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To establish procedures that ensure the safe operation of all radiology equipment, minimize radiation exposure to both patients and dental staff, and comply with State regulations.


Appropriate lead aprons will be placed over the patient for all radiographs. Lead aprons will be stored hanging; they will not be folded or creased when not in use, as this will increase the risk of holes or tears in the lead shield. Every year all lead aprons used for x ray protection will be sent to [appropriate location] for evaluation. All aprons, which fail the inspection, will be discarded. Records of testing will be maintained by [appropriate staff].

[If the facility uses a monitoring service] Each staff member shall be shown the radiation detection report each quarter that it is issued. Each staff member will initial the report and the [appropriate staff] will keep a copy on file.

"X ray", will be loudly announced before any staff member begins to take any radiograph. This announcement will serve to inform all personnel in the area to stand clear of the path of the radiation beam. The operator will also inform patients who are moving to and from the operatories to stand clear of the path of the x ray beam.

All radiographs will be taken using a film positioner. At no time will a patient hold a film to position that film during x-ray exposure.

A conspicuous sign shall be posted in the panoramic x ray area announcing to all personnel that "WARNING! PERSONNEL SHOULD NOT BE IN THIS AREA DURING X RAY USE".

[Insert competency procedure}


The dental assistants shall yearly be evaluated on their clinical radiographs and radiological safety according to the IHS radiological criteria for quality care.

X-Ray Machine Certification

Insert appropriate State regulations and procedures



To establish procedures that ensure the safe operation of all equipment, comply with facility safety policies, and comply with applicable State and federal regulations.



Each dental unit will have a logbook pertaining to maintenance. Any maintenance that is required is entered into the book for that particular unit. The [appropriate individual] for maintenance required will check the logbooks weekly. If maintenance is required the [designated individual] will complete the necessary maintenance requests, refer them to [appropriate source for repairs such as :bio medical engineering or refer them to maintenance personnel]. The [designated individual] will initial the logbook as the maintenance is completed.

Should the bio medical engineering be contacted, they will check the equipment and note in the logbook their findings. When the equipment is repaired the engineer will note the repair in the log.

Alternative Procedure

A contracted vendor makes quarterly maintenance visits. The vendor shall provide a copy of maintenance performed for each dental unit and the [designated individual] will maintain these records.

Product Recalls

When the dental department receives notice that a product is subject to a recall [designated individual] will check lot numbers, serial numbers or other product designators, gather all affected products, and comply with manufacturer’s instructions regarding the recall.



To establish procedures for the safe and effective use of nitrous oxide/oxygen therapy to protect patients and facility employees.

The following National Institute for Occupational Safety and Health recommendations will be observed when using nitrous oxide/oxygen.

System maintenance

Inspect and maintain the anesthetic delivery system to prevent N2O leaks in all hoses, connections and fittings. Repair all leaks immediately.


Scavenging system used will maintain a flow rate of 45 LPM, measured by a calibrated flow device, and vented outdoors.

Work Practices

Select scavenging masks of proper size to fit patients.

Prudent use of N2O to appropriately sedate patients is encouraged.

Monitor the air concentration of N2O to insure Controls are effective in achieving low levels during dental operations.






Visually inspect all N2O equipment (reservoir bag, hoses, mask, connectors) for worn parts, cracks, holes, or tears.

Replace defective equipment and/or parts.


Turn on the N2O tank and check all high to low pressure connections for leaks. Use a non-oil-based soap worn solution to check for bubbles at high pressure connectors, or use a portable infrared gas analyzer.

Determine leak source and fix. If tank valve leaks, replace tank; if O-rings, gaskets, valves, hoses, or fittings, replace. Contact the manufacturer for parts tact the manufacturer for parts replacement. For threaded pipe fittings, use Teflon tape. Do not use this tape on compression fittings.


Select scavenging system and mask. Mask should come in various sizes to patients. Scavenging systems should operate at air flow rate of 45 lpm.

Provide a range of mask sizes for patients. Check to see that noise levels at the mask are acceptable when the scavenging system exhaust rate is operated at 45 lpm.


Connect mask to hose and turn on vacuum pump before turning on N2O. Scavenging system vacuum pump must have capacity to scavenge 45 lpm per dental operation.

Determine proper vacuum pump size for maintaining 45 lpm flowrates, especially when interconnected with other dental scavenging systems. If undersized, replace pump.


Place mask on patient and assure a good, comfortable fit. Make sure reservoir bag is not over or under inflated while the patient is breathing.

Secure mask with "slip" ring Secure mask with "slip" ring for "good activity" from patient breathing.


Check general ventilation for good room air mixing. Exhaust vents should not be close to air supply vents (use smoke tubes to observe air movement in room.)

If smoke from smoke tubes indicate room air mixing is poor, then increase the airflow or redesign. If exhaust vents are close to air supply vents, relocate (check with ventilation engineers to make adjustments).


Conduct personal sampling of dentist and dental assistant for N2O exposure. Use diffusive sampler or infrared gas analyzer (see sampling methods).

If personal exposures exceed 150 ppm during administration, improve mask fit and make sure it is secure over the patient's nose. Minimize patient talking while N2O is administered.


Repeat procedure in step 7.

If personal exposures are less than 150 ppm but greater than 25 ppm, implement auxiliary exhaust ventilation near the patient's mouth. Capture distance should no greater than 10 inches from the patient's nose and mouth area and exhaust no less than 250 cfm at the hood opening. Avoid getting between the auxiliary exhaust hood and patient's mouth and nose area.

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