Supervision and delegation to dental hygienists and dental assistants
This domain tests who may perform which tasks, under what level of supervision, and who remains responsible when something goes wrong.
Supervision levels
- Direct supervision: the dentist is on the premises, authorizes the procedure, and is available to see the patient.
- General supervision: the dentist has authorized the procedure but is not on the premises; the patient must be able to reach the dentist if needed.
- Public-health supervision: a hygienist practicing in an approved public-health setting under a dentist’s authorization, often without the dentist present, after meeting experience and program requirements.
Hygienists
Hygienists may perform prophylaxis, scaling and root planing, sealants, fluoride, radiographs, and patient education within their scope. They may not diagnose, treatment-plan, or perform procedures outside the hygienist scope. Any expanded function, such as local anesthesia or nitrous oxide, requires the specific Board authorization and training.
Assistants
Kentucky uses credential-specific expanded duties. Radiography, coronal polishing, and sealant placement require the applicable certification. An uncertified assistant may perform only basic supportive tasks. The dentist must not delegate a task merely because it is convenient.
Worked example
A hygienist wants to provide sealants at a school without the dentist present. Reasoning: this can be permissible only if the setting qualifies for public-health supervision and the hygienist meets the Board’s requirements. In a private office, the same task may require direct or general supervision depending on the rule. The setting and credential control, not the task alone.
Traps that cost marks
- Treating “general supervision” as permission for any procedure anywhere.
- Assuming a hygienist may diagnose or treatment-plan because the dentist is busy.
- Letting an assistant perform radiographs without the required certification.
- Forgetting that the dentist remains responsible for delegated acts.