dental hygienists’ role in administering local anaesthesia

Anisha Hall Hoppe, Dental Tribune International

Fri. 21 July 2023

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BOSTON, US: In the first part of an in-depth look into the scope of practice of dental hygienists as administrators of local anaesthesia, ten dental professionals have given their opinion on the overall efficacy of training offered in the US. As dental hygienists are able to receive certification to administer local anaesthesia in a majority of states with Texas and Delaware being notable exclusions, the overview is one perspective amid frequent warnings about the need for supervision in anaesthesia in dentistry.

Controversy over the scope of anaesthetic care that can be offered by dental hygienists is further heighted because each state relies on a different type of regulatory board. For some, it is a designated state dental board and, for others, the local department of public health. Although in a majority of locales, hygienists must have graduated from an accredited, relevant dental hygiene programme, fulfilled specific training requirements and completed continuing education to be certified, the actual administration of anaesthesia is not required to be performed with a supervising dentist in the room.

The language describing this situation varies from state to state, causing confusion, as it is still considered “direct supervision” by some states insomuch as the administration is authorised by a dentist, but it is regarded as “indirect supervision” in other states. Hygienists in Alaska are not subject to any supervision at all. Despite hygienists not being required to be certified through the national-level Commission on Dental Accreditation, the authors note that “competency is reliably achieved within the current models”.

As noted in a discussion on improving safety of anaesthesia in dentistry, published by Dental Tribune International this year, regardless of the stringency of the preparatory programmes, safety outcomes should be the ongoing focus for all state regulatory boards. This pertains specifically to whether a dental hygienist is sufficiently prepared to handle poor outcomes and emergencies during the administration of local anaesthesia.

The present overview cites a survey and study in which dental hygienists with local anaesthetic certifications rated themselves as feeling capable of handling potential adverse outcomes. However, considering the average of 30 hours of training for certification and that the overview makes no reference to the rates of local anaesthesia-related complications, either with or without direct supervision, it seems to offer more areas for concern than comfort. Perhaps the second instalment in the overview will offer more evidence to substantiate the confidence the authors have in hygienists’ abilities to handle negative outcomes, as any data on these issues is typically kept confidential by most insurance agencies.

The overview, titled “An in-depth look at the role of dental hygienists in administering local anesthesia”, was published in the May 2023 issue of Dimensions of Dental Hygiene.