Registered Dental Hygienists (RDH), Public Health Dental Hygienist (PHDH), Expanded Function Dental Assistant (EFDA), Certified Assistant (CA), Formally-trained Dental Assistant (FTDA), and Dental Assistant Trained on the Job (OJT) and may perform the following dental procedures pursuant to the designated level of supervision or direction: General Supervision (G), Written Collaborative Agreement (WCA), Direct Supervision (D), Immediate Supervision (I) or Delegation Not Allowed (N/A).

DELEGATED DUTY RDH PHDH EFDA CA FTDA OJT

1. (1) Review medical and dental history and consult when G W CA G G G G

   necessary with medical practitioner

2. (2) Perform preliminary evaluation to determine needed G W CA N/A N/A N/A N/A

   dental hygiene services

3. (3) Make referrals to dentists, physicians, and other G W CA N/A N/A N/A N/A

   practitioners in consultation with a dentist

4. (4) Provide oral health instruction G W CA G G G D

5. (5) Perform dietary screening for dental disease G W CA G G G N/A

   prevention and control

6. (6) Conduct dental screenings G W CA N/A N/A N/A N/A
7. (7) Record dental screenings G W CA D D D D
8. (8) Expose radiographs G W CA G G G G

9. (9) Evaluate radiographs for provision of dental hygiene G W CA N/A N/A N/A N/A

   services

   DELEGATED DUTY RDH PHDH EFDA CA FTDA OJT

10. (10) Take intra-oral photographs G W CA G G G G

11. (11) Perform and record charting of the oral cavity and G W CA N/A N/A N/A N/A

    surrounding structures, including but not limited to, existing dental restorations, lesions and periodontal probing depths

12. (12) Record charting of the oral cavity and surrounding G W CA D D D D

    structures, including but not limited to, dental restorations, lesions and periodontal probing depths

13. (13) Take and record vital signs G W CA G G G G

14. (14) Perform minor emergency denture adjustments to G W CA N/A N/A N/A N/A

    eliminate pain and discomfort in nursing homes and other residential or long term care facilities

15. (15) Perform pulp testing D N/A N/A N/A N/A N/A

16. (16) Apply anti-cariogenic agents, including fluoride G W CA G G G D

    varnish

17. (17) Apply topical anesthetic agents G W CA G G G D
18. (18) Apply and adjust dental sealants G W CA G D D N/A

19. (19) Take impressions for study casts, bite registrations, G W CA G G G I

    including for identification purposes, night guards, and custom fluoride and bleaching trays pursuant to a dentist’s prescription or order

20. (20) Take impressions for athletic mouth guards G W CA G G G I
21. (21) Retract lips, cheek, tongue and other oral tissue parts G W CA G G G G
22. (22) Irrigate and aspirate the oral cavity G W CA G G G G

23. (23) Re-cement and adjust intact temporary restorations G W CA G G G N/A

    intra-orally

24. (24) Place temporary restorations (not including G W CA G G G I

    temporization of inlays, on-lays, crowns, and bridges) to provide palliative treatment

25. (25) Assist or monitor nitrous oxide analgesia I I I I I I
26. (26) Place and remove gingival retraction materials D D D D D D
27. (27) Apply cavity varnish, liner(s) and bonding agents I I I I I I
28. (28) Apply desensitizing agents G W CA G D D D

29. (29) Place restorative materials in tooth for condensation I I I I I I

    and finishing by the dentist

30. (30) Remove temporary restorations with hand instruments G W CA G I I N/A
31. (31) Place and remove wedges G W CA G D D I
32. (32) Place and remove matrix bands G W CA G D D I
33. (33) Place and remove dental dams G W CA G G G D
34. (34) Place and remove periodontal dressings G W CA G G G N/A
35. (35) Remove sutures G W CA G G G D

36. (36) Removal of implant healing caps/cover screws for I I I I I I

    restorative procedures

37. (37) Dry root canals with paper points I I I N/A N/A N/A

38. (38) Place cotton pellets and temporary restorative G WCA G D D D

    materials into endodontic openings

39. (39) Remove excess cement and bonding agents G WCA G D D I

    from bridges and appliances with hand instruments

40. (40) Cement and remove temporary crowns and bridges G W CA G G G I

41. (41) Insert and/or perform minor adjustment of night G W CA G G G I

    mouth guards, athletic mouth guards, and custom fluoride trays

42. (42) Select and adapt stainless steel crowns or other pre­ I I I I I I

    formed crown for insertion by dentist

43. (43) Perform sub-gingival and supra-gingival scaling G W CA N/A N/A N/A N/A

    DELEGATED DUTY RDH PHDH EFDA CA FTDA OJT

44. (44) Polish teeth, after dentist or dental hygienist has G W CA G G G N/A

    determined that teeth are free of calculus, with slow speed hand piece

45. (45) Administer local anesthesia pursuant to 234 CM R D D N/A N/A N/A N/A

    6.00

46. (46) Perform gross debridement and/ or scaling and root G W CA N/A N/A N/A N/A

    planing

47. (47) Prepare and perform oral cytological smears or studies D N/A N/A N/A N/A N/A
48. (48) Use diagnostic and periodontic non-cutting lasers D N/A N/A N/A N/A N/A

49. (49) Preliminarily fit crowns to check contacts, adjust G W CA D D N/A N/A

    occlusion on crowns inside the mouth

50. (50) Place temporary soft liners in a removal prosthesis G W CA D D I N/A
51. (51) Obtain endodontic cultures D N/A D D I N/A

52. (52) Apply bleaching agents and activate with non-laser G W CA D D D I

    non-curing device

53. (53) Fabricate provisional restorations intraorally G W CA G D D I
54. (54) Place and condense amalgam restorations D N/A D N/A N/A N/A
55. (55) Carve, contour, adjust amalgam restorations D N/A D N/A N/A N/A
56. (56) Place and finish composite restorations D N/A D N/A N/A N/A

57. (57) Adjust dentures on the tissue side to eliminate tissue G W CA G N/A N/A N/A

    irritation

58. (58) Place temporary sedative restorations/fillings G W CA G I N/A N/A
59. (59) Place Stainless Steel Crowns D D D I I N/A
60. (60) Take impressions for orthodontic retainers G W CA G G G D
61. (61) Preliminary intra-oral fit of bands G W CA G G G D
62. (62) Preliminary oral fit of arch wire G W CA G G G D
63. (63) Select size of headgear G W CA G G G D
64. (64) Place and remove orthodontic separators G W CA G G G D
65. (65) Place and remove orthodontic arch wires G W CA G G G D

66. (66) Etch appropriate enamel surfaces before bonding of G W CA G G G D

    orthodontic appliances by a dentist

67. (67) Place elastics and ligature wires G W CA G G G D
68. (68) Remove fixed orthodontic appliances G W CA G G G D

69. (69) Remove excess cement and bonding agents from G W CA G G G D

    orthodontic appliances with hand instruments

70. (70) Perform minor emergency palliative orthodontic G W CA G G G I

    adjustments to eliminate pain and discomfort

71. (71) Perform any other procedure approved by the Board