Scope of practice and supervision levels for dental hygienists
What dental hygiene includes
Maryland law defines dental hygiene broadly: assessment, prophylaxis, scaling and root planing, polishing, fluoride application, sealants, radiographs when authorized, and patient education. The hygienist must work within the current scope and supervision list in the Dental Practice Act and COMAR 10.44. The dentist retains overall responsibility for the patient's care.
Supervision levels
- Direct supervision generally means the dentist is on the premises, has examined or authorized care for the patient, and is available to intervene.
- General supervision generally means the dentist has authorized the service and remains available for consultation, but need not be physically present. The regulation may require a prior examination within a set period.
- Expanded functions, such as local anesthesia or other listed procedures, require additional board-approved training or certification and the supervision level specified for that function.
A hygienist may not diagnose, prescribe, cut hard tissue, or perform an irreversible procedure unless the Act expressly authorizes it. Radiographs require a dentist's order and the applicable supervision.
Worked example
A patient returns for a routine prophylaxis. The dentist examined the patient earlier, authorized the hygiene appointment, and is reachable by phone but is at another office. If the regulation lists prophylaxis under general supervision and the prior-examination condition is met, the hygienist may proceed. If the service is listed as direct supervision, the dentist must be on the premises.
Traps that cost marks
General supervision does not mean “no dentist involvement.” It requires authorization and availability. Do not assume a task is permitted just because another state allows it or because a dentist asks for it.