• no curettage
• RDH can use laser, can’t initiate tip, need appropriate training to use lasers.
• Email “The general rule on delegation is found at 3 V.S.A. § 129a(a)(6), which prohibits “delegating professional responsibilities to a person whom the licensed professional knows, or has reason to know, is not qualified by training, experience, education, or licensing credentials to perform them, or knowingly providing professional supervision or serving as a preceptor to a person who has not been licensed or registered as required by the laws of that person’s profession.”
• “A dental hygienist may perform duties for which the dental hygienist has been qualified by successful completion of the normal curriculum offered by programs of dental hygiene accredited by the American Dental Association or in continuing education courses approved by the Board. A dental hygienist may perform tasks in the office of any licensed dentist consistent with the rules adopted by the Board.”  26 V.S.A. § 624(a).
• Board rule 1.11, captioned “Permitted Practices” distinguishes functions exclusive to dentists from those delegable to hygienists.

(a)      Dentists: The following tasks may be performed by licensed dentists only:

(1) Practices permitted by Chapter 13 of Title 26 including diagnosis, treatment planning and prescription, including prescription for drugs and medicaments or authorization for restorative, prosthodontic or orthodontic appliances; or 

(2) Surgical procedures on hard and soft tissues within or ancillary to them related to the treatment of the maxillofacial complex and any other intraoral procedure that contributes to and results in an irreversible alteration to the oral anatomy. 

(3) Dentists are responsible for general supervision of dental hygienists and “direct supervision” of dental hygienists where specifically required elsewhere in these rules. 

(4) Dentists are responsible for the direct supervision of dental assistants

(b)      Clarifications, Limitations on Scope of Practice, Dentists or Dental Hygienists:

Oral prophylaxis, oral debridement, periodontal descriptions and charting, including periodontal probing and placement of subgingival chemotherapeutic agents shall be performed only by a licensed dentist or dental hygienist.

Consequently, the permissibility of delegating laser use to a hygienist is determined by the hygienist’s particular training, experience, and education related to use of the laser.  And purpose matters.  Following Rule 1.11, laser procedures that permanently alter the oral anatomy would not be delegable.  A laser that potentiates a bleaching agent could fall on the permissible side of the distinction, while a laser used for cautery almost certainly would fall on the impermissible side of the distinction. 

I hope this offers some guidance on the limits of delegation.  Because lasers have so many distinct applications, it is not possible to articulate a blanket rule on lasers as such.  If you have a more specific laser procedure in mind, I would be happy to bring it to the Board for discussion.

• State: “(Cite as: 26 V.S.A. § 624) 624. Practice
  • (a) A dental hygienist may perform duties for which the dental hygienist has been qualified by successful completion of the normal curriculum offered by programs of dental hygiene accredited by the American Dental Association or in continuing education courses approved by the Board. A dental hygienist may perform tasks in the office of any licensed dentist consistent with the rules adopted by the Board.”