The question of whether a dental hygienist can place a filling often stems from confusion between the roles of licensed dental professionals. A dental hygienist focuses on preventive care, while a dentist specializes in restorative treatment. Understanding this distinction and the legal boundaries set by state licensing boards clarifies which team member manages tooth decay. This article explores the standard duties of a hygienist, the dentist’s role in restorative work, and exceptions that allow hygienists to perform limited, non-permanent filling procedures.
Defining the Scope of Practice
A licensed dental hygienist’s core function is disease prevention and patient education, operating within a scope of practice defined by state laws. Their work includes the professional cleaning of teeth, involving scaling and root planing to remove calculus and plaque. These actions are fundamental to managing periodontal disease and maintaining overall oral health.
Hygienists perform diagnostic support procedures, such as taking dental radiographs and conducting initial oral health assessments. They apply preventive agents, including fluoride treatments and dental sealants, to strengthen enamel and shield teeth from decay. Patient instruction on proper brushing and flossing techniques is also a standard part of the hygienist’s role.
The standard scope of practice for a hygienist is limited to these preventative and therapeutic procedures. Traditional, permanent restorative work—such as drilling out decayed tooth structure and placing a filling—is generally outside their defined responsibilities. Their training focuses on identifying and preventing disease, not on performing irreversible surgical procedures.
Who Performs Dental Fillings?
The diagnosis and treatment of permanent tooth decay are the exclusive responsibility of a licensed dentist, who holds either a Doctor of Dental Surgery (DDS) or Doctor of Dental Medicine (DMD) degree. When a dentist confirms a carious lesion (a cavity), they perform the irreversible procedure of preparing the tooth. This involves using a handpiece to remove the decayed enamel and dentin until only healthy tooth structure remains.
The dentist then places the permanent restorative material, whether it is an amalgam or a composite resin filling, into the prepared cavity. This process requires advanced surgical skill and the authority to diagnose and permanently alter tooth structure. The dental assistant helps the dentist during this process by providing suction and handing instruments, but they do not perform the filling procedure itself.
State-Specific Expanded Functions
The confusion about hygienists performing fillings often comes from expanded functions that vary significantly by state licensing boards. Some jurisdictions allow dental hygienists to complete additional training to achieve an expanded function certification. This certification permits them to perform certain reversible or supportive restorative tasks under the supervision of a dentist.
These expanded duties may include placing and finishing the restorative material, like a composite or amalgam, after the dentist has completed the tooth preparation. This is not the standard full filling procedure, but rather the final stage of restoration. Furthermore, some hygienists are trained to place Interim Therapeutic Restorations (ITRs), which are temporary fillings often made of glass ionomer cement. ITRs are used in public health settings to temporarily stabilize a tooth and halt decay progression until a patient can see a dentist for a permanent restoration.
The existence of a separate license, the Dental Therapist, also contributes to the public’s confusion. Dental Therapists are mid-level practitioners in some states who are specifically trained to perform basic, irreversible restorative procedures, including simple fillings. While this role is distinct from a standard dental hygienist, it shows the evolving landscape of mid-level providers within the dental team.