Licensed dental hygienists generally do not perform permanent dental fillings; this procedure is primarily the responsibility of the dentist. The roles of these two dental professionals are distinct, defined by legally mandated scopes of practice. The division of labor centers on prevention versus definitive treatment. This separation ensures that the individual performing the irreversible procedure of tooth preparation possesses the highest level of training and licensure.
The Primary Focus of Dental Hygienists
The core mission of a registered dental hygienist (RDH) centers on preventative care and the long-term management of periodontal health. Their duties are specifically tailored to intercepting disease before it requires surgical intervention. This foundational work involves professional cleaning, known as prophylaxis, which removes plaque and hardened calculus (tartar) that contribute to gum disease and tooth decay.
Hygienists are highly trained in the non-surgical management of gum tissues, often performing specialized procedures like scaling and root planing to treat periodontitis. They also apply topical agents such as fluoride varnish and dental sealants, which strengthen tooth enamel and protect vulnerable chewing surfaces.
The hygienist is typically the team member responsible for taking and interpreting diagnostic images, such as X-rays, and performing preliminary oral health assessments. They also empower patients through extensive education on brushing techniques and flossing methods. Their practice focuses on disease detection and prevention, preparing the patient for the dentist’s examination and subsequent treatment planning.
Who Performs Restorative Procedures
The responsibility for performing restorative procedures, including the placement of dental fillings, rests almost exclusively with the licensed dentist, who holds a Doctor of Dental Surgery (DDS) or Doctor of Dental Medicine (DMD) degree. This distinction is rooted in the significant difference in education and legal authorization between the professions. Dentists complete a rigorous four-year doctoral program following their undergraduate studies, which trains them in diagnosis, surgery, and comprehensive treatment planning.
A filling is a multi-step, irreversible procedure that requires the dentist to first diagnose the decay, often using X-rays and tactile examination. They then utilize high-speed rotary instruments to physically remove the decayed tooth structure, a process known as tooth preparation.
The dentist is responsible for ensuring all infected material is removed and that the remaining cavity shape is suitable for retaining the restorative material. After preparing the site, the dentist places the restorative material, such as composite resin or amalgam, and carves it to match the natural anatomy of the tooth. This process requires a deep understanding of occlusion (the bite) and material science to ensure the restoration is durable and functional.
Specialized Roles and Expanded Practice
While the general rule holds that a dental hygienist does not perform fillings, some jurisdictions allow for expanded functions that create limited exceptions to this standard. These roles are typically designated as Expanded Function Dental Hygienists (EFDH) or similar titles and require additional, specialized training and certification. This advanced training grants the hygienist the legal authority to perform certain reversible or supportive restorative tasks.
Limited Restorative Tasks
In states that authorize these expanded roles, the hygienist may be permitted to place and finish restorative materials, such as amalgam or composite resin. This occurs only after the dentist has completed the tooth preparation, meaning the dentist still performs the surgical step of drilling out the decay. Other limited restorative functions may include placing temporary fillings or applying glass ionomer cements, which are used as interim therapeutic restorations to slow the progression of decay.
These expanded duties are always performed under the direct or indirect supervision of a licensed dentist, depending on state regulations. The scope of practice for these specialized roles varies significantly from state to state. This variation underscores the importance of state dental practice acts, which strictly define the boundaries of each dental professional’s license.