Restorative Work Delegated to an Untrained Assistant
Dr. Patel practices solo in Springfield. He hires Lena, a dental assistant with six months of on-the-job training and no formal radiology or expanded-function certificate. On Tuesday, Dr. Patel prepares tooth #30 for a composite, then leaves for a hospital consultation 20 minutes away. He tells Lena, “Place the matrix, finish the composite, and light-cure it. Call me if the bite is high.” Lena also takes two bitewing radiographs on a new patient while he is gone. When Dr. Patel returns, he reviews the bite and signs the chart. The office has no written delegation policy. Lena asks whether she can “do fillings regularly” because she has watched many. The patient, a 34-year-old with no medical complications, later reports mild pain.
1. Identify each procedure Lena performed and determine whether Illinois law permits a dental assistant to perform it under these facts. Explain the required supervision level and the effect of Dr. Patel leaving the office.
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- Bitewing radiographs: Illinois permits dental assistants to expose radiographs only after the training or certification required by the Act and rules, and only under the required supervision. Lena has no formal radiology certificate. Even if a weekend course were enough, Dr. Patel was 20 minutes away, so he was not providing the on-premises availability that direct supervision requires.
- Composite placement and light curing: Restorative dentistry is the practice of dentistry. The Act does not delegate placement of a composite restoration to a dental assistant, even a certified expanded-function assistant. Dr. Patel’s later bite check and chart signature do not cure the unauthorized delegation.
- Effect of leaving the office: Dr. Patel’s absence defeats direct supervision for any task that requires it, and no level of supervision authorizes an assistant to perform a non-delegable restorative procedure. The assistant’s on-the-job experience does not create legal authority.
2. What disciplinary exposure do Dr. Patel and Lena face, and what should the office do immediately?
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Dr. Patel faces exposure for aiding and abetting unlicensed practice, failing to supervise, and permitting an assistant to perform procedures outside the delegated scope. Lena faces exposure for unlicensed practice. Each patient encounter can be treated as a separate violation, and the office’s lack of a written delegation policy aggravates the facts.
Immediate steps: stop all delegation of restorative work and unsupervised radiographs; audit charts for other improper delegations; verify Lena’s radiology training and certification status before she exposes any more images; adopt a written delegation and supervision policy; document retraining; and do not alter or backdate records. If the office bills the composite as Dr. Patel’s work, correct the record only through a truthful addendum, not by rewriting the chart.
3. Would the analysis change if Dr. Patel remained in the building at the front desk? Would it change if Lena were a certified dental assistant with expanded-function training?
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Remaining in the building may satisfy the physical-presence element of direct supervision for some tasks, but it does not make a composite restoration delegable. Restorative placement remains outside the dental assistant scope regardless of certification. For radiographs, a certified assistant might be permitted to expose images under direct supervision, but “in the building” is not a substitute for the specific training and certification the rules require. Expanded-function certification expands only the listed functions; it does not create general authority to practice dentistry. Dr. Patel should verify the exact function list before relying on any certificate.