The Weekend-Course Assistant and the Restorative Delegation
Dr. Alvarez practices in a busy Indianapolis general office. A 9-year-old patient presents with a symptomatic second primary molar and a newly erupted permanent first molar with deep pits. The schedule is running 50 minutes late. Dr. Alvarez asks Marcus, a dental assistant who completed a weekend expanded-functions course but holds no state-recognized credential, to place a resin sealant on the permanent molar and a small composite on the primary tooth, then adjust the bite. Marcus says he has done hundreds in his previous office. The parent, who is in the operatory, asks whether Marcus is a dentist. Dr. Alvarez wants to know if he can let Marcus finish while he starts the next patient, and whether the parent must be told. The office has no written expanded-functions policy. Dr. Alvarez calls you for a quick legal check.
1. Can Dr. Alvarez lawfully delegate the sealant and the composite restoration to Marcus under Indiana law? Explain the analysis, not just yes or no.
Read the worked answer
The answer turns on function-specific delegation, not on Marcus's claimed experience. Indiana's Dental Practice Act and board rules reserve diagnosis, treatment planning, and the practice of dentistry to licensed dentists, while allowing only certain listed procedures to be delegated to specified categories of auxiliaries. The delegate must hold whatever training or credential the board rule requires for that function, and the dentist must provide the required level of supervision.
A weekend course that is not a board-recognized credential does not create authority. A sealant may be delegable in some circumstances, but the composite restoration and occlusal adjustment are restorative and diagnostic-adjacent functions that are not automatically delegable to an uncertified assistant. Dr. Alvarez should not let Marcus place the composite or adjust the bite. Before allowing even the sealant, Dr. Alvarez must verify that the board rule expressly permits delegation of sealants to a dental assistant with Marcus's actual credential and that the supervision requirement is met. If the rule does not authorize it, Dr. Alvarez must perform the procedure himself or reschedule. Letting an unqualified person practice dentistry can expose both the assistant and the dentist to board discipline and creates malpractice risk.
2. What must Dr. Alvarez tell the parent before any delegable procedure, and what should be documented in the record?
Read the worked answer
Before treatment, Dr. Alvarez should identify who will perform each step and what level of supervision applies. The parent should be told that Marcus is a dental assistant, not a dentist, and that Dr. Alvarez remains responsible for the patient's care. Informed consent should cover the procedure, the alternatives, the material risks, and the fact that a trained auxiliary may perform a delegated step. The parent should be given a real opportunity to ask that the dentist perform the procedure instead; pressure or a vague 'the assistant will help' is not adequate.
The record should identify the provider for each procedure, the provider's credential, the procedure performed, the supervision level, the consent conversation, and any refusal. If a delegated procedure is permitted, the dentist should document the pre-procedure evaluation and the post-procedure check. The absence of a written office policy is not itself the legal violation, but it makes it harder to show that delegation was controlled and consistent with board rules.
3. If Marcus proceeds and the composite fractures two days later, what is Dr. Alvarez's exposure and what should he do?
Read the worked answer
Dr. Alvarez remains professionally responsible for treatment rendered in his office, even if an auxiliary performed a step. If the delegation was not authorized, the exposure includes board discipline for aiding unlicensed practice or failing to supervise, as well as civil malpractice exposure. A fracture alone does not prove a violation, but it triggers a duty to evaluate and remediate the patient promptly.
Dr. Alvarez should see the patient, document the fractured restoration and the clinical findings, provide corrective treatment or a referral, and explain what happened without blaming the assistant in a way that misleads the family. He should not alter the original record. He should also review whether the office must notify the board or an insurer, and he should stop any unauthorized delegation immediately. Defensive charting after the fact is less protective than an honest contemporaneous record and a clear corrective plan.