General - ANSThe dentist has prior knowledge and has given consent for the procedures being
performed during which the dentist is not required to be present in the dental office or on the
premises.
Indirect - ANSThe dentist is in the office, authorizes the procedures, and remains in the office
while the procedures are being performed by the allied dental personnel.
Direct - ANSThe dentist is in the dental office, personally diagnoses the condition to be treated,
personally authorizes the procedure, and before dismissal of the patient, evaluates the
performance of the allied dental personnel.
Personal - ANSThe dentist is personally operating on a patient and authorizes the allied dental
personnel to aid in treatment by concurrently performing supportive procedures.
DH General Supervision - ANSPerform preliminary charting of the oral cavity and surrounding
structures to include case histories,
perform initial and periodic examinations and assessments to determine periodontal status, and
formulate a dental hygiene treatment plan in coordination with a dentist's treatment plan.
LDA General Supervision - ANSComplete preliminary charting of the oral cavity and
surrounding structures with the exception of
periodontal probing and assessment of the periodontal structure.
DH/LDA General Supervision - ANSObtain informed consent within scope of practice.
DH/LDA General Supervision - ANSTake photographs extraorally or intraorally.
DH/LDA General Supervision - ANSTake vital signs such as pulse rate and blood pressure as
directed by a dentist.
DH General Supervision - ANSMake referrals to dentists, physicians, and other practitioners in
consultation with a dentist.
DH General Supervision - ANSComplete prophylaxis to include scaling, root planing, polishing
of restorations.
, DH General Supervision - ANSDietary analysis, salivary analysis and preparation of smears for
dental health purposes.
DH General Supervision - ANSReplacement, cementation, and adjustment of intact temporary
restorations extraorally or
intraorally.
DH/LDA General Supervision - ANSRecement intact temporary restorations.
DH/LDA General Supervision - ANSPlace temporary fillings (not including temporization of
inlays, onlays, crowns, and bridges).
DH/LDA General Supervision - ANSCut arch wires, remove loose bands, or remove loose
brackets on orthodontic appliances.
DH General Supervision
LDA Direct Supervision - ANSRemove excess bond material from orthodontic appliances.
DH/LDA Direct Supervision - ANSRemove bond material from teeth with rotary instruments after
removal of orthodontic appliances.
DH General Supervision
LDA Indirect Supervision - ANSEtch appropriate enamel surfaces, apply and adjust pit and
fissure sealants.
DH General Supervision - ANSAdminister local anesthesia.
DH General Supervision
LDA Direct Supervision - ANSAdminister nitrous oxide inhalation analgesia pursuant to the rule
provisions.
DH General Supervision
LDA Indirect Supervision - ANSMonitor a patient who has been induced by a dentist into nitrous
oxide-oxygen relative analgesia.
DH/LDA Indirect Supervision - ANSPerform restorative procedures limited to: placing,
contouring, and adjusting amalgam
restorations and glass ionomers; adapting and cementing stainless steel crowns; and placing,
contouring, and adjusting class I, II, & V supragingival composite restorations on primary and
permanent teeth.
DH General Supervision - ANSRemove marginal overhangs.
DH/LDA Direct Supervision - ANSPlace and remove matrix bands.
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