Tenn. Comp. R. & Regs. 0460-04-.08 - SCOPE OF PRACTICE

(1) A lawfully licensed and duly registered dentist may delegate to dental assistants those procedures for which they have received adequate training and for which the dentist exercises direct supervision and full responsibility, except as follows:
(a) Those procedures which require professional judgment and skill of a dentist as defined in the Dental Practice Act or rules of the Board.
(b) Those clinical procedures which are primarily concerned with the practice of dentistry or dental hygiene and which are allocated by the Dental Practice Act or Rules of the Tennessee Board of Dentistry specifically and solely to licensed dentists and/or licensed dental hygienists.
(2) Registered dental assistants, with additional Board-approved training, may, under the direct supervision of a licensed dentist perform the following procedures:
(a) Coronal polishing, pursuant to Rule 0460-04-.04; and
(b) Monitoring nitrous oxide, pursuant to Rule 0460-04-.05; and
(c) Application of sealants, pursuant to Rule 0460-04-.09.
(d) Performance of expanded restorative functions, pursuant to Rule 0460-04-.10.
(e) Performance of expanded prosthetic functions, pursuant to Rule 0460-04-.10.
(f) Exposure of dental radiographs, pursuant to Rule 0460-04-.11.
(3) Delegable or Assignable Procedures - In addition to those duties of the practical dental assistant or registered dental assistant which are commonly recognizable by the dental profession for safe performance, pursuant to T.C.A. § 63-5-108, a practical dental assistant or registered dental assistant may perform the following duties which are assigned or delegated by the employer/supervising dentist:
(a) The processing of radiographs, including digital, of the mouth, gums, jaws, teeth or any portion thereof for dental diagnosis.
(b) The application of topical fluorides.
(c) The instruction of patients in dietary principles.
(d) The taking and recording of a patient's blood pressure, pulse, temperature, and medical history, and charting of oral conditions.
(e) The maintenance of instrument and operatory infection control
(f) The preparation of instrument trays
(g) The placement and removal of matrices for restoration.
(h) The removal of cement from restorations and bands.
(i) The removal of sutures and staples.
(j) The fabrication, placement and removal of temporary restorations.
(k) The placement and removal of rubber dam.
(l) The placement and removal of socket dressings.
(m) The placement and removal of periodontal dressings.
(n) The taking of dental plaque smears.
(o) The taking of alginate impressions for any purpose other than permanent restorations.
(p) The removal of ligature and arch wires.
(q) Bending, selecting and pre-sizing arch wires and placing arch wires after final adjustment and approval by the dentist.
(r) The selection, prefitting, cementation, curing, and removing of orthodontic bands or brackets.
(s) Placement and removal of pre-treatment separators.
(t) Removal of loose or broken bands or brackets.
(u) Placement of springs on wires.
(v) Placement of hooks on brackets.
(w) Placement of chain elastics on brackets.
(x) Ligation of arch wires to brackets.
(y) Packing and removing retraction cord, with or without vasoactive chemicals, for restorative dental procedures.
(z) Removal of cement excess from supragingival surface of teeth by hand instruments only.
(aa) The placement of amalgam in prepared cavities for condensation by the dentist.
(bb) The application of topical anesthetics.
(cc) The application of desensitizing agents.
(dd) Placement of cavity bases and liners.
(ee) Application of tooth conditioners for bonding.
(ff) Selecting and pre-fitting of stainless steel crowns or other pre-formed crowns for insertion by the dentist.
(gg) The taking of oral cytologic smears.
(hh) Performing pulp testing.
(ii) Packing of pulpotomy paste.
(jj) Drying canals with absorbent paper points.
(kk) Demonstration of oral hygiene procedures and oral health care regimen
(ll) Calling in prescriptions to the pharmacist as instructed by the employer/dentist.
(mm) Fitting, adjusting and cementation of correctional appliances.
(nn) Wound care as directed.
(oo) Irrigating extraction site.
(pp) Placement of exposure chains and attachments.
(qq) Other duties specifically approved by the Board at a regularly scheduled meeting of the Board.
(4) Prohibited Procedures-In addition to the duties defined as the practice of dentistry or dental hygiene by T.C.A. § 63-5-108, dental assistants are not permitted to perform the following:
(a) Examination, diagnosis and treatment planning;
(b) Surgical or cutting procedures on hard or soft tissue, including laser, air abrasion or micro-abrasion procedures, including curettage or root planing;
(c) Fitting, adjusting, and placement of prosthodontics appliances;
(d) Issuance of prescription medications or medications not authorized by T.C.A. § 63-5-108(c) or Rule 0460-04-.08 (3), or work authorizations;
(e) Performance of direct pulp capping, pulpotomy, and other endodontic procedures not authorized by T.C.A. § 63-5-108(c) or Rule 0460-04-.08 (3);
(f) Approving the final occlusion;
(g) Placement of sutures;
(h) Administration of local anesthesia, nitrous oxide, conscious sedation, or general anesthesia;
(i) Monitoring of nitrous oxide without certification as provided in Rule 0460-04-.05 and 0460-04-.08 (2);
(j) Coronal polishing without certification as provided in Rule 0460-04-.04 and 0460-04-.08 (2);
(k) Application of sealants without certification as provided by Rule 0460-04-.09 and 0460-04-.08 (2);
(l) Use of a high-speed handpiece intraorally;
(m) Utilization of laser equipment and technology in the course of the performance of their duties unless specifically authorized by T.C.A. § 63-5-108(c) or Rule 0460-04-.08 (3). Only dentists licensed by the Tennessee Board of Dentistry shall be authorized to perform procedures involving laser technology.
(n) The exposure of radiographs without certification as provided by Rule 0460-04-.11 and Rule 0460-04-.08 (2).
(o) Expanded restorative or prosthetic functions without certification as provided by Rule 0460-04-.10 and Rule 0460-04-.08 (2).
(5) Dental assistants who perform procedures not delegable pursuant to this rule, or who perform procedures specifically prohibited by T.C.A. § 63-5-108, or who perform procedures without the direct supervision of a dentist, or who perform coronal polishing, application of sealants or nitrous oxide monitoring without the applicable certification or in violation of the rules governing those procedures, may be subject to disciplinary action pursuant to T.C.A. § 63-5-116(b).


Tenn. Comp. R. & Regs. 0460-04-.08
Original rule certified June 7, 1974. Amendment filed August 26, 1980; effective December 1, 1980. Repeal and new 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. Amendment filed August 3, 2005; effective October 17, 2005. Amendment filed October 12, 2007; effective December 26, 2007. Amendment filed September 25, 2008; effective December 9, 2008. Amendment filed September 30, 2014; effective 12/29/2014.

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

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