Scope of Practice and General Supervision of Dental Auxiliaries
Supervision levels
Scope-of-practice questions turn on two things: whether the procedure is delegated at all, and what supervision level applies. Direct supervision generally means the dentist is in the office and available; general supervision means the dentist has examined the patient and authorized the procedure but need not be present. Board rules identify which procedures hygienists and assistants may perform and in which settings general supervision is allowed.
What hygienists commonly perform
- Prophylaxis, scaling, root planing, polishing, and fluoride.
- Sealants and radiographs when the radiology permit is held.
- Patient education and screening within the licensed scope.
- Local anesthesia or other expanded functions only with the specific authorization and training the Board requires.
Worked example
A dentist examines a patient, writes an order for a prophylaxis, and leaves for a meeting while the hygienist treats in the same office. If the rule allows general supervision for that procedure and setting, the hygienist may proceed. If the procedure requires direct supervision, the dentist's absence makes the treatment unauthorized. The reasoning: the label "general supervision" is not a blanket permission; it must match the procedure and setting.
Traps
- Treating general supervision as independent practice.
- Skipping the dentist's prior examination.
- Performing an expanded function after a weekend course that is not Board-approved.
- Assuming an assistant may perform hygiene services.