Dentists > Supervision of Personnel

Overview
In all instances, a dentist assumes responsibility for determining, on the basis of diagnosis, the specific treatment patients will receive and which aspects of treatment may be delegated to qualified personnel. A dentist may only delegate to a dental hygienist those services that are within their authorized scope of practice. A dentist may only delegate to a dental assistant those services that are within their authorized scope of practice.

Definitions
“Direct supervision” means that the dentist is present in the treatment facility, but it is not required that the dentist be physically present in the treatment room. Direct supervision is required for all intraoral services (except suctioning) provided by a registered dental assistant. Direct supervision is also required for a dental hygienist administering local anesthesia or nitrous oxide inhalation analgesia, or for a hygienist providing services to a new patient (except under public health supervision). An exam by the dentist must also take place during an initial visit by a new patient.  
“General supervision of a dental assistant” means that a dentist has delegated the services to be provided by a registered dental assistant, which are limited to all extraoral duties, dental radiography, and intraoral suctioning. The dentist need not be present in the facility while these services are being provided.
“General supervision of a dental hygienist” means that a dentist has examined the patient and has prescribed authorized services to be provided by a dental hygienist. The dentist need not be present in the facility while these services are being provided. If a dentist will not be present, the following requirements shall be met:
1. Patients or their legal guardians must be informed prior to the appointment that no dentist will be present and therefore no examination will be conducted at that appointment.
2. The hygienist must consent to the arrangement.
3. Basic emergency procedures must be established and in place and the hygienist must be capable of implementing these procedures.
4. The treatment to be provided must be prior prescribed by a licensed dentist and must be entered in writing in the patient record.
“Personal supervision” means the dentist is physically present in the treatment room to oversee and direct all intraoral or chairside services of the dental assistant trainee and a licensee or registrant is physically present to oversee and direct all extraoral services of the dental assistant.
“Public health supervision” may be provided to a dental hygienist who has entered into a written public health supervision agreement with a dentist.

Public Health Supervision
In 2004, the Iowa Dental Board approved a rule change allowing "public health supervision" of a dental hygienist. “Public health supervision” means 1) The dentist authorizes and delegates the services provided by a dental hygienist to a patient in a public health setting, with the exception that hygiene services may be rendered without the patient’s first being examined by a licensed dentist and 2) the dentist and the dental hygienist have entered into a written supervision agreement that details the responsibilities of each licensee. The dentist is not required to provide future dental treatment to patients served under public health supervision.

Eligibility

To be eligible to work under public health supervision, a dental hygienist must have an active Iowa license with a minimum of three years of clinical practice experience.

Licensee responsibilities

When working together in a public health supervision relationship, a dentist and dental hygienist shall enter into a written agreement that specifies the following responsibilities.

Dentist responsibilities:
  1. Be available to provide communication and consultation with the dental hygienist;
  2. Have age- and procedure-specific standing orders for the performance of dental hygiene services. Those standing orders must include consideration for medically compromised patients and medical conditions for which a dental evaluation must occur prior to the provision of dental hygiene services;
  3. Specify a period of time in which an examination by a dentist must occur prior to providing further hygiene services. However, this examination requirement does not apply to educational services, assessments, screenings, and fluoride if specified in the supervision agreement; and
  4. Specify the location or locations where the hygiene services will be provided under public health supervision.
Hygienist Responsibilities:
  1. Maintain contact and communication with the dentist providing public health supervision;
  2. Practice according to age- and procedure-specific standing orders as directed by the supervising dentist, unless otherwise directed by the dentist for a specific patient;
  3. Provide to the patient, parent, or guardian a written plan for referral to a dentist and assessment of further dental treatment needs;
  4. Have each patient sign a consent form that notifies the patient that the services that will be received do not take the place of regular dental checkups at a dental office and are meant for people who otherwise would not have access to services; and
  5. Specify a procedure for creating and maintaining dental records for the patients that are treated by the dental hygienist, including where these records are to be located.

Allowable hygiene duties

A dental hygienist providing services under public health supervision may provide assessments; screenings; data collection; and educational, therapeutic, preventive, and diagnostic services as defined in rule 10.3(153), except for the administration of local anesthesia or nitrous oxide inhalation analgesia. The hygienist can only provide services as specified in the written supervision agreement and under the protocols specified in the agreement.

Public health settings defined

For the purposes of this rule, public health settings are limited to schools; Head Start programs; federally qualified health centers; public health dental vans; free clinics; nonprofit community health centers; nursing facilities; and federal, state, or local public health programs.