Licensed Dental Hygienists may only practice under direct
and/or general supervision in the employment of a licensed dentist consistent
with the provisions of T.C.A. Title 63, Chapter 5.
Delegable or Assignable Procedures - In
addition to those duties of the licensed dental hygienist which are commonly
recognizable by the dental profession for safe performance, pursuant to T.C.A.
a licensed dental
hygienist may perform the following duties which are assigned or delegated to
the licensed dental hygienist by the employer dentist:
(a) The removal of all hard and soft deposits
and stains from the human teeth to the depth of the gingival sulcus, polishing
natural and restored surfaces of teeth, performing clinical examination of
teeth and surrounding tissues for diagnosis by the dentist, and performing
other such procedures as may be delegated by the dentist consistent with the
provisions of T.C.A. Chapter 5, Title 63.
(c) The application of sealants.
(d) The exposure of radiographs, including
digital, of the mouth, gums, jaws, teeth or any portion thereof for dental
(e) The application of
instruction of patients in dietary principles.
(g) Demonstration of oral hygiene procedures
and oral health care regimen.
The taking and recording of a patient's blood pressure, pulse, temperature, and
medical history and charting of oral conditions.
(i) The serving as chairside
(j) The maintenance of
instrument and operatory infection control
(k) The preparation of instrument
(l) The placement and removal
of matrices for restoration.
The removal of cement from restorations and bands.
(n) The removal of sutures and
(o) The fabrication,
placement and removal of temporary restorations.
(p) The placement and removal of rubber
(q) The placement and removal
of socket dressings.
placement and removal of periodontal dressings.
(s) The taking of dental plaque
(t) The taking of alginate
impressions for any purpose other than permanent restorations.
(u) The removal of ligature and arch
(v) Bending, selecting and
pre-sizing arch wires and placing arch wires after final adjustment and
approval by the dentist.
selection, prefitting, cementation, curing, and removing of orthodontic bands
(x) The placement and
removal of pre-treatment separators.
(y) Removal of loose or broken bands or
(zz) Placement of springs
(aa) Placement of hooks
(bb) Placement of
chain elastics on brackets.
Ligation of arch wires to brackets.
(dd) Packing and removing retraction cord,
with or without vasoactive chemicals, for restorative dental
(ee) Removal of excess
cement from the surfaces of the teeth.
(ff) The placement of amalgam in prepared
cavities for condensation by the dentist.
(gg) Placement of cavity bases and
(hh) Sulcular irrigation
with antimicrobial agents only when prescribed by the employer/supervising
(ii) Application of
Application of topical anesthetic and anti-inflammatory agents.
(kk) Placement of antibiotic-treated
materials, if prescribed.
Application of tooth conditioners for bonding.
(mm) Selecting and pre-fitting of stainless
steel crowns or other pre-formed crowns for insertion by the dentist.
(nn) The taking of oral cytologic
(oo) Performing pulp
(pp) Packing of pulpotomy
(qq) Drying canals with
absorbent paper points.
Calling in prescriptions to the pharmacist as instructed by the
adjusting and cementation of correctional appliances.
(tt) Wound care as directed.
(uu) Irrigating extraction site.
(vv) Placement of exposure chains and
(ww) The use of lasers
for examination and/or for periodontal treatment under the supervision of a
Tennessee licensed dentist.
Other duties specifically approved by the Board at a regularly scheduled
meeting of the Board.
Dental hygienists may perform delegable
procedures for patients of record of their employer dentist who reside in
nursing homes pursuant to the following protocol:
A letter from the employer dentist must
be entered in both the dentist's and the nursing home's patient records which
includes all of the following:
2. Facility name;
3. Procedures to be performed including the
frequency of services if on a regular basis and unchanged;
4. Family or patient consent if
5. Patient's physician's
6. Consent of facility
supportive staff to aid hygienist if needed.
7. Consent of facility for registered nurse
or physician to be available upon code.
(b) If any major variation of this protocol
is required, approval of the Board must be obtained pursuant to rule
(3) Under the direct supervision of a
licensed dentist, licensed dental hygienists may perform services including,
but not limited to, root planing and subgingival curettage.
(4) Administration and/or monitoring of
nitrous oxide sedation must be under the direct supervision of a licensed
dentist, and the licensed dental hygienist must possess certification pursuant
to Rule 0460-03-.06.
Administration of local anesthesia must be under the direct supervision of a
licensed dentist who, at that time, is physically present at the same office
location. The licensed dental hygienist must possess certification pursuant to
of restorative or prosthetic functions must be under the direct supervision of
a licensed dentist, and the licensed dental hygienist must possess
certification pursuant to Rule 0460-03-.10.
Prohibited Procedures - In addition to
the duties defined as the practice of dentistry by T.C.A. §
, licensed dental
hygienists are not permitted to perform the following:
(a) Comprehensive examination, diagnosis and
(b) Surgical or
cutting procedures on hard or soft tissue, including laser, air abrasion or
micro-abrasion procedures, except curettage or root planing;
(c) Fitting, adjusting, and placement of
Issuance of prescription medications or medications not authorized by Rule
0460-03.09 (1), or work authorizations;
(e) Performance of direct pulp capping,
pulpotomy, and other endodontic procedures not authorized by T.C.A. §
63-5-108 or Rule
(f) Approving the
(g) Placement of
(h) Administration of
conscious sedation or general anesthesia.
(i) Administration of local anesthesia on
patients without certification as provided in Rule 0460-03-.12.
(j) Administration or monitoring of nitrous
oxide without certification as provided in Rule 0460-03-.06;
(k) Use of a high-speed handpiece
(8) In no
event shall a licensed dental hygienist perform dental services inconsistent
with T.C.A. §
63-5-108. Licensed dental
hygienists who perform procedures not delegable pursuant to this rule or
procedures specifically prohibited by T.C.A. §
63-5-108 or who perform procedures
without the direct supervision of a dentist, or who administer or monitor
nitrous oxide without certification or who perform restorative or prosthetic
functions without certification are in violation of the rules governing those
procedures, and may be subject to disciplinary action pursuant to T.C.A. §