Expanded Duties, Expanded Risk? - Julie Goldberg, DDS, CCDS October 2026 E NEWS

 

Expanded Duties, Expanded Risk?

Author: Julie Goldberg, DDS, Sr. Dental Risk Specialist at PMIG

What Dentists Should Know About Delegation, Scope of Practice, and Professional Liability

Across the country, states continue to explore expanded duties for dental hygienists and dental assistants as a way to improve access to care, address workforce shortages, and increase practice efficiency. While these changes create opportunities for dental practices, they also introduce important considerations related to patient safety, documentation, supervision, professional liability, and insurance coverage.

As scopes of practice evolve, dentists may benefit from periodically evaluating not only what duties can be delegated, but how those duties are implemented, supervised, documented, and communicated within the practice.

Delegation Is Not the Same as Transfer of Responsibility

One of the most common misunderstandings surrounding expanded-duty personnel is the belief that delegation transfers responsibility. In most situations, even when a procedure is legally delegated, the dentist retains responsibility for patient assessment, diagnosis, treatment planning, and the clinical decisions that support patient care.

When an adverse event occurs, allegations often focus not only on the delegated procedure itself, but also on questions such as:

• Was the individual properly trained and credentialed?
• Was the procedure within the individual's authorized scope of practice?
• Was supervision provided as required by state law?
• Was the patient appropriately evaluated before treatment?
• Was adequate documentation maintained?

In many malpractice cases, the issue is not whether delegation occurred. Rather, the issue becomes whether the delegation process was reasonable and appropriately managed.

Scope of Practice Varies Significantly by State

Expanded-duty laws differ substantially across jurisdictions.

A procedure that may be permitted for a dental assistant in one state could be prohibited in another. Similarly, levels of supervision may vary from direct supervision to indirect supervision, general supervision, or independent authority, depending on the provider type and the state.

For practices with multiple locations or providers licensed in different states, periodically reviewing current regulations can help reduce confusion and promote consistency.

Questions worth considering include:

• Have state regulations changed since our protocols were developed?
• Are job descriptions aligned with current state requirements?
• Have newly hired team members received state-specific training?
• Are supervision requirements clearly understood by all providers?

Documentation Remains a Critical Defense Tool

Expanded-duty models often create additional handoffs during patient care. More handoffs mean more opportunities for communication breakdowns.

Documentation may become especially important when treatment involves multiple providers participating in the patient's care.

Areas frequently reviewed during an investigation include:

• Treatment planning documentation
• Supervision records
• Informed consent discussions
• Training and credentialing records
• Clinical notes related to delegated procedures
• Follow-up and postoperative instructions

A well-documented process often provides stronger support for the clinical decisions made by the practice.

Consider the Impact on Professional Liability Exposure

As practices expand services and delegation models, their risk profile may evolve as well.

Examples include:

• Expanded function restorative procedures
• Interim therapeutic restorations
• Local anesthesia administration by hygienists where permitted
• Expanded periodontal services
• Community-based or public health programs
• Teledentistry-supported preventive care

These activities may be entirely appropriate and permissible, but they can create new questions regarding supervision, training, documentation, and liability allocation.

Dentists may wish to discuss significant operational changes with their insurance professional, particularly when adding new services, locations, provider types, or delegation models.

What About Board Complaints?

Many dentists associate risk primarily with malpractice lawsuits. However, board investigations can arise independently of litigation.

A patient complaint involving a delegated procedure may prompt questions regarding:

• Scope of practice
• Supervision requirements
• Documentation
• Credential verification
• Patient safety protocols

In some cases, a board matter may create greater concern for a provider than the underlying malpractice allegation because of the potential impact on licensure.

For this reason, dentists may find it worthwhile to understand whether their professional liability policy includes defense coverage related to board investigations and what limits or conditions apply.

A Practical Opportunity for Practices

Expanded duties continue to play an important role in modern dentistry. When implemented thoughtfully, they can improve efficiency, support access to care, and allow practices to maximize team capabilities.

As regulations continue to evolve, practices may benefit from periodically reviewing:

• State-specific delegation requirements
• Supervision protocols
• Training records
• Credential verification processes
• Documentation practices
• Professional liability and board defense provisions

The goal is not to avoid delegation. The goal is to ensure that delegation occurs within a framework that supports patient safety, regulatory compliance, and defensible clinical decision-making.

Key Takeaway

As dentistry continues to expand the responsibilities of hygienists and dental assistants, dentists may wish to view delegation not only as a workforce strategy, but also as a risk management strategy. The strongest programs combine appropriate training, clear supervision, thorough documentation, and an understanding of how evolving practice models may affect professional liability and board-related exposures.

For questions related to dental risk management, contact Dr. Julie Goldberg, Professional Dental Risk Specialist with PM Dental Protect, PMIG. julie.goldberg@phmic.com.

This information is intended to provide general information only on specific risk management topics. It is not intended to provide coverage determinations or coverage positions, nor is it to be construed as legal, medical, or professional advice in any form whatsoever.