Supervision of a Dental Assistant Performing Coronal Polishing
Dr. Sarah Nguyen practices in a group practice in Birmingham. She employs a dental assistant, Tyler, who has completed a Board-approved coronal polishing course and holds a certificate. Alabama law allows dental assistants to perform coronal polishing under direct supervision. On a Friday afternoon, Dr. Nguyen is running behind and asks Tyler to polish the teeth of a 10-year-old patient, Emma, while Dr. Nguyen steps out to pick up her children from school. Tyler completes the polishing without incident. The parent later learns that the dentist was not present and complains to the Board, alleging that the assistant performed an unauthorized procedure without supervision.
1. Was Tyler's performance of coronal polishing lawful? Explain the supervision requirement and whether Dr. Nguyen violated the law.
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No, Tyler's performance was not lawful under the circumstances. Alabama law permits dental assistants to perform coronal polishing only under direct supervision. Direct supervision means the dentist must be physically present in the office and immediately available to observe and assist. Dr. Nguyen left the office, so she was not physically present. Therefore, Tyler was not under direct supervision. Although Tyler had the required certification, the absence of the dentist made the delegation unlawful. Dr. Nguyen violated the Dental Practice Act by delegating the procedure without providing the required level of supervision. Tyler also violated the law by performing the procedure without direct supervision. Both may be subject to Board discipline.
2. What are the potential consequences for Dr. Nguyen and Tyler, and what should Dr. Nguyen have done differently?
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Dr. Nguyen could face disciplinary action for failing to properly supervise an auxiliary, including reprimand, fine, suspension, or probation. Tyler could also be disciplined for practicing beyond the authorized scope. Dr. Nguyen should have either remained in the office during the procedure or scheduled the polishing for a time when she could be present. She could have asked another dentist in the group practice to supervise, if that dentist was willing to assume responsibility. She should also ensure that all staff understand the supervision requirements and that procedures are not performed when the dentist is absent. Proper planning and adherence to supervision rules would have avoided the violation.