Tenn. Comp. R. & Regs. 0460-03-.09 - SCOPE OF PRACTICE

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.

(1) 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. § 63-5-108 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.
(b) Prophylaxis.
(c) The application of sealants.
(d) The exposure of radiographs, including digital, of the mouth, gums, jaws, teeth or any portion thereof for dental diagnosis.
(e) The application of topical fluorides.
(f) The instruction of patients in dietary principles.
(g) Demonstration of oral hygiene procedures and oral health care regimen.
(h) 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 assistant.
(j) The maintenance of instrument and operatory infection control
(k) The preparation of instrument trays
(l) The placement and removal of matrices for restoration.
(m) The removal of cement from restorations and bands.
(n) The removal of sutures and staples.
(o) The fabrication, placement and removal of temporary restorations.
(p) The placement and removal of rubber dam.
(q) The placement and removal of socket dressings.
(r) The placement and removal of periodontal dressings.
(s) The taking of dental plaque smears.
(t) The taking of alginate impressions for any purpose other than permanent restorations.
(u) The removal of ligature and arch wires.
(v) Bending, selecting and pre-sizing arch wires and placing arch wires after final adjustment and approval by the dentist.
(w) The selection, prefitting, cementation, curing, and removing of orthodontic bands or brackets.
(x) The placement and removal of pre-treatment separators.
(y) Removal of loose or broken bands or brackets.
(zz) Placement of springs on wires.
(aa) Placement of hooks on brackets.
(bb) Placement of chain elastics on brackets.
(cc) Ligation of arch wires to brackets.
(dd) Packing and removing retraction cord, with or without vasoactive chemicals, for restorative dental procedures.
(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 liners.
(hh) Sulcular irrigation with antimicrobial agents only when prescribed by the employer/supervising dentist.
(ii) Application of desensitizing agents.
(jj) Application of topical anesthetic and anti-inflammatory agents.
(kk) Placement of antibiotic-treated materials, if prescribed.
(ll) 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 smears
(oo) Performing pulp testing.
(pp) Packing of pulpotomy paste.
(qq) Drying canals with absorbent paper points.
(rr) Calling in prescriptions to the pharmacist as instructed by the employer/dentist.
(ss) Fitting, adjusting and cementation of correctional appliances.
(tt) Wound care as directed.
(uu) Irrigating extraction site.
(vv) Placement of exposure chains and attachments.
(ww) The use of lasers for examination and/or for periodontal treatment under the supervision of a Tennessee licensed dentist.
(xx) Other duties specifically approved by the Board at a regularly scheduled meeting of the Board.
(2) 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) 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:
1. Patient's name;
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 possible;
5. Patient's physician's consent;
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 0460-01-.03(4)(b) 3.(vi).
(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.
(5) 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 Rule 0460-03-.12.
(6) Performance 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.
(7) Prohibited Procedures - In addition to the duties defined as the practice of dentistry by T.C.A. § 63-5-108, licensed dental hygienists are not permitted to perform the following:
(a) Comprehensive examination, diagnosis and treatment planning;
(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 prosthodontics appliances;
(d) 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 0460-03-.09(1);
(f) Approving the final occlusion;
(g) Placement of sutures;
(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 intraorally;
(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. § 63-5-116.


Tenn. Comp. R. & Regs. 0460-03-.09
Original rule filed December 11, 1991; effective January 25, 1992. Amendment filed May 15, 1996; effective September 27, 1996. Amendment filed September 17, 2003; effective December 1, 2003. Amendments filed August 3, 2005; effective October 17, 2005. Amendments filed October 12, 2007; effective December 26, 2007. Amendment filed September 25, 2008; effective December 9, 2008. Amendments filed October 22, 2010; effective January 20, 2011.

Authority: T.C.A. §§ 4-5-202, 4-5-204, 63-5-105, 63-5-107, 63-5-108, 63-5-115, 63-5-116 and 63-5-124.

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