Scope of Practice, Supervision Levels, and Delegated Procedures
The delegation architecture
Scope questions are answered with a three-part analysis: whether the task falls within the statutory definition of dental hygiene, whether a Board rule assigns it a supervision level, and whether the treating dentist has authorized it for that patient. The Act establishes that dentistry is practiced by or under the supervision of a licensed dentist, so the hygienist's authority is derivative and patient-specific. Delegation is not a blanket permission attached to the license.
Supervision in practice
Direct supervision generally means the dentist has authorized the procedure and is physically present in the office. General supervision generally means authorization without required presence. Indirect supervision typically means prior authorization with the dentist reachable by phone. Some hygiene services may be provided without dentist examination under limited statutory conditions, but those exceptions are narrow and should be verified in the current Act. Questions often hinge on whether the patient is a patient of record and whether a prior examination and treatment plan exist.
Traps to expect
Frequent traps include treating a procedure as delegable because it appears on a list, ignoring the dentist's authorization requirement, assuming a hygienist may diagnose or prescribe, and assuming expanded functions may be self-taught. Expanded functions generally require specific training and often a Board-recognized certification before delegation. Another trap is assuming a hygienist may independently determine a treatment plan or alter a dentist's prescription. Local anesthesia and nitrous oxide oxide-related authorities are commonly tested and depend on specific statutory conditions and training; verify current requirements.
Rule of thumb
If an item describes a task and asks "may the hygienist do this," check scope, then supervision level, then authorization, in that order, and reject any answer that skips a step.
Worked example
A hygienist wants to perform an expanded function after completing a continuing education course but without the Board-recognized training or the dentist's authorization. Even if the task is within hygiene scope generally, the missing training credential and missing authorization make the answer no.