Supervision and Delegation of Duties

Supervision
Supervision includes four (4) types of supervision as follows:

1. "Direct supervision" means the dentist is in the dental office, personally diagnoses the condition to be treated, personally authorizes the procedure(s)/duty(ies), remains in the dental office while the procedure(s)/duty(ies)are being performed and examines the patient before his/her dismissal.
2. "General Supervision" means the dentist has authorized the procedure(s)/duty(ies) and such is being carried out in accordance with his/her diagnosis and treatment plan.
3. "Indirect Supervision" means the dentist is in the dental office, personally diagnoses the condition to be treated, personally authorizes the procedure(s)/duty(ies), and remains in the dental office while the procedure(s)/duty(ies) is being performed by the dental auxiliary.
4. "Personal Supervision" means the dentist is personally operating on a patient and authorizes the dental auxiliary to aid his/her treatment by concurrently performing a supportive procedure.

Delegation of Duties

Dental Hygienist
A dental hygienist may remove calcareous deposits, accretions and stains from both supragingival and subgingival tooth scaling and root planing, as well as any duties performed by a Certified Dental Assistant or a Dental Assistant. These procedures may be accomplished under general supervision, in a dental office, and under general supervision of the dentist.

Certified Dental Assistant

1. A certified dental assistant may perform reversible intraoral procedures under the direct supervision of the dentist.
2. Such procedures may include the application of pit and fissure sealants and fluoride treatments, provided:
1. such procedures were incorporated into the academic training from which the certified dental assistant graduated; or
2. provided he/she has completed academic clinical training to clinical competence.
3. The certified dental assistant may not perform any of the procedures specifically listed for a dental hygienist, nor any irreversible intraoral procedures.

Dental Assistant
A dental assistant may perform reversible intraoral procedures under the personal supervision of the dentist. He/she may not perform any of the procedures listed specifically for a licensed dental hygienist nor any irreversible intraoral procedures.

Non-Delegable (Exclusionary) Procedures/Duties
The following procedures or duties are prohibited by a dental hygienist, certified dental assistant or dental assistant:

1. Diagnosis and treatment planning;
2. Surgical procedures on hard or soft tissue;
3. Prescribing medications;
4. Administering injectables and/or general anesthesia;
5. Administering inhalants or other conscious sedation agents;
6. Taking impressions for models upon which full or partial dentures, or permanent crowns, bridges, inlays, onlays, posts and cores will be fabricated;
7. Adjusting occlusion of fixed and removable prosthodontic appliances;
8. Final cementation of permanent crowns, bridges, inlays, onlays and posts and cores; and insertion of final prosthesis.
9. Condensing and carving restorative materials in teeth, except temporary restoratives;
10. Placement or removal of bonded orthodontic attachments and/or cementation or removal of orthodontic bands;
11. Placement of sutures;
12. Exposure of radiographs without successful completion of a course in dental radiography which is offered by an education institution with a program accredited by the Commission on Dental Accreditation and which fulfills institutional requirements as set forth in the Rules and Regulations for the Control of Radiation, RI Department of Health Office of Occupational and Radiological Health;
13. Perform direct pulp capping procedures;
14. Orthodontic arch wire activation with the exception of minor adjustments to eliminate pain or discomfort;
15. Flush root canal;
16. Temporary wire ligation;
17. Use of a rotary instrument in the oral cavity unless licensed or certified under the provisions of the Dental Practice Act and the regulations.