Practice Standards and Law
Practice Standards and Law
This domain tests the legal framework of hygiene practice: licensure, supervision, delegation, records, privacy, and malpractice. The key is that state law controls scope and supervision, while federal law controls privacy and workplace safety.
Core rules
- Licensure is state-based; practice without a current license is illegal. Scope varies by state, especially for local anesthesia, monitoring, and expanded functions.
- Supervision levels: direct (supervisor on premises and sees the patient), indirect (supervisor authorized but not on premises), general (no prior authorization but dentist available). Know your state’s rules.
- Records must be accurate, contemporaneous, and retained per state law; corrections use a single line, date, and initials-never obliterate.
- HIPAA governs privacy and security; OSHA governs bloodborne pathogens and hazard communication.
- Standard of care is what a reasonably prudent clinician would do; malpractice requires duty, breach, causation, and damages.
- Mandatory reporting includes child and elder abuse and certain communicable diseases per jurisdiction.
Worked example
A dentist asks a hygienist to place a permanent restoration. The hygienist checks state law and finds it is not a permitted hygiene function. She declines and offers to assist or refer. Reasoning: the dentist’s request does not expand statutory scope; following it could constitute unlicensed practice and expose both to liability.
Traps
- Assuming “the dentist said it’s okay” overrides state scope.
- Altering records after an adverse event.
- Posting patient images without HIPAA authorization.
- Confusing general supervision with no supervision.
- Ignoring mandatory reporting duties.