Scope of Practice and Supervision
Scope questions turn on who may perform what and under what supervision. Dentists have the broadest scope; hygienists and assistants work under delegation with defined supervision levels. Know the difference between direct supervision (dentist on premises, examines patient, authorizes and evaluates) and general/indirect supervision (dentist authorizes but need not be present). Certain tasks-diagnosis, treatment planning, prescribing, surgery-are reserved to the dentist.
Hygienists may perform prophylaxis, scaling, and related services under the applicable supervision level, and there are rules on prescriptive authority and on services in certain settings. Assistants may take radiographs only with proper certification. Teledentistry and delegation to out-of-office settings carry their own rules.
Traps: the biggest is swapping direct and general supervision. Another is assuming a hygienist can independently diagnose or treatment-plan. Questions also test whether a specific task (e.g., administering local anesthesia, taking radiographs, coronal polishing) requires a permit or certification versus simple delegation. Watch for items that let a dentist delegate a non-delegable act.
Rule of thumb: ask two questions-is this act reserved to the dentist? and what supervision level applies? Worked example: an assistant is asked to expose a radiograph. The act is delegable only if the assistant holds the required radiography certification and the dentist has authorized it; without certification, delegation is improper regardless of supervision.