License Pending, Patients Booked
A hygienist licensed in Massachusetts moves to Concord and applies for New Hampshire licensure by credentials. Her application is complete except for an official transcript that the school has not sent; the Board has not issued a license. The owner-dentist says, 'New Hampshire reciprocity is automatic; while you wait, work as a dental assistant and do prophies under my direct supervision. I'll advertise you as RDH, EFDA, and pay you the hygiene rate.' The hygienist's CPR card expired two months ago, and she has 12 documented CE hours from a weekend course; she is unsure whether they qualify. The practice website is updated that day with her photo and the line 'Our new RDH is accepting hygiene appointments-book now!' A patient calls asking for 'the new hygienist.' The dentist tells her to see the patient because 'the Board takes months and nobody checks.'
1. May she see patients as described? Address license status, supervision, title, and advertising.
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No. A pending application is not a license. New Hampshire does not grant 'automatic reciprocity'; licensure by credentials requires the Board to review and issue a license, and the missing transcript means the application is incomplete. Until the license is issued:
- She may not perform dental hygiene, including prophylaxis, under any title. 'Direct supervision' by the dentist does not create authority for an unlicensed person to do hygiene.
- She may perform only dental-assisting duties that New Hampshire law allows a dental assistant to perform under the applicable supervision-and only if the office is using her as an assistant, not as a hygienist.
- She may not use 'RDH' or 'EFDA' in advertising or introduce herself as a hygienist. EFDA is a separate credential, and she has not stated she holds New Hampshire EFDA status.
- The website statement is false and misleading and must come down immediately.
The CPR and CE questions matter for licensure or renewal, but they do not cure the license gap.
2. What should she do about the website and the scheduled patient, and what should she tell the dentist?
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She should tell the dentist, in writing if possible: 'I am not licensed in New Hampshire; I cannot see hygiene patients or be advertised as an RDH. Please remove my name and photo from the website today and reschedule the patient with a licensed hygienist.' She should not see the patient. If the dentist refuses, she should not participate, should document the instruction and her refusal, and may contact the Board for guidance. She should also correct anything she personally posted and keep copies of what was published. The scheduled patient should be told simply that the appointment needs to be handled by a licensed provider; the office should not bill for her services. If she has already seen patients, she should not create backdated notes; she should report the situation accurately to the Board and cooperate.
3. If a complaint is filed, describe the Board process and the likely issues.
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A complaint would likely be investigated by the Board of Dental Examiners. The Board typically sends notice and an opportunity to respond, may request records, and may offer an informal resolution or set a hearing. Issues would include unlicensed practice, aiding unlicensed practice, false advertising, and possibly failure to meet licensure or renewal requirements. The hygienist should cooperate, provide truthful documents, not alter records, and get legal advice. Possible outcomes range from dismissal to reprimand, fine, conditions, suspension, or denial of the pending license. The dentist also faces exposure for permitting unlicensed practice and advertising it.