Delegating Final Crown Impressions to an Unlicensed Assistant
Dr. S runs a busy Delaware practice with one expanded function dental assistant (EFDA) and two unlicensed dental assistants. On a Friday, 14 patients are scheduled and Dr. S is running 50 minutes behind. Tooth #30 has been prepared and cord placed for a crown. Dr. S asks T, an unlicensed assistant with six years of experience, to 'take the final impression, pour the model, and make the temporary' while Dr. S starts a root canal in another operatory. T has taken many alginate impressions for study models and has watched Dr. S take final impressions, but she is not EFDA-certified. The practice's written policy says assistants may 'take impressions after a competency check.' T passed an in-office check last year. The patient is not told that T is doing the impression. The impression is unacceptable; the crown is remade and the patient returns twice. The patient complains to the Board. Dr. S argues that the task was routine and delegated under general supervision.
1. Was Dr. S's delegation of the final impression to T lawful under Delaware dental law? Analyze the scope and supervision issues.
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Likely not. Delaware law draws a line between supportive tasks that may be delegated to unlicensed assistants and clinical procedures that require a licensed dentist or a credentialed expanded function assistant. A final impression for a fixed crown is part of restorative treatment, not a routine study-model impression. An unlicensed assistant may take alginate impressions for study models or perform suction/retraction, but taking the final impression, pouring the model, and making the temporary crown are expanded functions. Those functions require an EFDA or other Board-recognized credential and direct supervision by the dentist. 'General supervision' and an office competency check cannot expand the statutory scope. Dr. S aided unlicensed practice and failed to supervise.
2. What difference would it have made if the EFDA had performed the task?
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An EFDA may perform specified expanded functions only if properly trained, credentialed, and working under the required level of supervision. The dentist still must have examined the patient, authorized the procedure, and be on premises if direct supervision is required. The record should identify the EFDA and the dentist's order. Even with an EFDA, Dr. S could not delegate diagnosis or treatment planning. The EFDA credential would cure the unlicensed-practice problem but not a failure of supervision.
3. What should Dr. S have done about scheduling, informed consent, and documentation?
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Dr. S should have scheduled enough time to take the final impression himself or assigned the EFDA with proper supervision. The patient should have been told who would perform the procedure and given the choice to wait. The record should include the dentist's exam, the order, the impression material, the assistant's credential, and the patient's consent. If the impression was defective, Dr. S should have documented the remake and the reason. Apologizing and remaking the crown does not erase the scope violation.