local anesthesia obtained from the supervising dentist.(c) Upon completion of the treatment, any unused portion of the local anesthesia and armamentarium shall be returned to the supervising dentist and disposed of in accordance with M.G.L. c. 94C.