4.2 Dental Hygienist Scope, Places of Practice & the Two-Year Prescription

Dental Hygienist Scope of Practice — s. 466.023, F.S.

The exclusive tasks — s. 466.023(1)

"Except as otherwise provided in s. 466.024, only dental hygienists may be delegated the task of removing calculus deposits, accretions, and stains from exposed surfaces of the teeth and from the gingival sulcus and the task of performing root planing and curettage."

This is a delegation monopoly, not a grant of independence. The tasks may still be delegated only by a dentist and only at the supervision level the Board sets by rule. But no dental assistant may perform them, at any supervision level, with any amount of training. Section 466.024(6) reinforces the point from the other direction: a dentist may delegate gingival curettage and root planing to a dental hygienist but not to a dental assistant.

The same subsection confirms that hygienists may expose dental X-ray films, apply topical preventive or prophylactic agents, and perform all tasks delegable by the dentist under s. 466.024. The Board "by rule shall determine whether such functions shall be performed under the direct, indirect, or general supervision of the dentist" — which is the delegating authority for Rule 64B5-16.006.

Where hygienists may perform their duties — s. 466.023(2)

The prescription route — s. 466.023(2)(d)

A hygienist may serve a patient of record of a dentist who has issued a prescription for the services of a dental hygienist. The prescription "shall be valid for 2 years unless a shorter length of time is designated by the dentist." The permitted locations are:

1. Licensed public and private health facilities;
2. Other public institutions of the state and Federal Government;
3. Public and private educational institutions;
4. The home of a nonambulatory patient; and
5. Other places in accordance with the rules of the board.

Two qualifiers control this route:

• "The dentist issuing such prescription shall remain responsible for the care of such patient." The prescription does not transfer clinical responsibility.
• "Patient of record" is defined in the same subsection and the definition is exacting: "a patient upon whom a dentist has taken a complete medical history, completed a clinical examination, recorded any pathological conditions, and prepared a treatment plan." All four elements. A patient who has merely been screened is not a patient of record.

Rule 64B5-9.010, F.A.C., "Prescriptions for the Services of a Dental Hygienist," carries the form and content requirements for these prescriptions. Note again that Rule Chapter 64B5-9 is Prescriptions for Dental Hygiene Services and Certification of Dental Radiographers — it has nothing to do with infection control.

Without supervision — s. 466.023(3)

Hygienists may, without supervision:

• Provide educational programs, faculty or staff training programs, and authorised fluoride rinse programs;
• Apply fluorides;
• Instruct a patient in oral hygiene care;
• Supervise the oral hygiene care of a patient; and
• Perform other services that do not involve diagnosis or treatment of dental conditions and that are approved by rule of the Board.

Read the list precisely. Prophylaxis is not on it. Neither are sealants. Unsupervised prophylaxis and sealants exist in Florida only through the separate health access setting provision in s. 466.024(2), on the conditions set out in Chapter 5 of this guide. In an ordinary dental office, prophylaxis is a general supervision task under Rule 64B5-16.006(7)(a) — which still requires a dentist's authorization and a clinical examination within the preceding 24 months.

Dental charting without supervision — s. 466.023(5)

Hygienists may, without supervision, perform dental charting as provided in s. 466.0235 — covered in section 4.5.

Supervision ratios — s. 466.023(4)

The Board may by rule limit the number of hygienists or assistants a dentist supervises if they perform expanded duties requiring direct or indirect supervision. The stated purpose is to protect patients and ensure that procedures requiring more than general supervision are adequately supervised.

One express carve-out: the Department of Children and Families, Department of Health, Department of Juvenile Justice, and Board-approved public institutions may not be limited in the number of hygienists or assistants working under a licensed dentist's supervision.

One express limit currently in the rules: under Rule 64B5-16.0051(1)(b), a dentist delegating remediable restorative functions may not supervise more than four (4) dental hygienists or dental assistants in combination simultaneously performing those tasks.

Two provisions that are easy to miss

• Section 466.023(6): dental hygienists are exempt from the provisions of part IV of chapter 468 — the statute regulating basic X-ray machine operators and radiologic technologists. A hygienist's authority to expose radiographs comes from Chapter 466, not from a separate radiologic technology credential.
• Section 466.023(7): "A dental hygienist may administer local anesthesia as provided in ss. 466.017 and 466.024." The authority exists in Florida but is heavily conditioned — see section 6.5.

Prohibited to hygienists

Section 466.024(8) is the controlling prohibition, and it is stated as a limit on the dentist: a dentist may not delegate to anyone other than another licensed dentist (a) any prescription of drugs or medications requiring the written order or prescription of a licensed dentist or physician, or (b) any diagnosis for treatment or treatment planning. Those two are the absolute floor, and s. 466.024(9) makes the dentist primarily responsible for all procedures delegated by her or him.