Delegation, supervision, and scope of dental hygiene practice
Supervision levels
North Carolina uses supervision categories to decide when a dentist must be present. Under direct supervision, the dentist is physically present in the office, has examined the patient, and is available to approve the work. Under general supervision, the dentist has authorized the procedure in advance and need not be on the premises, but the patient must have been examined and the dentist must remain reachable. Public-health supervision is narrower: a public health dental hygienist may deliver services in approved settings under a written protocol with a consulting dentist.
Delegable and nondelegable acts
A dentist may delegate hygiene services-prophylaxis, scaling and root planing, sealants, fluoride, radiographs, and patient education-within the hygienist's training and the rule's supervision level. Some services need extra certification, such as local anesthesia or nitrous oxide monitoring. A hygienist may not accept delegation of diagnosis, treatment planning, prescription, or irreversible surgical procedures.
Worked example
A dentist examines a child, authorizes sealants, and leaves for a hospital emergency. The hygienist may place sealants under general supervision if the office's rules and the dentist's authorization permit it; the dentist's prior examination and availability by phone satisfy general supervision. If the procedure were a surgical extraction, delegation would be unlawful regardless of supervision.
Traps
- Reading "general supervision" as "no dentist involvement."
- Performing expanded functions without the required certificate.
- Assuming public-health supervision applies in private practice.
- Believing the hygienist may decide that a lesion needs biopsy.