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California

California recognizes three tiers of hygienist licensure (RDH, RDHEF, and RDHAP) with most routine preventive/therapeutic duties (prophylaxis, scaling/root planing, sealants, fluoride, radiographs) performed under general supervision, while a small set of invasive procedures (local anesthesia, nitrous oxide) require direct supervision. The Registered Dental Hygienist in Alternative Practice (RDHAP) is California's expanded-practice category: RDHAPs may independently provide the full general-supervision scope with no dentist present, in settings like homebound residences, schools, and dental health professional shortage areas.

Verify before relying on this: scope-of-practice regulations change frequently. This entry was last checked against primary sources on 2026-08-30. Confirm current requirements with the California dental board before making decisions based on it.

Permitted functions & supervision required

  • Scaling and root planing

    General supervision

    Cal. Business & Professions Code (BPC) §1910(a). RDHAPs may perform the same duty entirely without supervision (16 CCR §1090(c)).

  • Local anesthesia administration

    Direct supervision

    BPC §1909(b): requires a Dental Hygiene Committee of California-approved course. RDHAPs practicing independently may not administer local anesthesia, expressly excluded under 16 CCR §1090(a)(8).

  • Nitrous oxide monitoring/administration

    Direct supervision

    BPC §1909(c): requires a DHCC-approved course.

  • Application of sealants

    General supervision

    16 CCR §1088(c)(4). Becomes unsupervised in a government public-health program (BPC §1911(c)) or when performed by an RDHAP.

  • Application of fluoride varnish

    General supervision

    BPC §1910. Same public-health-program and RDHAP exceptions as sealants apply (BPC §1911(c)).

  • Taking radiographs (x-rays)

    General supervision

    BPC §1914 / §1910.5. Since 2018, an RDH may independently decide which radiographs to expose on a patient the dentist hasn't yet examined, following the dentist's protocols.

  • RDHAP independent/community-based practice (full general-supervision RDH scope)

    Direct access

    BPC §§1900–1966.6. Requires 2,000 clinical hours, a bachelor's degree (or 120 semester units), a 150-hour approved RDHAP program, and a licensing exam. No prior dentist exam is needed for the first 18 months treating a given patient; after that, written verification from a dentist or physician is required (BPC §1931).

  • Preventive services in government public health programs

    Unsupervised / independent practice

    BPC §1911 lets any RDH (not just RDHAP) provide screenings, fluoride, and sealants entirely without supervision in a public health program run by a federal, state, county, or local government entity.

Sources

  1. Tables of Permitted Duties California Dental Association, 2019.
  2. Direct Access States American Dental Hygienists' Association, 2025.
  3. Business and Professions Code Section 1910 (Dental Hygienists: General Supervision) California Legislative Information, State of California, 2009.