Scope of Practice, Supervision, and Delegation
What this domain tests
This domain tests the boundary between what a dentist may delegate and what remains the dentist’s professional responsibility. Missouri recognizes supervision categories and authorizes specific duties for hygienists and assistants, but delegation is never unlimited. The exam favors scenarios where an office custom conflicts with the Act or rule.
Core rules and concepts
- The dentist owns diagnosis, treatment planning, and irreversible procedures. Those cannot be delegated to a hygienist or assistant. Delegable services must be authorized by statute or Board rule and within the delegate’s training.
- Supervision levels matter. Direct supervision generally requires the dentist to be on the premises and to have examined the patient; indirect supervision typically requires the dentist’s availability and prior authorization; general supervision generally allows the dentist to be absent but requires prior examination and a treatment plan. Apply the definition in the current rule, not the office’s label.
- A new patient generally lacks an established diagnosis and plan. That makes many hygiene or assistant procedures inappropriate under general supervision until the dentist has examined the patient.
Worked example
A hygienist working under general supervision sees a new patient and performs scaling and root planing because the patient “reported bleeding gums.” The dentist is out of the office and has not examined the patient. This is not permissible general-supervision hygiene. General supervision presupposes a dentist’s prior examination and authorized plan; a patient complaint is not a diagnosis. The hygienist should limit care to what the rule allows and arrange a dentist examination before definitive treatment.
Traps that cost marks
- Treating general supervision as independent practice.
- Letting an assistant perform a procedure because “the dentist showed them once.”
- Delegating diagnosis or treatment planning along with a task.
- Assuming a hygiene license authorizes every dental procedure.