Scope of Practice and Supervision Levels for Dentists, Hygienists, and Assistants
This section covers who may perform which dental procedures and the supervision level Nevada requires for each.
Dentist scope and delegation
The dentist holds ultimate responsibility for diagnosis, treatment planning, prescribing, and surgical care. Nevada law permits delegation of specific tasks to hygienists and assistants only when the required supervision level is met. "Direct" supervision generally means the dentist is on the premises, has authorized the procedure, and examines the patient as required; "indirect" means the dentist is on the premises but not necessarily in the operatory; "general" means the dentist has authorized care but is not onsite. The exact definitions and permitted tasks are in NRS 631 and NAC 631, and they differ by procedure.
Hygienists
Hygienists perform prophylaxis, scaling and root planing, sealants, fluoride, radiographs, and patient education; some expanded functions, such as local anesthesia, require additional certification. Supervision level depends on the procedure and the hygienist's qualifications.
Assistants
Dental assistants may perform basic supportive tasks and certain expanded functions only with required training or certification and under the specified supervision. Placing a final restoration or performing irreversible procedures without authorization exceeds scope.
Worked example
A certified assistant places a composite restoration while the dentist is at lunch. Even though the assistant has taken a course, a final restoration requires direct supervision by an onsite dentist. The assistant exceeds scope and the dentist may be disciplined for inadequate supervision.
Traps
Memorize supervision by procedure, not by job title. "The dentist was in the building" satisfies indirect but not direct supervision if direct requires chairside presence. Do not let unlicensed staff perform irreversible tasks. Scope cannot be expanded by a signed office protocol.