The role of a Registered Dental Hygienist (RDH) is centered on preventive oral health, focusing on maintaining the health of teeth and gums. This licensed professional operates within a defined scope of practice emphasizing therapeutic and educational services. Whether a dental hygienist performs fillings is a common question, and the answer requires understanding the state-by-state variations in dental practice law. While traditional functions are distinct from permanent restorative work, legislative changes in many states have created new roles with expanded responsibilities.
Primary Scope of Practice for Dental Hygienists
A dental hygienist’s foundational duties are primarily non-restorative, focusing on the health of periodontal tissues. The most widely recognized service is prophylaxis, which involves removing plaque, calculus, and stains from tooth surfaces. Hygienists also perform scaling and root planing, which are deeper cleaning procedures designed to treat periodontal disease by removing irritants from below the gumline.
Beyond clinical cleaning, the hygienist’s job involves patient education, teaching proper brushing and flossing techniques, and counseling on nutrition. They also play a diagnostic support role by performing dental charting, conducting preliminary oral health assessments, and taking dental radiographs (X-rays). In many states, hygienists are authorized to administer local anesthesia during therapeutic procedures, a specialized skill requiring a separate state-level permit.
Who Performs Permanent Restorative Procedures?
Responsibility for permanent restorative procedures, such as placing a traditional filling, rests with a licensed dentist (DDS or DMD). The dentist is legally and clinically responsible for diagnosing decay, preparing the tooth by removing the carious material, and placing the final restorative material. Restorative dentistry focuses on repairing damaged or missing tooth structure to restore function and health.
Dental Assistants often work alongside the dentist, but their role is typically limited to preparing materials, suctioning the area, and assisting with instrumentation. Assistants do not independently perform the clinical steps of removing decay or placing the final restoration.
Expanded Functions and State Variability
The ability of a dental auxiliary, including a dental hygienist, to place a permanent filling depends on the regulations of their licensing state. State dental boards determine the scope of practice, leading to significant variations across the country. Many states have established an advanced role known as an Expanded Function Dental Auxiliary (EFDA) or Registered Dental Assistant with Expanded Functions (RDAEF).
In these expanded roles, auxiliaries may be legally authorized to perform duties beyond the scope of a standard hygienist or assistant. The most relevant function is the ability to place and shape direct restorations—placing and contouring the filling material after the dentist has prepared the tooth structure. States like Washington and Minnesota allow for this high-level function, but it requires a distinct certification separate from the original dental hygiene license.
Procedures Often Mistaken for Fillings
Dental hygienists routinely perform procedures that involve placing material onto or into a tooth. The most common is the application of dental sealants, which are thin, plastic coatings painted onto the chewing surfaces of the back teeth. Sealants flow into the pits and fissures to create a barrier against bacteria and food debris, serving as an entirely preventative measure, not a restorative one.
Another procedure is the placement of Interim Therapeutic Restorations (ITR), which are temporary restorations using a glass ionomer or similar material. ITRs are provisional and stabilize a tooth by sealing off a cavity until the patient can receive a definitive, permanent restoration from a dentist. Their purpose is therapeutic and temporary, not a final, long-term repair.
Licensing and Training for Expanded Roles
Transitioning from a standard Registered Dental Hygienist to an Expanded Function role requires a substantial commitment to advanced, post-licensure education and certification. This process is distinct from the initial hygiene degree and is mandatory for performing restorative work. Candidates must complete a board-approved EFDA course, which involves clinical and didactic instruction hours focused exclusively on restorative functions.
Hands-on Training
The training includes hands-on practice in placing and carving both amalgam and composite restorative materials. This ensures the auxiliary can shape the material correctly and achieve proper function.
Certification and Authorization
Following the coursework, candidates must pass a state-specific board examination. This often includes a written component, such as the Dental Assisting National Board (DANB) Restorative Exam, and a clinical component to demonstrate proficiency. This additional training grants the legal authorization to perform expanded restorative functions under the supervision of a dentist.