7.1 The Dentist's Scope of Practice and Procedures That Need Extra Credentials
Key Takeaways
California B&P § 1625 defines dentistry as the diagnosis or treatment of diseases, lesions, and malpositions of the teeth, alveolar process, gums, jaws, or associated structures.
Managing or owning a place where dental operations are performed counts as practicing dentistry under California B&P § 1625(e).
California dentists need an elective facial cosmetic surgery permit, which requires a CODA-accredited oral and maxillofacial surgery residency, for procedures such as rhinoplasty or facelifts (B&P § 1638.1).
California B&P § 1625.6 lets a dentist independently prescribe and give influenza and COVID-19 vaccines to people 3 and older after biennial immunization training.
Before first diagnosing or treating malocclusion with orthodontic appliances, a California dentist must examine the patient and review recent radiographs or equivalent bone imaging (B&P § 1680(ah)).
The statutory definition (K1071)
B&P § 1625 defines dentistry as "the diagnosis or treatment, by surgery or other method, of diseases and lesions and the correction of malpositions of the human teeth, alveolar process, gums, jaws, or associated structures," including related procedures and the use of drugs, anesthetic agents, and physical evaluation. A person practices dentistry if they do any of the following:
| § 1625 | Conduct that counts as practicing dentistry |
|---|---|
| (a) | Advertising or representing oneself as a dentist, including on a website or social media |
| (b) | Performing or offering an operation or diagnosis, or treating or correcting the teeth and associated structures |
| (c) | Indicating they will operate, or will construct, alter, repair, or sell a bridge, crown, denture, or orthodontic appliance |
| (d) | Examining with intent to perform or cause an operation |
| (e) | Managing or conducting, as manager, proprietor, lessor, or otherwise, a place where dental operations are performed |
Subdivision (e) is why an unlicensed investor who runs clinical operations violates the Act. § 1626 makes practicing without a license or special permit unlawful, with narrow exemptions:
- A physician practicing oral surgery.
- Dental and hygiene students in approved programs.
- Out-of-state dentists teaching in California dental colleges, or giving demonstrations with Board consent.
- Dental laboratories making prostheses from a licensed dentist's impressions with a written work authorization, or in the dentist's office under supervision.
- Wholesale dental supply sales.
- Federal military and public health service personnel on duty.
Scope has an ethical limit too. A license may technically allow a procedure, but the ADA Code, Section 2.B, requires referral when "the welfare of patients will be safeguarded or advanced" by someone with more skill (Chapter 11). B&P § 125.6(b)(2) confirms that a licensee is never required to perform a procedure they are not qualified to perform.
Procedures that need something more (K1072)
| Procedure | What is required | Source |
|---|---|---|
| Deep sedation or general anesthesia | General anesthesia permit, plus a pediatric endorsement for patients under 7 | B&P § 1646.1 (Section 7.2) |
| Moderate sedation | GA or moderate sedation permit, plus a pediatric endorsement for patients under 13 | B&P § 1647.2 |
| Pediatric minimal sedation (under 13) | GA permit, moderate sedation permit with pediatric endorsement, or pediatric minimal sedation permit | B&P § 1647.31 |
| Oral conscious sedation for patients 13 and older | GA or moderate sedation permit, or an adult oral conscious sedation certificate | B&P § 1647.19 |
| Elective facial cosmetic surgery | Elective facial cosmetic surgery permit | B&P § 1638.1 |
| Vaccines (influenza and COVID-19) | Biennial immunization training; primary-care and registry reporting | B&P § 1625.6; 16 CCR § 1066 |
| Operating dental X-ray equipment | Board-approved radiation safety course (or the pre-1985 Board exam) | B&P § 1656 |
| Oral and maxillofacial surgery by a physician without a California dental license | Oral and maxillofacial surgery permit from the Board | B&P § 1638 |
Elective facial cosmetic surgery
A dentist needs a permit to perform cosmetic contouring of the osteocartilaginous facial structure (such as rhinoplasty or otoplasty), cosmetic contouring or rejuvenation of the facial soft tissue (such as facelift, blepharoplasty, skin resurfacing, or lip augmentation), or both (§ 1638.1(b)). Applicants must have completed a CODA-accredited oral and maxillofacial surgery residency. They must also either be certified by the American Board of Oral and Maxillofacial Surgery (or be a candidate) with a program director's letter and at least 10 operative reports per category from the last five years, or hold hospital privileges for those procedures. Active hospital staff status is required.
Vaccines
§ 1625.6 lets a dentist independently prescribe and administer influenza and COVID-19 vaccines to persons 3 years or older. The Board's rule (16 CCR § 1066) requires:
- One hour of immunization training every two years from the CDC or a Board-approved provider, with certificates kept on site.
- Notice to the patient's primary care provider within 14 days, and to a pregnant patient's prenatal provider.
- Reporting to the California Immunization Registry (CAIR) within 14 days for influenza and 24 hours for COVID-19.
Failing to follow § 1066 is unprofessional conduct.
Orthodontics, including remote aligner models
AB 1519 added § 1680(ah) in 2020. Before the initial diagnosis and correction of malpositions or the initial use of orthodontic appliances, the treating dentist must perform an examination meeting the patient-of-record standard of § 1684.5(b), including a review of the patient's most recent radiographs or equivalent bone imaging. The dentist orders new imaging if appropriate. Failing to do so is unprofessional conduct. This targets direct-to-consumer aligner models that begin treatment from photos alone.
Equipment rules inside the general license
- Nitrous oxide needs no separate permit, but the machine must be fail-safe with an exhaust system (§ 1680(ab)).
- Irrigating an exposed pulp with water that is not sterile, or that lacks recognized disinfecting or antibacterial properties, is unprofessional conduct (§ 1680(ag)).
Worked example
A general dentist wants to add two services: in-office flu shots and lip filler for cosmetic enhancement.
- Flu shots: permitted after the immunization training, with reporting to CAIR and the primary care provider.
- Lip augmentation marketed as cosmetic: lip augmentation is on the § 1638.1 list of elective facial cosmetic soft-tissue procedures, so doing it for cosmetic purposes requires the elective facial cosmetic surgery permit, which requires oral and maxillofacial surgery residency training.
- Any new service: the dentist must be competent to provide it, advertise it truthfully as a general dentist (Section 3.1), and refer when the case exceeds their skill.
An unlicensed business owner hires dentists, sets clinical schedules, and directs which procedures each dentist performs at her clinic. Under B&P § 1625, what is she doing?
Nothing unlawful, as long as each dentist she hires holds a license
Operating a lawful dental laboratory
Acting under the exemption for wholesale dental supply sales
Practicing dentistry without a license, because managing or conducting a place where dental operations are performed is the practice of dentistry
Which requirement applies before a California dentist begins clear-aligner therapy for a new patient?
Only a video consultation and intraoral photographs
An examination meeting the patient-of-record standard, including review of the patient's most recent radiographs or equivalent bone imaging
An orthodontic specialty permit from the Dental Board
Written approval from the aligner manufacturer
A general dentist administers an influenza vaccine to a 10-year-old patient of record. What reporting does the Board's vaccine regulation require?
Notify the patient's primary care provider and report to the California Immunization Registry within 14 days
Report to the Dental Board within 7 days
No reporting, because dental offices are exempt from immunization registries
Report to CAIR within 24 hours, with no notice to the primary care provider
Sections you finish are checked off in the contents.