Expanded Functions When the Hygienist Is Out

Assistant A may not perform scaling and root planing. SRP is periodontal therapy that requires a dentist's diagnosis and treatment plan and must be performed by a licensed dentist or dental hygienist; it is not within the dental assistant scope even for an assistant with a coronal-polishing certificate. Assistant B may not polish or apply fluoride without the required expanded-function credential. Even if Assistant B had the certificate, coronal polishing and fluoride application are delegated functions subject to the Board's supervision rules. With Dr. Ramos 25 minutes away and reachable only by phone, the clinic likely cannot satisfy direct supervision, which requires the dentist to be physically present and immediately available. The 4-year-old's age and cooperation also make an on-site dentist prudent. The correct response is to stop both assignments, reschedule or obtain a licensed hygienist, and have Dr. Ramos perform or directly supervise procedures that require his presence.

Indiana distinguishes direct supervision-dentist on the premises and immediately available-from general supervision-dentist not on the premises but available and having authorized the service under the applicable rules. The key is that phone availability from another clinic is not direct supervision. Dr. Ramos must either remain on-site for functions requiring direct supervision, hire a temporary hygienist, or reschedule those patients. He may perform the SRP himself after his own periodontal examination. Sealants may be delegable to an appropriately trained assistant only if the Board's expanded-function rules and supervision level are satisfied; he should verify the assistant's certificate and the specific rule before proceeding. The periodontal patient needs a real periodontal diagnosis and treatment plan, not a prophy labeled as one. Staff should document who performed each service, under what supervision, and with what consent. If the patient is delayed, the clinic should explain the reason and offer a new appointment rather than let an unqualified assistant proceed.

The dentist remains professionally responsible for delegating within scope and for supervising the person to whom care is delegated. If an assistant performs SRP or an expanded function without the required credential or supervision, the dentist faces Board discipline for aiding unlicensed or unauthorized practice, and the practice faces civil exposure for any injury. The patient's consent should identify who will perform the service and the supervision arrangement. The record should include the dentist's examination and diagnosis, the specific procedure, the operator, the supervising dentist's presence or availability, and any complications. A note that simply says "prophy done" is inadequate for a patient with bone loss and bleeding. If harm occurs, the dentist should ensure follow-up, document objectively, and not alter the record. The clinic should also correct its scheduling templates so unbooked SRP is not mistaken for routine hygiene.