Clinical decision-support only. For use by licensed dental professionals. Not a substitute for professional judgment or a complete drug reference. Always verify with primary sources.
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Texas

Texas primarily uses a general-supervision model for routine dental hygiene services: a supervising dentist must have examined the patient within the preceding 12 months and delegate the task, but need not be on-site while the hygienist performs it. Higher-risk procedures (local anesthesia, nitrous oxide monitoring) require Texas's 'direct supervision': the dentist physically present in the office/facility, not necessarily the treatment room. Narrow carve-outs allow select unsupervised practice, e.g. a Limited Fluoride Varnish Permit and treatment in certain facilities under advance written authorization.

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 Texas dental board before making decisions based on it.

Permitted functions & supervision required

  • Scaling and root planing

    General supervision

    Supervising dentist must have examined the patient within the preceding 12 months and delegate the task, but need not be present when performed (Tex. Occ. Code §262.151; 22 TAC §115.2).

  • Local anesthesia administration

    Direct supervision

    Requires a hygienist to hold a Board-issued Local Anesthesia certificate. Texas's 'direct supervision' means the dentist is physically present in the facility and continuously aware of the patient's status, not necessarily in the treatment room (22 TAC §115.10).

  • Nitrous oxide monitoring/administration

    Direct supervision

    Hygienist must complete a Board-approved nitrous oxide monitoring course. Texas's 'direct supervision' means dentist physical presence in the office/facility, not necessarily the treatment room (22 TAC §115.2).

  • Application of sealants

    General supervision

    Delegable under the same general-supervision framework as scaling/x-rays (22 TAC §115.2).

  • Application of fluoride varnish

    General supervision

    Under standard delegation, general supervision applies (22 TAC §115.2). A hygienist holding a separate Limited Fluoride Varnish Permit may administer it with no dentist supervision at all. See the separate entry below.

  • Taking radiographs (x-rays)

    General supervision

    Delegable under general supervision (22 TAC §115.2).

  • Fluoride varnish under Limited Fluoride Varnish Permit

    Unsupervised / independent practice

    A dental hygienist who holds a Board-issued Limited Fluoride Varnish Permit may administer fluoride varnish without any dentist supervision, per Tex. Occ. Code §262.153. Distinct from routine fluoride application under general delegation.

  • Practice in nursing facilities, school-based health centers, or community health centers

    General supervision

    A hygienist with 2+ years' experience may treat patients in these settings under a dentist's advance written authorization, even if the dentist hasn't examined that patient within the past 12 months and isn't present, looser than standard general supervision (22 TAC §115.5).

Sources

  1. Dental Hygiene Practice Act Overview: Permitted Functions and Supervision Levels by State American Dental Hygienists' Association, 2022.
  2. Occupations Code, Chapter 262: Regulation of Dental Hygienists (§262.151 Delegation of Duties by Dentist; §262.153 Limited Fluoride Varnish Permit) Texas Legislature (Texas Statutes), 2024.
  3. 22 Tex. Admin. Code §115.10: Administration of Local Infiltration Anesthesia by Dental Hygienists Texas State Board of Dental Examiners, 2026.