Scope of Practice, Supervision, and Delegation
Start with the definition
The statutory definition of “practice of dentistry” is deliberately broad and captures diagnosis, treatment planning, prescribing, surgery, and any irreversible procedure. Anything inside that set cannot be delegated to anyone, at any supervision level. Hygienists deliver preventive and therapeutic services - assessment, scaling and root planing, polishing, radiographs, sealants, fluoride, and education - and may add services such as local anesthesia infiltration or nitrous oxide only with the required training and permit. Expanded function dental assistants perform an enumerated list of reversible restorative and supportive tasks under authorization.
The supervision ladder
New Hampshire uses tiered supervision. Direct supervision generally means the dentist is physically present in the office and immediately available; indirect supervision means prior authorization with the dentist off-site; some settings - public health programs, schools, institutional care - carry additional exceptions allowing hygienists greater autonomy. Delegation requires that the dentist have examined the patient or authorized the service, that the auxiliary be competent, and that the work be documented and reviewed.
Accountability
Supervision does not transfer liability. The dentist remains responsible for delegated acts, including outcomes and follow-up.
Worked example
A hygienist in private practice asks whether she may place a composite restoration. Test it in three steps: is the act enumerated for EFDAs, is there dentist authorization and required supervision, and is the dentist credentialed to supervise that function? If any answer is no, the act is outside scope no matter how experienced the hygienist is.
Rule of thumb
If the act requires a diagnosis, a prescription, or a permanent change to hard or soft tissue, it belongs to the dentist.