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).
(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;
