Can Texas dental hygienists smooth roughened root surfaces (root planing) if a dentist delegates the task?

Texas AG Opinion JM-420: Dental Hygienist Root Planing

Plain-English summary

The Texas State Board of Dental Examiners asked whether it could let dentists delegate to dental hygienists the task of smoothing roughened root surfaces, a basic gum-disease treatment also called root planing. JM-420 said yes. Source: https://www.texasattorneygeneral.gov/sites/default/files/opinion-files/opinion/1985/jm0420.pdf

The question came up because the Dental Hygiene Act generally bars the board from letting dentists delegate to hygienists any procedure that is irreversible or that involves intentional cutting of soft or hard tissue. Root planing may be irreversible, so the board wanted to know whether it could still authorize the delegation. Source: https://www.texasattorneygeneral.gov/sites/default/files/opinion-files/opinion/1985/jm0420.pdf

The answer turned on 1985 amendments by the Sixty-ninth Legislature. That legislation added "the smoothing of roughened root surfaces" to the statutory definition of dental hygiene and separately provided that the delegation limits do not prohibit the incidental removal of cementum by a hygienist during that smoothing. The opinion read those two changes together as a clear signal that the legislature wanted the board to be able to permit dentists to delegate root planing. Source: https://www.texasattorneygeneral.gov/sites/default/files/opinion-files/opinion/1985/jm0420.pdf

The opinion concluded that the board may adopt a rule allowing dentists to delegate the smoothing of roughened root surfaces to hygienists working under the dentist's supervision, using generally accepted methods, that is, the methods hygienists are trained to use. Source: https://www.texasattorneygeneral.gov/sites/default/files/opinion-files/opinion/1985/jm0420.pdf

Currency note

This opinion was issued in 1985. Subsequent statutory amendments, court decisions, or later AG opinions may have changed the analysis. Treat this page as historical context, not current legal advice. Verify current law before relying on any specific rule, deadline, or remedy mentioned here.

Common questions

What is "smoothing of roughened root surfaces"?

It is root planing, a basic treatment for gum disease. The opinion noted that dental hygienists could already perform the procedure in 43 other states and that it was part of a hygienist's training. Source: https://www.texasattorneygeneral.gov/sites/default/files/opinion-files/opinion/1985/jm0420.pdf

Doesn't the law stop hygienists from doing irreversible procedures?

As a general rule, yes. Section 3(a) of the Dental Hygiene Act bars the board from letting dentists delegate irreversible procedures or procedures involving the cutting of tissue. The 1985 amendments created a specific path for root planing despite that general rule. Source: https://www.texasattorneygeneral.gov/sites/default/files/opinion-files/opinion/1985/jm0420.pdf

So can the board actually authorize hygienists to do root planing?

Yes. JM-420 concluded the board may promulgate a rule allowing dentists to delegate the smoothing of roughened root surfaces to hygienists under the dentist's supervision, performed by generally accepted methods. Source: https://www.texasattorneygeneral.gov/sites/default/files/opinion-files/opinion/1985/jm0420.pdf

Does a hygienist need direct dentist supervision to do it?

The delegation runs through the dentist. The statute lets the board permit a dentist to delegate a task to a licensed hygienist under the dentist's direct or general supervision, and the opinion framed the root-planing delegation the same way. Source: https://www.texasattorneygeneral.gov/sites/default/files/opinion-files/opinion/1985/jm0420.pdf

Background and statutory framework

The Dental Hygiene Act, V.T.C.S. art. 4551e, defines dental hygiene and governs what dentists may delegate to hygienists. In 1985 the Sixty-ninth Legislature, through House Bill No. 1229, amended the section 1 definition to include the smoothing of roughened root surfaces, and amended the section 3(a) delegation provision to state that the delegation prohibitions do not bar the incidental removal of cementum by a hygienist during that smoothing. Source: https://www.texasattorneygeneral.gov/sites/default/files/opinion-files/opinion/1985/jm0420.pdf

Section 3(a) still generally prohibits delegating to a hygienist any procedure that is irreversible or that involves intentional cutting of tissue, and it bars hygienists from diagnosing disease, prescribing treatment, or dispensing medication. The opinion assumed root planing is irreversible but read the specific 1985 changes as the controlling signal of legislative intent, so it concluded the board could authorize the delegation by rule. The opinion did not decide whether generally accepted methods of root planing involve cutting tissue, because it found the amendments resolved the question either way. Source: https://www.texasattorneygeneral.gov/sites/default/files/opinion-files/opinion/1985/jm0420.pdf

Citations and references

• V.T.C.S. art. 4551e
• V.T.C.S. art. 4551e, §3(a)
• Acts 1985, 69th Leg., ch. 80, §1, at 320
• Acts 1985, 69th Leg., ch. 80, §3, at 321

Source: https://www.texasattorneygeneral.gov/sites/default/files/opinion-files/opinion/1985/jm0420.pdf

Source

• Landing page: https://www.texasattorneygeneral.gov/opinions/jim-mattox/jm-0420
• Original PDF: https://www.texasattorneygeneral.gov/sites/default/files/opinion-files/opinion/1985/jm0420.pdf

Original opinion text

Best-effort transcription from a scanned PDF via OCR. Minor errors may remain; the linked PDF is authoritative.

