Dental Therapist, Off-Site Dentist, and a Pediatric Case
A federally qualified health center in Machias employs a licensed dental therapist, Maya, and a dentist, Dr. Patel, who is on site only on Mondays. Maya has a written supervision agreement with Dr. Patel. On a Thursday, a 7-year-old patient presents with a large carious lesion on the primary mandibular second molar. The tooth is tender to percussion but there is no swelling, fever, or fistula. Maya plans to place a stainless steel crown and to extract a retained primary incisor. A dental assistant who is not licensed or certified in expanded functions offers to help by extracting the incisor so Maya can finish the crown faster. The clinic's schedule is full, and the family has no transportation to return next week.
1. What supervision and agreement issues determine whether Maya may treat the child on Thursday?
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The starting point is that a dental therapist practices under a written supervision agreement with a dentist and within the scope the Board authorizes. The agreement and the Board's dental therapist rules determine which services may be provided under direct versus general supervision, and in which settings.
Because Dr. Patel is off site on Thursday, Maya must confirm that the agreement authorizes general supervision for these procedures and that the setting qualifies. If the agreement requires direct supervision for stainless steel crowns or extractions, she cannot proceed without Dr. Patel present or otherwise available as the rule requires. The therapist should also have a way to consult the dentist about the periapical tenderness. Transportation barriers are a real access concern, but they do not expand scope or supervision authority; the clinic should arrange a compliant schedule rather than improvise.
2. Can the dental assistant extract the retained primary incisor at Maya's request? Explain.
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No. Extraction is not a dental assisting function. A dental assistant may perform only delegated tasks that the Board permits and that fall within the assistant's training and authorization; surgical extraction of a tooth is not among them. Having Maya-a dental therapist-ask the assistant to do it does not cure the problem, because Maya cannot delegate a procedure the assistant is not authorized to perform, and the assistant cannot practice beyond her credential.
The assistant can provide supportive duties such as suction, retraction, and instrument transfer within her training. If the incisor needs extraction, Maya must perform it herself if it is within her scope and supervision level, or Dr. Patel must perform it. Allowing the assistant to extract would be unlicensed or unauthorized practice and would expose both providers and the clinic.
3. The tooth is tender to percussion. How should that finding affect Maya's treatment plan?
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Tenderness to percussion suggests possible pulpal or periapical involvement, not simply a mechanical caries problem. That matters because a stainless steel crown on a primary molar with irreversible pulp involvement may require pulp therapy or extraction rather than a simple crown. Maya should assess vitality, mobility, radiographic findings, and the child's symptoms before deciding.
If the case exceeds what her agreement and scope authorize-for example, if complex pulp therapy or a surgical extraction is needed-she should consult Dr. Patel and arrange referral rather than proceed. The absence of swelling and fever is reassuring but does not rule out significant pathology. Document the percussion finding, the diagnostic reasoning, the consultation, and the plan. The access problem should be solved through scheduling or referral, not by stretching scope.