Delegation, collaboration, and referral responsibilities
Who may do what
The dentist is responsible for the overall treatment plan and for delegating only tasks that the Dental Practice Act and COMAR permit. A hygienist may perform dental hygiene services within scope and supervision, but may not delegate those services to an unlicensed person or to an assistant who lacks the required certification. The hygienist should collaborate with the dentist, report findings, and refer conditions that exceed her scope or the practice's ability to treat.
Collaboration and referral
Referral is required when a patient has a condition needing diagnosis, medical evaluation, or treatment outside dental hygiene. Examples include suspicious oral lesions, uncontrolled bleeding, severe infection, or a medical condition that changes treatment risk. The referral should be documented and, when appropriate, followed up. In public-health or community settings, the hygienist still works under the supervision model and protocols that apply to that setting.
Worked example
A dental assistant is asked to take a radiograph while the hygienist is with another patient. If the assistant does not hold the required Maryland radiography certification and the dentist has not authorized the task under the correct supervision, the assistant must not expose the image. The hygienist should not “cover” the delegation by signing off. The dentist should assign the task to a qualified person.
Traps that cost marks
General supervision is not permission to delegate to anyone. A hygienist cannot clear a patient for treatment or diagnose a lesion. Referral is not abandonment when documented and communicated.