PURPOSE: This rule specifies the level of supervision for and the procedures that a dentist may and may not delegate to a hygienist.

1. (1) A hygienist may be employed by any person or entity so long as the hygienist is working under the supervision of a dentist as set forth in section 332.311, RSMo, and does not engage in the practice of dentistry as set forth in section 332.071, RSMo.
2. (2) The dentist is responsible for patient care. Nothing contained in the authority given the dentist by this rule to delegate the performance of certain procedures shall relieve the dentist from responsibility to the patient.

3. (3) A hygienist may perform the following procedures under general supervision:

   1. (A) Scaling and polishing teeth (prophylaxis);
   2. (B) Applying dental sealants;
   3. (C) Periodontal root planing, debridement, and curettage;
   4. (D) Nonsurgical periodontal procedures;
   5. (E) All procedures delegable to a dental assistant or certified dental assistant, except the expanded functions in section (5) of this rule.

4. (4) A hygienist may perform the following procedures under indirect supervision:

   1. (A) Administering nitrous oxide analgesia, as outlined in section (8) of this rule;
   2. (B) Administering local anesthesia, as outlined in sections (9) and (10) of this rule; 20 CSR 2110-2
   3. (C) Procedures deemed appropriate by a dentist as outlined in section 332.091, RSMo; and
   4. (D) All procedures allowed under general supervision as outlined in section (3) of this rule.

5. (5) A hygienist may perform the following procedures under direct supervision:

   1. (A) All procedures allowed under general supervision and indirect supervision as outlined in sections (3) and (4) of this rule; and
   2. (B) Expanded functions in 20 CSR 2110- 2.120 with proof of competency, with the exception of periodontal procedures as outlined in section (3) of this rule, made available to the board upon request. Neither a Missouri basic skills test nor certification in dental assisting is required for a dental hygienist to take expanded functions courses.

6. (6) A hygienist may not perform procedures considered the practice of dentistry as set forth in section 332.071, RSMo including, but not limited to, the following:

   1. (A) Diagnosis, including the interpretation of dental radiographs and treatment planning;
   2. (B) Cutting of tooth structure;
   3. (C) Surgical procedures on hard and soft tissues including, but not limited to, the removal of teeth and the cutting and suturing of soft tissues;
   4. (D) Prescription, injection, and parenteral administration of drugs, with the exception of the administration of nitrous oxide analgesia or local anesthesia as outlined in sections (8), (9), and (10) of this rule; and
   5. (E) Final bending of an archwire prior to ligation.
7. (7) A hygienist may provide oral hygiene instructions, conduct oral screenings, and apply fluoride without a dentist being present. The hygienist shall refer the individual screened to a dentist for diagnosis.

8. (8) A hygienist may administer nitrous oxide analgesia if s/he:

   1. (A) Obtains proof of competency in a nitrous oxide analgesia course; and

   2. (B) Obtains a nitrous oxide analgesia permit, issued by the board, upon submitting the following:

      1. 1. A completed application form provid-

ed by the board; and

1. 2. A nonrefundable fee, payable to the

Missouri Dental Board; and

1. 3. A copy of proof of competency.

1. (9) A hygienist may administer local anesthesia, which includes infiltration and block anesthesia, if s/he: FINANCIAL INSTITUTIONS AND PROFESSIONAL REGISTRATION

   1. (A) Obtains proof of competency in a local anesthesia course or holds a Missouri Dental Board infiltration anesthesia permit issued prior to the effective date of this rule and obtains proof of competency in a local anesthesia course which includes block anesthesia; and

   2. (B) Receives a local anesthesia permit, issued by the board, upon submitting the following:

      1. 1. A completed application form provid-

ed by the board; and

1. 2. A nonrefundable fee, payable to the

Missouri Dental Board; and

1. 3. A copy of proof of competency.

1. (10) A hygienist may administer only infiltration anesthesia if s/he currently holds a Missouri Dental Board infiltration anesthesia permit issued prior to the effective date of this rule.
2. (11) For purposes of this rule, proof of competency means documentation verifying completion of didactic and clinical training and passage of competency testing of that training from a dental, dental hygiene, or dental assisting school accredited by the Commission on Dental Accreditation of the American Dental Association or a board-approved sponsor as defined in 20 CSR 2110-2.240.
3. (12) The provisions of this rule are declared severable. If a court of competent jurisdiction holds any provision of this rule invalid, the remaining provisions of this rule shall remain in full force and effect, unless otherwise determined by a court of competent jurisdiction.

AUTHORITY: sections 332.031 and 332.091, RSMo 2000 and sections 332.071 and 332.311, RSMo Supp. 2008.* This rule originally filed as 4 CSR 110-2.130. Original rule filed Dec. 12, 1975, effective Jan. 12, 1976. Amended: Filed March 8, 1978, effective June 11, 1978. Rescinded and readopted: Filed April 14, 1982, effective Oct. 11, 1982. Rescinded and readopted: Filed Oct. 13, 1983, effective Jan. 13, 1984. Amended: Filed April 16, 1985, effective Aug. 26, 1985. Amended: Filed May 2, 1988, effective July 28, 1988. Amended: Filed May 4, 1992, effective Sept. 6, 1992. Rescinded and readopted: Filed Jan. 28, 2000, effective Aug. 30, 2000. Amended: Filed May 3, 2004, effective Nov. 30, 2004. Moved to 20 CSR 2110-2.130, effective Aug. 28, 2006. Amended: Filed Aug. 30, 2007, effective Feb. 29, 2008. Amended: Filed Dec. 12, 2008, effective June 30, 2009. *Original authority: 332.031, RSMo 1969, amended 1981, 1993, 1995; 332.071, RSMo 1969, amended 1976, 1995, 2003, 2004, 2006; 332.091, RSMo 1969, amended 1995; and 332.311, RSMo 1969, amended 1997, 2001, 2006.