Controlled Substances, Anesthesia Permits, and Recordkeeping
Prescribing authority
Dental hygienists do not prescribe controlled substances. Dentists may prescribe Schedule II–V drugs only with a valid Massachusetts Controlled Substances Registration (MCSR) and DEA registration. Massachusetts requires PMP checks in specified circumstances and electronic prescribing, with limited exceptions.
Anesthesia and permits
Sedation and general anesthesia require a Board permit at the appropriate level, plus equipment, monitoring, and rescue capability. Local anesthesia by a hygienist requires the specific permit and supervision required by 234 CMR.
Recordkeeping
Maintain prescription records, drug inventory, and administration logs. Store controlled substances securely. Document the indication, dose, and patient instructions. Documentation should be contemporaneous and retrievable for inspection.
Worked example
A dentist asks a hygienist to phone in hydrocodone for a patient. Reasoning: the hygienist lacks prescribing authority; the dentist must issue the prescription personally or through an authorized agent under the dentist's direction. The hygienist may transmit a dentist's order only if Board rules and federal law permit it.
Traps
Do not assume a DEA number authorizes a hygienist. Do not skip the PMP check when required. Do not treat a sedation permit as covering a different level. Do not leave controlled substances unsecured.