Can a dental hygienist work on patients without the dentist physically present in the building?

Dentists must use the ASA Classifications to determine a patient’s health and treatment plan and the degree of supervision of dental hygienists. Most notably, the definition of general supervision states that hygienists may provide hygiene services to patients within one year of a dentist having examined a patient, rendered a diagnosis and treatment plan and authorized the hygiene services. Previously, hygienists had to provide these services within 90 days of the dentist’s examination.

Direct supervision is still defined as the dentist having examined the patient, authorized the procedure to be performed, is physically present in the dental facility and available when the procedure occurs and takes full professional responsibility for the completed procedure.

The following are the supervision requirements applying to these hygiene services:

Placement of subgingival agents:
Hygienists may provide this service under direct supervision, but general supervision would apply if the dentist has reviewed the patient’s records and medical history and has written a prescription or given an order for the placement of subgingival agents.

Periodontal probing, scaling, root planning, polishing or another procedure required to remove calculus deposits, accretions, excess or flash restorative materials and stains from the exposed surfaces of the teeth and beneath the gingiva: Hygienists may provide these services under direct supervision when the patient is suffering from systemic disease which is severe, incapacitating or life threatening. General supervision would apply if the patient is free of systemic disease or suffers from mild systemic disease (as determined by the dentist, with input from the hygienist.)

Evaluation of that patient to collect data to identity dental hygiene care needs: Hygienists may provide this service under general supervision.

Application of fluorides and other recognized topical agents for the prevention of oral diseases: Hygienists may provide this service under general supervision.

Conditioning of teeth for and application of sealants:
Hygienists may provide this service under general supervision.

Taking impressions of teeth for athletic appliances: Hygienists may provide this service under general supervision.

Administration of local anesthesia: Hygienists may provide this service only under direct supervision.

Answer is informational only and not intended as legal advice. Answer may contain excerpts from The ADA Practical Guide to Frequently Asked Legal Questions.