Scope of practice, supervision levels, and delegation of duties to auxiliary personnel
Domain 3 - Scope of practice, supervision levels, and delegation
This domain tests the boundary between what a dentist may delegate and what must remain with the dentist. Questions often describe a task and a supervision level and ask whether the arrangement is lawful.
Supervision categories
- Direct supervision: the dentist is physically present in the office, has examined the patient, and is available to intervene.
- Indirect supervision: the dentist is in the office but not necessarily in the treatment room; the patient has been examined and the procedure authorized.
- General supervision: the dentist has authorized the service but is not on the premises. In Connecticut this is limited - it is not a free-standing permission a dentist can create by writing a standing order. It applies to specified services and settings, notably public health programs.
What each auxiliary may do
- Hygienists: prophylaxis, scaling and root planing, polishing, fluoride, sealants, radiographs, and patient education, within the supervision level the regulations assign. Local anesthesia and nitrous oxide require separate certification and direct supervision.
- Dental assistants: reversible, supportive tasks under direct supervision. Expanded functions such as coronal polishing, sealant placement, or radiograph exposure require the training or certification the regulations specify, and some tasks remain non-delegable.
- Never delegable: diagnosis, treatment planning, prescription writing, surgical procedures reserved to the dentist, and final evaluation of treatment.
Worked example
A dentist wants a hygienist to perform root planing at a satellite office on days the dentist is at the main office, with a phone available. The arrangement fails: general supervision is not available for that service in a private office, and the hygienist cannot independently assess and treat periodontal disease. The dentist must be present at the required supervision level, or the patient must be scheduled when the dentist is on site.
Traps that cost marks
- Using 'general supervision' as a synonym for 'the dentist is reachable by phone.'
- Assuming a certified assistant may perform any task the dentist is willing to delegate.
- Letting a hygienist diagnose caries or periodontal disease.
- Overlooking the requirement that the dentist examine the patient before certain delegated services.