Delegation, Dental Assisting, and Supervision Requirements
This domain tests who may perform which service, and under whose eyes.
The supervision ladder
- Direct supervision: the dentist is on the premises, has examined the patient, and is available to intervene.
- Indirect supervision: the dentist has authorized the procedure and is on the premises, but is not necessarily in the operatory.
- General supervision: the dentist authorized the service in advance, often in writing, and is not on the premises. The procedure's legal classification - not the schedule's convenience - determines which level applies.
Assistants and hygienists
- North Carolina dental assistants work within defined categories; expanded-function assistants must meet the experience and course requirements in rule before performing those functions.
- Hygienists hold their own license, with a scope centered on assessment, prophylaxis, periodontal therapy, sealants, and patient education. Additional services such as administering local anesthesia require specific training and permit authority.
- Some acts are never delegable: diagnosis, treatment planning, prescribing, and surgical procedures.
Worked example
A hygienist sees a recall patient while the dentist is at a second office. If the patient is a routine recall and the setting and rule allow general supervision, the prophylaxis is lawful. If the patient reports new swelling, the hygienist may assess and record but may not diagnose or prescribe; the dentist must be reached and the patient managed accordingly.
Traps that cost marks
- Assuming hygienists may always work without the dentist present; general supervision is setting- and circumstance-specific.
- Confusing "the assistant has done it for years" with legal authority.
- Failing to document the supervising dentist's authorization for delegated services.