Hygienist Scheduling Across Two Offices
Dr. Patel is the sole dentist and owner of two general dental offices 25 miles apart. She employs five hygienists. On Tuesdays, three hygienists are scheduled at Office A and two at Office B. Dr. Patel examines patients at Office A from 8:00 a.m. to noon, then drives to Office B for the afternoon. At 10:00 a.m. on Tuesday, a hygienist at Office B performs a prophylaxis and places sealants on a 9-year-old whose last dental exam was 11 months ago. The hygienist has three years of experience and a current Georgia license. No dentist is in Office B. The office manager asks whether the appointment can proceed and whether the hygienist can also apply fluoride varnish and take a bitewing. Dr. Patel says, 'The hygienist is licensed and I reviewed the chart last year, so general supervision should cover it.'
1. Identify the supervision level required for the 10:00 a.m. services and analyze whether Dr. Patel's plan satisfies Georgia requirements.
Read the worked answer
Issue: Whether a licensed hygienist may perform prophylaxis and sealants at an office where no dentist is present.
Rule and reasoning: Georgia uses supervision categories. Direct supervision generally means the dentist is in the office, has examined the patient, and is immediately available. General supervision generally means the dentist has authorized the service and examined the patient within the required time but is not on the premises. The category depends on the specific procedure and patient, not merely on the hygienist holding a license. A chart review from 11 months earlier may not satisfy a current-examination requirement, and a blanket statement that 'general supervision should cover it' is not a written authorization or a patient-specific evaluation.
Application: The practice must first confirm the Board's supervision level for prophylaxis, sealants, fluoride varnish, and radiographs for a 9-year-old. If the Board requires direct supervision for any of these services, the 10:00 a.m. appointment cannot proceed with Dr. Patel 25 miles away. Even if general supervision is permitted, Dr. Patel must have a current examination and a documented, patient-specific authorization, and the hygienist must stay within licensed scope.
Conclusion: Do not let the appointment proceed until supervision level, current exam, and written authorization are verified. 'Licensed' alone is not enough.
2. What should the practice verify about the number of hygienists supervised and the hygienist's scope of practice?
Read the worked answer
Ratio: Georgia limits how many hygienists a dentist may supervise at one time. The schedule places five hygienists under one dentist across two offices. Even if the offices are separate, the dentist remains the supervising licensee. The practice should count every hygienist working under Dr. Patel during the same period and compare that number with the Board's ratio. If the limit is exceeded, the schedule must be changed, another dentist must provide supervision, or one office must close for that period.
Scope: The hygienist may perform only duties the Board authorizes for a licensed hygienist under the applicable supervision level. Sealants, prophylaxis, fluoride varnish, and radiographs may have different supervision or certification requirements. The practice should keep a current license, evidence of required certifications, and a written delegation protocol in the chart or office manual.
Documentation: Record the supervising dentist, the examination date, the authorized services, and the supervision level. The office manager should not resolve the question informally; the supervising dentist is accountable.
3. If Dr. Patel wants a dental assistant to take the bitewing and apply fluoride varnish, what supervision and credentialing issues arise?
Read the worked answer
Issue: Whether expanded duties may be delegated to a dental assistant.
Reasoning: Georgia permits dental assistants to perform certain expanded functions only if the assistant holds the required Board credential or certificate and works under the required level of supervision. Taking radiographs and applying fluoride varnish are not automatically delegable to any assistant. The dentist must confirm the specific duty, the assistant's credential, and whether direct supervision is required. Direct supervision normally means the dentist is in the office and immediately available.
Application: If the assistant is not certified for radiographs, the bitewing cannot be delegated. If fluoride varnish is permitted for assistants, it still must be ordered by the dentist after a current examination and documented in the record. At Office B, no dentist is present, so any duty requiring direct supervision cannot be performed there at 10:00 a.m.
Conclusion: Verify the assistant's credential and the supervision level for each duty before delegation. Uncertified or improperly supervised delegation is a scope and supervision violation.