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
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
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.
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.
fluorides and other recognized topical agents for the prevention of oral
diseases: Hygienists may provide this service under general
Conditioning of teeth for and application of
sealants: Hygienists may provide this service under general
Taking impressions of teeth for athletic
appliances: Hygienists may provide this service under general
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.