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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Washington

Washington uses a two-tier supervision system for dental hygienists: general supervision (dentist has diagnosed/authorized in advance and need not be present) and close supervision (dentist has authorized the procedure and is on-site in the facility, though not necessarily in the operatory). Most preventive and periodontal procedures fall under general supervision, while local anesthesia (absent specific pre-conditions) and nitrous oxide require close supervision; separately, experienced hygienists may work without any supervising dentist on-site in health care facilities and senior centers under RCW 18.29.056.

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 Washington dental board before making decisions based on it.

Permitted functions & supervision required

  • Scaling and root planing

    General supervision

    WAC 246-817-550 lists subgingival/supragingival scaling and root planing among acts performable under general supervision.

  • Local anesthesia administration

    Indirect supervision

    Requires close supervision (dentist on-site in the facility, not necessarily the operatory) per WAC 246-817-560, unless four conditions in WAC 246-817-550(6) are met (patient 18+, examined by the delegating dentist within the prior 12 months, no interim change in medical history, documented dentist approval), then general supervision applies.

  • Nitrous oxide monitoring/administration

    Indirect supervision

    Classified under close supervision per WAC 246-817-560; requires additional competency and, for limited-license hygienists, a specific endorsement.

  • Application of sealants

    General supervision

    Listed under general supervision in WAC 246-817-550.

  • Application of fluoride varnish

    General supervision

    Listed as fluoride treatments under general supervision in WAC 246-817-550.

  • Taking radiographs (x-rays)

    General supervision

    Intraoral and extraoral radiographs are listed under general supervision in WAC 246-817-550.

  • Practice in health care facilities & senior centers without an on-site dentist

    Unsupervised / independent practice

    RCW 18.29.056: hygienists with 2 years' clinical experience (within the preceding 5 years) may work in hospitals, nursing homes, tribal clinics, and similar facilities without a supervising dentist present, for a limited procedure set (deposit/stain removal, topical preventive/anesthetic agents, polishing restorations, root planing, soft-tissue curettage). Injections of anesthetic, nitrous oxide, and diagnosis are excluded. Senior-center work additionally requires a written offsite-supervision practice plan with a Washington-licensed dentist.

Sources

  1. RCW 18.29.050: Scope of licensee's functions, Employment, Supervision Washington State Legislature (Revised Code of Washington), 2023.
  2. WAC 246-817-550: Acts that may be performed by licensed dental hygienists under general supervision Washington State Dental Quality Assurance Commission / Washington State Department of Health, 2019.
  3. WAC 246-817-560: Acts that may be performed by licensed dental hygienists under close supervision Washington State Dental Quality Assurance Commission / Washington State Department of Health, 2019.
  4. RCW 18.29.056: Employment by health care facilities authorized, Limitations, Requirements for services performed in senior centers Washington State Legislature (Revised Code of Washington), 2019.