Finishing the Crown After the Dentist Leaves

Not the restorative and occlusal steps. Michigan's Dental Practice Act, Part 166 of the Public Health Code, defines the practice of dentistry broadly: diagnosing, treating, operating, and prescribing for oral conditions. Preparing a tooth, placing and curing a restorative material, and adjusting occlusion are irreversible clinical procedures that require a licensed dentist. The Board's administrative rules permit dental assistants to perform only specified supportive, reversible tasks under direct supervision, which generally means the dentist is physically present in the office, has examined the patient, and is available to intervene. Even if some impression-taking might be delegated under the rules, the restoration and occlusal adjustment may not. On-the-job training does not expand the statutory scope. Dr. Alvarez's statement that assistants may do 'anything' he delegates is wrong and is itself evidence of unprofessional conduct. If Maya performs these steps, she practices dentistry without a license and Dr. Alvarez aids and abets unlicensed practice. Both face Board discipline under MCL 333.16221, including fines, probation, suspension, or revocation, and the practice faces civil exposure.

No. A Michigan dental hygiene license authorizes the hygienist to perform the services defined in the dental hygiene practice act and the Board's rules. Administering local anesthesia is an expanded function that requires additional board-approved education, a certificate or permit, and current basic life support; the dentist must provide direct supervision and be prepared to manage emergencies. Kim has neither the course nor the credential, so she may not give the inferior alveolar block. Similar rules apply to nitrous oxide and conscious sedation, which require separate training and permits. Dr. Alvarez could delegate the block only to a hygienist who holds the credential, or he could administer it himself. Allowing Kim to proceed would be unlicensed practice and would also violate the supervision and standard-of-care rules. The office should verify each team member's credential file, keep copies of certificates, and build a delegation matrix that lists which procedures each person may perform under which level of supervision.

Dr. Alvarez and the practice face administrative, civil, and possibly criminal exposure. Under the Public Health Code, the Board may discipline a licensee for aiding and abetting unlicensed practice, failing to supervise, incompetence, or unprofessional conduct. Sanctions range from a reprimand and fine to probation with monitoring, suspension, or revocation. The assistant and hygienist could also be prosecuted for unlicensed practice, and the practice's malpractice carrier may deny coverage for treatment rendered outside scope. The bill should not be submitted under Dr. Alvarez's provider number for services Maya performed; that could be insurance fraud. Immediate corrective steps: stop the delegation, have a licensed dentist verify or redo the restoration, notify the patient if care was compromised, audit charts for prior incidents, document the corrective action, and train staff on Michigan scope and supervision rules. If a complaint is filed, cooperate, retain counsel, and consider self-reporting to the Board if required.