The question of whether a dental hygienist can perform fillings is complex, as the answer depends on the specific state or jurisdiction where the hygienist practices. Dental hygiene focuses on preventing and treating oral diseases. While core duties are established, many regulatory bodies are expanding professional duties. This variability means the ability to perform restorative procedures, often called fillings, is a function of state-level policy, not a universal right. The evolving role of the dental hygienist highlights an effort to improve public oral health outcomes.
The Core Responsibilities of a Dental Hygienist
The traditional duties of a dental hygienist center on oral health promotion and the non-surgical treatment of periodontal disease. These professionals provide clinical preventive care, which involves removing hard and soft deposits from tooth surfaces above and below the gumline through procedures like scaling and root planing. They conduct patient assessments, including reviewing medical histories and screening for oral cancer and periodontal breakdown.
Hygienists also educate patients on proper oral hygiene, dietary habits, and the connection between oral and systemic health. Preventative services routinely provided include applying topical fluoride and placing pit and fissure sealants to protect vulnerable tooth surfaces from decay. The hygienist often acts as the first line of defense, identifying early signs of disease and coordinating with the dentist for definitive diagnosis and treatment planning.
State-Specific Scope of Practice for Restorative Procedures
Dental hygiene practice is regulated independently by each state’s dental board, leading to wide variations in permitted procedures. This regulatory environment explains why the scope of practice for restorative care is inconsistent across the country. A growing number of states are shifting policy to allow dental hygienists to perform some restorative functions, often under the designation of an Expanded Functions Dental Hygienist (EFDH) or a similar title.
Although most states limit hygienists to supportive services, many authorize them to perform minor restorative tasks. These expanded duties often focus on placing and finishing restorative materials after a dentist has completed the tooth preparation. The required dentist supervision also varies considerably, ranging from the dentist needing to be physically present (direct supervision) to allowing practice under a collaborative agreement (direct access).
Procedures Allowed Under Expanded Functions
Expanded functions for dental hygienists involve technical procedures that move beyond traditional preventive care into restoration. These procedures are typically limited to non-complex, reversible actions that aid in the final restoration of a tooth. The specific allowance for each procedure depends on the authorizing state’s regulations and the hygienist’s additional certification.
Placing Temporary Restorations
Many jurisdictions permit dental hygienists to place temporary or interim restorations, which are not intended as permanent solutions. This often involves placing materials like glass ionomer cement into a cavity, frequently as part of an Interim Therapeutic Restoration (ITR). The purpose of this action is to halt the progression of decay and protect the tooth structure until the patient can receive definitive care from a dentist. Hygienists must inform the patient that the material is temporary and that a follow-up appointment for a permanent filling is necessary.
Placing Permanent Restorative Materials
In some states, a certified Expanded Functions Dental Hygienist may be authorized to place and finish permanent restorative materials, such as amalgam or composite resin. This duty is generally limited to inserting the material into a cavity that the dentist has already prepared by removing the decay and shaping the tooth. The hygienist’s role includes condensing the material, carving the final anatomy, and polishing the restoration to ensure proper fit and function. This distinction is important, as the dentist is still responsible for the invasive preparation phase of the procedure.
Sealant Application and Preventive Resin Restorations
The application of pit and fissure sealants is a standard, non-restorative duty for dental hygienists, aimed at preventing decay in the deep grooves of chewing surfaces. A distinct, slightly more involved procedure is the Preventive Resin Restoration (PRR), used when minimal decay is present, often limited to the enamel. Placing a PRR may involve minimally invasive preparation using a small bur or air abrasion to remove a small amount of decay before placing the resin material. While PRRs are sometimes categorized with fillings, they are viewed as a conservative, prophylactic treatment that preserves tooth structure.
Preparing the Tooth Surface
The most significant limitation on a dental hygienist’s scope of practice concerning fillings is the preparation of the tooth surface. This involves using a dental drill to remove carious tissue and sound tooth structure to create the necessary retention for a restoration. This step is almost universally reserved for the dentist or a dental therapist. In rare cases, a hygienist may be permitted to remove decay using hand instruments or a slow-speed handpiece, typically only as part of an ITR. However, the comprehensive preparation of a tooth for a permanent filling remains outside the typical hygienist’s scope.
Required Training and Certification
For a dental hygienist to legally perform expanded functions, the state requires specialized post-licensure education and certification beyond their initial degree. This training ensures clinical competency in the technical skills associated with restorative procedures. Requirements often mandate completing specific continuing education courses approved by the state dental board or an accredited dental program.
These programs typically involve both didactic instruction and a rigorous clinical component, where the hygienist must demonstrate proficiency by performing a designated number of procedures under direct supervision. After completing the course, the hygienist must usually pass a clinical competency exam and apply for a specific endorsement from the state licensing board. This certification process creates a tiered system of practice.
Understanding the Role of the Dental Therapist
The role of a dental therapist (DT) is a mid-level provider model distinct from an Expanded Functions Dental Hygienist. Dental therapists are specifically trained and licensed to perform routine restorative procedures, including the invasive step of preparing the tooth for a filling. They are authorized to diagnose and manage common oral diseases, perform simple extractions of baby teeth, and place permanent fillings.
The educational pathway for a dental therapist is more extensive than the typical dental hygiene program, often involving an advanced degree focused on restorative care. This model was created explicitly to increase access to routine dental treatment, particularly in underserved communities. The DT’s ability to perform both the preparation and placement of fillings clearly separates their role from the hygienist, whose restorative duties are usually limited to placement after the dentist has prepared the site.
Impact on Dental Care Access
The expansion of the dental hygienist’s scope of practice and the introduction of dental therapists have significant implications for public health, particularly in addressing disparities in access to care. These mid-level providers can extend the reach of the dental team, enabling routine preventive and restorative services to be delivered in non-traditional settings like schools or public health clinics. States that have adopted broader scopes of practice often show a correlation with improved oral health outcomes for their populations.
By delegating certain routine restorative tasks, dentists can focus their time on more complex procedures and diagnoses. This shift improves the efficiency of the entire dental care system and makes it more feasible to provide care to individuals facing geographic or financial barriers. The creation of these specialized roles serves as a policy mechanism to deploy a skilled workforce where it is most needed to close the gap in oral health service availability.