RDH Scope of Practice, Supervision Levels, Settings, and Extended Functions
The three supervision levels
- Direct supervision: the dentist is physically present in the treatment facility and available for immediate consultation.
- General supervision: the dentist has examined the patient and authorized the procedure but need not be on site.
- Independent practice: only the RDHAP (Registered Dental Hygienist in Alternative Practice) may work without dentist supervision, and only in authorized settings.
Core RDH scope
Assessment, oral health education, prophylaxis, scaling and root planing, periodontal maintenance, polishing, fluoride, radiographs, sealants, and charting. Additional functions - local anesthesia, nitrous oxide-oxygen analgesia, soft tissue curettage - require board-approved coursework and a permit; local anesthesia also requires direct supervision.
Boundaries and delegation
An RDH does not diagnose, prescribe, or cut hard tissue. An RDH may supervise dental assistants in limited tasks defined by regulation, but the dentist retains overall responsibility. General supervision never authorizes treating a new patient the dentist has not examined.
RDHAP
Requires RDH licensure plus a board-approved RDHAP education program, a bachelor's degree, and clinical experience. An RDHAP may practice in homes of homebound patients, schools, residential care facilities, and dental health professional shortage areas, and may bill Medi-Cal directly; referral to a dentist is required for care beyond hygienist scope.
Traps
Mixing up direct and general supervision; assuming general supervision permits SRP or sealants on an unexamined patient; forgetting the additional permit for anesthesia; assuming an RDHAP may diagnose or place restorations. Only a dentist performs the comprehensive exam and prescribes treatment.
Worked example: A homebound resident of a skilled nursing facility needs periodontal maintenance. An RDHAP may provide it with no dentist present. A standard RDH could not, because no dentist has examined and prescribed.