4.3 Remediable Tasks Delegable to Dental Hygienists, by Supervision Level

What a Hygienist May Do, and Under What Supervision

Rule 64B5-16.006 is organised along two axes: the supervision level and the training required. Both matter. A task listed as requiring formal training may not be performed by a hygienist who has only on-the-job experience with it, regardless of the supervising dentist's willingness.

Historical note. Rule 64B5-16.007, "Levels of Supervision for Dental Hygienists," was repealed 12-9-18. Older review material that cites 64B5-16.007 for a hygiene supervision matrix is citing a rule that no longer exists; the operative matrix is Rule 64B5-16.006.

Direct supervision

By virtue of training and licensure, no additional training — Rule 64B5-16.006(1):

• Gingival curettage

With pre-licensure education or formal training — Rule 64B5-16.006(2):

• Fabricating temporary crowns or bridges intra-orally, with no adjustment of occlusion to the appliance or existing dentition
• Selecting and pre-sizing orthodontic bands — selection of proper size only, with no adapting, contouring, trimming, cementing, or other modification that would constitute fitting the band
• Selecting and pre-sizing archwires prescribed by the patient's dentist, so long as the dentist makes all final adjustments to bend, arch form and symmetry before final placement
• Selecting prescribed extra-oral appliances by pre-selection or pre-measurement, excluding final fit adjustment
• Preparing a tooth surface by applying conditioning agents for orthodontic appliances by conditioning or placing sealant materials — not including placing brackets
• Packing and removing retraction cord, so long as it contains no vasoactive chemicals and is used solely for restorative procedures
• Removing and re-cementing properly contoured and fitting loose bands not permanently attached to any appliance
• Inserting or removing dressings from alveolar sockets in post-operative osteitis where the patient is uncomfortable due to loss of a dressing in a diagnosed case
• Assisting the dentist in initiating nitrous-oxide inhalation analgesia for special needs or ASA Category IV patients, provided the patient has not been previously sedated and the hygienist complies fully with Rule 64B5-14.003(4)(b)

With on-the-job training — Rule 64B5-16.006(3):

• Changing bleach pellets in the internal bleaching of non-vital, endodontically treated teeth after placement of a rubber dam. The hygienist may not make the initial access preparation.

Local anesthesia — Rule 64B5-16.006(4): administered only by a Certified Registered Dental Hygienist (CRDH) under direct supervision, to a patient eighteen years of age or older who is not sedated, and limited to intraoral block and soft tissue infiltration anesthesia. Section 6.5 covers the certification.

Indirect supervision

No additional training — Rule 64B5-16.006(5):

• Removal of excess remaining bonding adhesive or cement following orthodontic appliance removal, with a slow-speed rotary instrument, hand instrument, or ultrasonic scaler

With pre-licensure education or formal training — Rule 64B5-16.006(6):

• Placing or removing rubber dams
• Placing or removing matrices
• Applying cavity liners, varnishes or bases
• Securing or unsecuring an archwire by attaching or removing the fastening device
• Marginating restorations with finishing burs, green stones and/or burlew wheels using slow-speed rotary instruments, not for the purpose of changing existing contours or occlusion
• Cementing temporary crowns and bridges with temporary cement
• Assisting the dentist in initiating nitrous-oxide inhalation analgesia for ASA Category I–III patients, in full compliance with Rule 64B5-14.003(4)(b)
• Using adjunctive oral cancer screening medical devices approved by the U.S. Food and Drug Administration

General supervision

No additional training — Rule 64B5-16.006(7):

• Removing calculus deposits, accretions and stains from exposed tooth surfaces and from tooth surfaces within the gingival sulcus (prophylaxis)
• Placing and exposing dental and carpal radiographic film and sensors
• Root planing

That third entry is the one candidates most often miss. Florida places root planing at general supervision for hygienists. Study material that puts root planing at indirect supervision is describing another jurisdiction. Note the contrast with gingival curettage, which sits at direct supervision — the two procedures are frequently paired in clinical discussion but are two supervision levels apart in Florida rule.

With pre-licensure education or formal training — Rule 64B5-16.006(8):

• Polishing restorations (burnishers, slow-speed handpieces, rubber cups, bristle brushes) and polishing clinical crowns (adding porte polishers and air-abrasive polishers), in each case not to change existing contour
• Applying topical fluorides approved by the ADA or FDA, including fluoride varnishes and silver diamine fluoride
• Removing excess cement from restorations and appliances with non-mechanical hand instruments or ultrasonic scalers only
• Placing and removing periodontal or surgical dressings
• Removing sutures
• Using appropriate implements to assess and chart suspected findings of the oral cavity
• Applying sealants
• Placing or removing prescribed pre-treatment separators
• Inserting and performing minor adjustments to sports mouth guards and custom fluoride trays
• Placing subgingival resorbable chlorhexidine, doxycycline hyclate, or minocycline hydrochloride
• Applying bleaching solution, activating the light source, monitoring and removing in-office bleaching materials
• Taking impressions for study casts not used to fabricate intra-oral appliances, restorations or orthodontic appliances; for opposing models, bleaching stents and palatal-coverage surgical stents, and home fluoride trays; for and delivery of at-home bleaching trays; and for passive appliances, occlusal guards, space maintainers and protective mouth guards

The subgingival antimicrobial entry deserves emphasis: placing localised resorbable antimicrobials is a general supervision task in Florida, not a direct supervision task.

With pre-licensure education or on-the-job training — Rule 64B5-16.006(9):

• Fabricating temporary crowns and bridges in a laboratory (extra-orally)
• Applying topical anesthetics and anti-inflammatory agents that are not applied by aerosol or jet spray

Quick reference