"Just Cement the Temp Before You Go"
It is 4:40 pm Friday. The dentist has finished preparing tooth #14, packed cord, and taken the impression. He is called away for a family medical emergency and says over his shoulder, "Temp it, adjust the bite, and polish the anteriors I charted - you've done a hundred of these." In this state, temporary crown cementation by an RDA requires direct supervision, meaning the dentist must be on the premises. Coronal polishing is permitted under general supervision once the dentist has authorized it in writing for that patient. Occlusal adjustment is not a delegable function for RDAs at all. The patient is still numb, has been in the chair for 90 minutes, and expects to leave with a crown on.
1. Sort the three tasks into what you may do, what you may not, and why the distinction is about supervision level rather than skill.
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Polish anteriors - permitted. Coronal polishing under general supervision with prior authorization is within scope. He has charted it, which is the authorization; you can document that.
Cement the temporary - not permitted today. The function itself is delegable, but the supervision level is direct, which means the dentist must be physically present. He is not. Your competence is irrelevant to that analysis - the rule is about who is available if something goes wrong mid-procedure, not about whether you can do it well.
Adjust the occlusion - not permitted under any level of supervision in this state. It is not on the delegable list.
That is the whole reasoning: scope questions are answered by the supervision level attached to each function in your board's rules, plus the patient-specific authorization. "I've done a hundred of these" describes your hands; it says nothing about the rule. Verify the exact wording in your own state's regulations rather than relying on this scenario - the lists differ, and the office should keep a current copy of the rule where staff can reach it.
2. You cannot cement the crown, but the tooth is prepared and the patient is waiting. What do you do in the next ten minutes?
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The unaccepted option is doing nothing and sending her home with an open preparation - that is the actual harm in this scenario, and it is worse than the rule violation.
Steps:
- Stop the dentist before he is out the door. One sentence: "I can't cement the temp without you on the premises in this state - what do you want to do?" Give him the constraint, not a complaint.
- Options he can choose from: return to seat the temporary himself; call the on-call or covering dentist, if one is available and licensed, to come in; or direct you to place interim coverage that is within your scope.
- Protect the tooth meanwhile - keep the preparation isolated and keep the patient comfortable and informed.
- Tell the patient the truth, briefly and without blaming the dentist: "Dr. X had to leave for a family emergency. I'm not permitted to cement your temporary without him here, so we're arranging for someone to finish, or we'll cover the tooth and get you back first thing." Give a realistic time. Do not leave the room and let her wonder.
- Do the polishing - it is authorized, it is within scope, and it uses the wait productively.
The judgment: the patient's immediate need is a protected tooth and honest information. You meet that need through the dentist or a covering dentist, not by exceeding your scope.
3. What do you document, and what conversation do you have with the dentist on Monday?
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Document: the dentist's departure and the reason given (factually, no editorializing); the three tasks requested; what you did and did not perform and why; the time the patient was told; who was contacted; the interim coverage placed and by whom; the patient's status on leaving; and the plan for seating the temporary.
Monday conversation: keep it about the system, not the emergency. "Friday showed we have no plan for a dentist leaving mid-appointment. Can we agree on who covers and what I'm authorized to do before anyone walks out?" That is a request for a protocol, which is something a dentist can say yes to.
Also: confirm the delegation rule in writing rather than from memory - print the board's rule on delegated functions and supervision levels, and ask that a copy live in the sterilization area or front office. If the dentist's response is that the rule does not matter and it should be handled quietly next time, that is the point at which you stop treating it as a scheduling problem. Your name is on the record and your certification is on the line alongside his license.