Scope of Practice, Supervision, and Delegation
Domain focus
This domain tests who may perform which procedure and under what level of supervision. The exam favors scenarios: a procedure, a license type, and a supervision label, and you must decide whether the arrangement is lawful.
Scope by license type
A dentist holds the broadest scope: diagnosis, treatment planning, prescribing, surgery, and irreversible procedures. A dental hygienist may provide prophylaxis, scaling and root planing, periodontal maintenance, radiographs, fluoride, and sealants; with additional Board-recognized certification, a hygienist may administer local anesthesia or nitrous oxide-oxygen under direct supervision. A dental assistant may perform reversible functions delegated by the dentist and may expose radiographs only with the required radiography credential.
Supervision levels
Direct supervision means the dentist is physically present in the office, available, and examines the patient as the rule requires. Indirect supervision means the dentist has examined the patient and authorized treatment but need not be on site. General supervision means the dentist authorizes care without having examined the patient; it is limited to defined situations, such as certain public-health settings where the rules permit a hygienist to treat without a prior dentist examination.
Delegation limits
A dentist may not delegate diagnosis, treatment planning, or irreversible procedures. Delegated tasks must be within the auxiliary's training and legal scope, and the dentist remains responsible for the care.
Worked example
A hygienist performs scaling and root planing in a private office under general supervision, relying on a dentist's examination from thirteen months earlier. The arrangement fails: general supervision is not the default for private-practice periodontal therapy, and a stale examination does not supply the required authorization. The hygienist should not have treated until the dentist provided the supervision the rule requires.
Traps that cost marks
Treating indirect and general supervision as interchangeable. Assuming a dentist's presence cures a scope violation. Letting an assistant perform a procedure because "the dentist was in the building." Ignoring certification conditions attached to anesthesia or radiography authority.