Hygienist's Expanded Duties Without Certification
Dr. Alan Reyes operates a solo practice in a rural Alabama county. In March 2025, he hired Jamie, a dental hygienist licensed in Alabama but whose permit to administer local anesthesia expired in December 2024. Jamie has not renewed it. On a busy Tuesday, Dr. Reyes asks Jamie to administer a local anesthetic block to a 42-year-old patient, Mr. Thompson, before a deep scaling procedure. Dr. Reyes is scheduled to perform a root canal in the next operatory and will not be present during the injection. Jamie hesitates, but Dr. Reyes assures her that 'it's fine as long as I'm in the building.' After the injection, Mr. Thompson experiences prolonged numbness and returns two days later complaining of persistent tingling in his lower lip. The patient files a complaint with the Alabama Board of Dental Examiners.
1. Did Dr. Reyes violate the Alabama Dental Practice Act by allowing Jamie to administer the injection? Explain the statutory basis and the role of supervision.
Read the worked answer
Yes. Under Alabama law, a dental hygienist may administer local anesthesia only if she holds a current, valid permit issued by the Board. Jamie's permit expired in December 2024, so she was not authorized to perform the injection in March 2025. Dr. Reyes, as the supervising dentist, is responsible for ensuring that delegated duties are within the auxiliary's scope and that the auxiliary holds any required credentials. Allowing an unpermitted hygienist to administer anesthesia constitutes delegation of a procedure to an unqualified person, which is a violation of the Dental Practice Act and grounds for disciplinary action. The fact that Dr. Reyes was in the building does not cure the defect; supervision levels (direct vs. general) do not override the requirement for a valid permit. Dr. Reyes could face sanctions including reprimand, fine, suspension, or revocation.
2. What are the potential consequences for Jamie, and what should she have done when asked to perform the injection?
Read the worked answer
Jamie may also face Board discipline for practicing beyond her authorized scope. As a licensed hygienist, she is independently responsible for knowing her scope of practice and ensuring her credentials are current. When asked to perform the injection without a valid permit, she should have declined and informed Dr. Reyes that her permit had lapsed. She could have offered to complete the renewal process or suggested that Dr. Reyes administer the anesthesia himself. Administering the injection anyway exposed the patient to risk and violated the law. The Board may impose penalties such as a fine, probation, suspension, or required remedial education.