The Dentist Wants a Temporary Crown Placed
A dentist is running 45 minutes behind and asks the hygienist to place a temporary crown on tooth #30 while he goes to lunch. The hygienist has watched the procedure many times but has no formal expanded-function training or certificate for crown fabrication. The patient is already anesthetized, the tooth is prepared, and the dentist says, “It’s easy; just cement it and adjust the bite. I’ll check it when I get back.” The hygienist hesitates, and the dentist says, “If you don’t do it, I’ll have to cancel my lunch, and the patient will be angry.” The hygienist has been written up once before for refusing to “help out” with a procedure outside her comfort level. The office has no written delegation policy.
1. May the hygienist place and adjust the temporary crown under Illinois law? Explain the scope and supervision analysis.
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No. A dental hygienist may perform only those functions authorized by the Illinois Dental Practice Act and Department rules, and only under the required level of supervision. Placing a temporary crown and adjusting the occlusion is a restorative procedure, not a dental hygiene procedure. On-the-job observation does not create delegated authority. Even if the dentist is willing to supervise, the hygienist lacks the formal expanded-function training or credential required for this task, and the procedure is not within the hygienist’s lawful scope. The dentist’s promise to “check it later” does not cure the problem. The hygienist should refuse clearly and offer lawful alternatives: reschedule the patient, have the dentist place the temporary before lunch, or arrange for another qualified dentist to cover. She should not proceed just because the patient is already anesthetized or because the dentist is impatient.
2. What should the hygienist document and say to the patient?
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The hygienist should document the request, her refusal, and the reason in an objective note, without editorializing about the dentist’s motives. She should tell the patient that the dentist will complete the temporary or that the visit will be rescheduled, without blaming the dentist or disclosing internal conflict. If the patient is left with a prepared tooth and no temporary, the dentist must provide interim protection before the patient leaves. The hygienist should not tell the patient “it’s fine” if the tooth is unprotected. She should also notify the office manager or dentist in writing that a written delegation policy is needed. If the dentist pressures her to proceed, she should escalate through the practice’s compliance process and, if necessary, seek guidance from the Department.
3. Does this situation create a reporting obligation?
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It may. Illinois licensees have obligations to report certain conduct, and a dentist who directs a hygienist to perform a procedure outside her scope may be engaged in unprofessional conduct. The hygienist should first use internal channels: document the request, refuse, and ask the dentist to confirm in writing that the procedure will be done by a licensed dentist. If the dentist continues to pressure her or actually allows an unqualified person to perform the procedure, she should report the conduct to the Illinois Department of Financial and Professional Regulation. She should not report frivolously, but she should not remain silent to protect a coworker. The hygienist should also protect her own license by not accepting the delegated task. A written refusal and a clear record are important if the matter is later investigated.