Regulatory FAQ > General FAQ Questions > What procedures can a hygienist perform when a dentist is not in the office?
A hygienist, in most practice settings, works under the dentist's close or general supervision. Close supervision means “a dentist [must] be physically present in the treatment facility while the procedures [are] performed” (WAC 246-817-510). General supervision allows a hygienist to perform procedures “based on examination, diagnosis…and instructions given by a licensed dentists…[without] the physical presence of the supervising dentist in the treatment facility” (WAC 246-817-510).
Under state law, a hygienist can perform the following procedures under a dentist’s general supervision: oral inspection and measuring of periodontal pockets with no diagnosis, patient education in oral hygiene, taking intra-oral and extra-oral radiographs, applying topical preventive or prophylactic agents, polishing and smoothing restorations, oral prophylaxis and removal of deposits and stains from the surfaces of the teeth, recording health histories, taking and recording blood pressure and vital signs, performing sub-gingival and supra-gingival scaling, performing root planning, and applying sealants (WAC 246-817-550).
Attached are WAC 246-817-510, WAC 246-817-550, & WAC 246-817-550 as they relate to this question:
“Definitions for WAC 246-817-501 through 246-817-570.”
"Close supervision" means that a licensed dentist whose patient is being treated has personally diagnosed the condition to be treated and has personally authorized the procedures to be performed. A dentist shall be physically present in the treatment facility while the procedures are performed. Close supervision does not require a dentist to be physically present in the operatory; however, an attending dentist must be in the treatment facility and be capable of responding immediately in the event of an emergency.
"General supervision" means supervision of dental procedures based on examination and diagnosis of the patient and subsequent instructions given by a licensed dentist but not requiring the physical presence of the supervising dentist in the treatment facility during the performance of those procedures.
[Statutory Authority: RCW HYPERLINK "http://apps.leg.wa.gov/RCW/default.aspx?cite=18.32.035" 18.32.035. 95-21-041, § 246-817-510, filed 10/10/95, effective 11/10/95.]
“Acts that may be performed by licensed dental hygienists under general supervision.”
A dentist may allow a dental hygienist licensed under the provisions of Chapter 18.29 RCW to perform the following acts under the dentist's general supervision: (1) Oral inspection and measuring of periodontal pockets, with no diagnosis. (2) Patient education in oral hygiene. (3) Take intra-oral and extra-oral radiographs. (4) Apply topical preventive or prophylactic agents. (5) Polish and smooth restorations. (6) Oral prophylaxis and removal of deposits and stains from the surfaces of the teeth. (7) Record health histories. (8) Take and record blood pressure and vital signs. (9) Perform sub-gingival and supra-gingival scaling. (10) Perform root planing. (11) Apply sealants.
[Statutory Authority: RCW 18.32.035. 95-21-041, § 246-817-550, filed 10/10/95, effective 11/10/95.]
“Acts that may be performed by licensed dental hygienists under close supervision.”
In addition to the acts performed under WAC 246-817-520, a dentist may allow a dental hygienist licensed under the provisions of Chapter 18.29 RCW to perform the following acts under the dentist's close supervision: (1) Perform soft-tissue curettage. (2) Give injections of a local anesthetic. (3) Place restorations into the cavity prepared by the dentist, and thereafter could carve, contour, and adjust contacts and occlusion of the restoration. (4) Administer nitrous oxide analgesia. (5) Place antimicrobials.