Dental Hygienists

PURPOSE: This rule specifies the level of supervision for and the procedures that a dentist may and may not delegate to a hygienist. (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) 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) A hygienist may perform the following procedures under general supervision: (A) Scaling and polishing teeth (prophylaxis); (B) Applying dental sealants; (C) Periodontal root planing, debridement, and curettage; (D) Nonsurgical periodontal procedures; (E) Administering local anesthesia, as outlined in sections (9), (10), and (11) of this rule; (F) Expanded functions in 20 CSR 2110-2.120 after receiving a permit to perform expanded functions duties issued by the Missouri Dental Board. The supervising dentist must diagnose, using techniques and/or equipment to render an appropriate diagnosis and treatment plan for the care being delegated to the hygienist. The supervising dentist must document the authorization for the treatment in the patient’s record prior to the start of treatment. Neither a Missouri basic skills test nor certification in dental assisting is required for a dental hygienist to take expanded functions courses. The board shall issue the appropriate expanded functions permit upon receipt of a completed application form, payment of the appropriate fee specified in 20 CSR 2110-2.170, and proof that the dental hygienist has completed a board-approved expanded functions training course. The requirements of this section must be completed within one (1) year of the date of submission of the application form. The board-issued expanded functions permit must be displayed in plain view in any facility where the dental hygienist will be providing expanded functions prior to delegation of expanded functions to that dental hygienist. Dental hygienists shall renew expanded functions permits in accordance with the requirements in 20 CSR 2110-2.120. A licensed dental hygienist may use continuing education hours obtained for license renewal to renew an expanded functions permit; and (G) All procedures delegable to a dental assistant or certified dental assistant. (4) A hygienist may perform the following procedures under indirect supervision: (A) Administering nitrous oxide analgesia, as outlined in section (8) of this rule; (B) Procedures deemed appropriate by a dentist as outlined in section 332.091, RSMo; and (C) All procedures allowed under general supervision as out lined in section (3) of this rule. (5) A hygienist may perform the following procedures under direct supervision: (A) All procedures allowed under general supervision and indirect supervision as outlined in sections (3) and (4) of this rule. (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: (A) Diagnosis, including the interpretation of dental radio graphs and treatment planning; (B) Cutting of tooth structure; (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; (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 (E) Final bending of an archwire prior to ligation. (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) A hygienist may administer nitrous oxide analgesia if s/he— (A) Obtains proof of competency in a nitrous oxide analgesia course; and (B) Obtains a nitrous oxide analgesia permit, issued by the board, upon submitting the following: 1. A completed application form provided by the board; and 2. A nonrefundable fee, payable to the Missouri Dental Board; and 3. A copy of proof of competency. (9) A hygienist may administer local anesthesia, which includes infiltration and block anesthesia, if s/he— (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 (B) Receives a local anesthesia permit, issued by the board, upon submitting the following: 1. A completed application form provided by the board; and 2. A nonrefundable fee, payable to the Missouri Dental Board; and 3. A copy of proof of competency. (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. (11) A hygienist may administer local anesthesia under general supervision to a patient of record of the supervising dentist. A written authorization shall be included in the patient’s record prior to the administration of local anesthesia under general supervision. The supervising dentist shall document the applicable American Society of Anesthesiologists (ASA) classification in the patient record. ASA class III patients may be administered local anesthesia under general supervision after a consultation with the applicable physician of record. ASA class IV and V patients are not candidates for local anesthesia under general supervision. Patients being administered local anesthesia under general supervision must have been examined by the supervising dentist within the previous twelve (12) months. If the patient’s medical history has changed since the last examination by the supervising dentist, the hygienist must consult with the dentist before administering local anesthetics. The supervising dentist shall be responsible for the care provided by the hygienist and shall ensure that the office is equipped with appropriate emergency equipment and that the staff are properly trained and competent to address emergency situations that may arise as a result of the administration of local anesthesia under general supervision. (12) 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 other training courses approved by the Missouri Dental Board. (13) The provisions of this rule are declared severable. If a court of competent jurisdiction holds any provision of this rule in valid, 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, 332.071, 332.091, 332.098, and 332.311, RSMo 2016.* 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 re adopted: 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, effec tive 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. Amended: Filed July 26, 2012, effective Feb. 28, 2013. Amended: Filed March 25, 2024, effective Nov. 30, 2024. Amended: Filed Feb. 4, 2026, effective Sept. 30, 2026. *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; 332.098, RSMo 2010; and 332.311, RSMo 1969, amended 1997, 2001, 2006.