Scope of practice for dental therapists and advanced dental therapists
All dental therapists, regardless of whether they have earned “advanced dental therapist” status, must practice in conjunction with a dentist licensed in Minnesota. There are varying levels of supervision. The levels are as follows, as taken directly from Minnesota Rule 3100.0100:
Subp. 21. Supervision. “Supervision” means one of the following levels of supervision, in descending order of restriction.
- “Personal supervision” means the dentist is personally operating on a patient and authorizes the allied dental personnel to aid in treatment by concurrently performing supportive procedures.
- “Direct supervision” means the dentist is in the dental office, personally diagnoses the condition to be treated, personally authorizes the procedure, and before dismissal of the patient, evaluates the performance of the allied dental personnel.
- “Indirect supervision” means the dentist is in the office, authorizes the procedures, and remains in the office while the procedures are being performed by the allied dental personnel.
- “General supervision” means the supervision of tasks or procedures that do not require the presence of the dentist in the office or on the premises at the time the tasks or procedures are being performed but require the tasks be performed with the prior knowledge and consent of the dentist.
This Board of Dentistry chart shows that many of the duties that a dentist may legally delegate to a dental therapist are under the general supervision of the dentist with whom the therapist has a collaborative management agreement. These duties are either preventive or data collection in nature or do not require cutting of hard tissue.
All of the remaining duties may be delegated by a dentist to a dental therapist under indirect supervision; that is, the dentist is present in the office or clinic, has authorized the procedure and remains on the premises while the procedure is being performed. (Unlike direct supervision, with indirect supervision, the dentist need not check the procedure upon completion.)
Scope of Practice
While the advanced dental therapist is able to practice in the absence of a dentist, he or she must have a collaborative management agreement with a Minnesota licensed dentist to call upon whenever needed. Most importantly, the collaborative agreement states only those procedures that the dentist feels confident that the advanced dental therapist can perform safely and fall within the scope of practice.
Not all dentists feel comfortable at the outset delegating certain procedures that historically have been the sole domain of the dentist, such as using a bur to prepare a tooth for a restoration or extracting a mobile permanent tooth. Dentists who employ a properly licensed and credentialed dental therapist and who have entered a collaborative management agreement with that therapist may choose not to delegate a particular function. However several dentists who have employed dental therapists/advanced dental therapists report that they are comfortable delegating anything that was legally allowable. In some instances, they said they wished the scope of practice was even broader.
Dental therapists who are also licensed as dental hygienists may perform duties of both therapists and hygienists if both licenses are current. But, some confusion exists around the fact that a dental therapist may perform a limited number of hygiene duties but not the entire list. Therefore, it is imperative to pay close attention to the list of functions/delegated duties provided on the Minnesota Board of Dentistry website.
General Supervision (i.e. dentist may or may not be present)
- Oral health instruction and disease prevention education, including nutritional counseling and dary analysis
- Preliminary charting of the oral cavity
- Making radiographs
- Mechanical polishing;
- Application of topical preventive or prophylactic agents, including fluoride varnishes and pit and fure sealants
- Pulp vitality testing
- Application of desensitizing medication or resin
- Fabrication of athletic mouthguards
- Placement of temporary restorations
- Fabrication of soft occlusal guards
- Tissue conditioning and soft reline
- Atraumatic restorative therapy;
- Dressing changes
- Tooth reimplantation
- Administration of local anesthetic
- Administration of nitrous oxide
Indirect Supervision (i.e. dentist onsite)
- Emergency palliative treatment of dental pain
- The placement and removal of space maintainers
- Cavity preparation
- Restoration of primary and permanent teeth
- Placement of temporary crowns
- Preparation and placement of preformed crowns
- Pulpotemies on primary teeth
- Indirect and direct pulp capping on primary and permanent teeth
- Stabilization of reimplanted teeth
- Extractions of primary teeth
- Suture removal
- Brush biopsies
- Repair of defective prosthetic devices
- Recementing of permanent crowns