The Attorney General of Texas

JIM MATTOX
Attorney General

December 31, 1985

Mr. William S. Nail
Executive Director
Texas State Board of Dental Examiners
411 West 13th Street, Suite 503
Austin, Texas 78701

Opinion No. JM-420

Re: Whether the Texas State Board of Dental Examiners may allow the delegation to dental hygienists of smoothing roughened root surfaces

Dear Mr. Nail:

You ask for a clarification of certain amendments made by the Sixty-ninth Legislature to the Dental Hygiene Act. V.T.C.S. art. 4551e.

The legislature amended the definition of "dental hygiene" to read as follows:

The term 'dental hygiene,' and the practice thereof as used in this Act shall mean and is hereby defined as (a) the removal of accumulated matter, tartar, deposits, accretions or stains, except mottled enamel stains, from the natural and restored surfaces of exposed human teeth, and restorations therefor in the human mouth, the smoothing of the roughened root surfaces, and the polishing of said surfaces; (b) the making of topical application of drugs to the surface tissues of the human mouth and to the exposed surface of human teeth; (c) the making of Dental X-rays; and (d) such other services and procedures as may be prescribed by the Texas State Board of Dental Examiners in its Rules and Regulations; provided, however, that such services, tasks, or procedures defined as dental hygiene are performed in compliance with Section 3 of this Article. (Emphasis in original).

Acts 1985, 69th Leg., ch. 80, §1, at 320 (underlined language added by Sixty-ninth Legislature) (to be codified as article 4551e, §1, V.T.C.S.).

Section 3(a) of article 4551e, V.T.C.S., governs delegation of certain tasks to dental hygienists. This provision was also amended by the Sixty-ninth Legislature.

The Texas State Board of Dental Examiners may by rule permit a licensed dentist to delegate the performance of a service, task, or procedure to a licensed hygienist under the direct or general supervision of the dentist; provided, however, that the licensed hygienist shall not be permitted to diagnose a dental disease or ailment, prescribe any treatment or a regimen thereof, prescribe, order, or dispense medication, or perform any procedure which is irreversible or which involves the intentional cutting of the soft or hard tissue by any means. Nothing herein shall be construed to prevent a dentist from authorizing a dental hygienist employed by said dentist to instruct and educate a patient in good oral hygiene technique or to provide a medication as ordered by said dentist to said patient. This Act does not prohibit the incidental removal of cementum by a dental hygienist during the smoothing of roughened root surfaces.

Id. §3, at 321 (underlined language added by 69th Leg.) (to be codified as art. 4551e, §3(a), V.T.C.S.).

In regard to those amendments, you ask:

Assuming that 'the smoothing of the roughened root surfaces' is an irreversible procedure or 'involves the intentional cutting of the soft or hard tissue by any means,' may the dental board delegate to dental hygienists the permitted duty of smoothing of the roughened root surfaces in view of the language added by the Sixty-ninth Legislature to article 4551e, section 1.

The Sixty-ninth Legislature passed a bill the purposes of which were (1) to add "the smoothing of roughened root surfaces" to the list of tasks that make up the practice of dental hygiene and (2) to provide that the prohibitions on the delegation of certain kinds of tasks to dental hygienists are not intended to prohibit "the incidental removal of cementum by a dental hygienist during the smoothing of roughened root surfaces." Acts 1985, 69th Leg., ch. 80, at 320.

As a general rule, the board may not allow dentists to delegate to dental hygienists irreversible procedures or procedures involving the cutting of tissue. V.T.C.S. art. 4551e, §3(a). The legislative history of House Bill No. 1229 informs us that the smoothing of roughened root surfaces, also known as "root planing," is a basic treatment for gum disease. Dental hygienists may perform the procedure in 43 other states, and the procedure is part of a hygienist's training. Bill Analysis to H.B. No. 1229, prepared for House Committee on Public Health, filed in Bill File to H.B. No. 1229, Legislative Reference Library. We assume that the smoothing of roughened root surfaces is, by its nature, irreversible. You do not inform us whether generally accepted methods of smoothing roughened root surfaces involve the cutting of tissue. Obviously, however, House Bill No. 1229 was intended to make clear that the board could permit dentists to delegate to hygienists the task of smoothing roughened root surfaces. The legislature obviously contemplated that hygienists would do so using the method or methods generally taught to them in their training. Thus, the board may permit a dentist to delegate to a hygienist working under the dentist's supervision the smoothing of roughened root surfaces by generally accepted methods.

SUMMARY

The Texas State Board of Dental Examiners may promulgate a rule allowing dentists to delegate to dental hygienists the smoothing of roughened root surfaces by generally accepted methods.

Very truly yours,

JIM MATTOX
Attorney General of Texas

JACK HIGHTOWER
First Assistant Attorney General

MARY KELLER
Executive Assistant Attorney General

ROBERT GRAY
Special Assistant Attorney General

RICK GILPIN
Chairman, Opinion Committee

Prepared by Sarah Woelk
Assistant Attorney General