Dental Hygienist Requirements in Maryland: Scope of Practice & Direct Access
Dental Hygienists in Maryland are regulated by the Maryland State Board of Dental Examiners. The ADHA records a direct-access provision for Maryland — General Supervision (Md. Health Occupations Code Ann. § 4-308) — the rule that decides whether a dental hygienist there can work without a dentist on site; see below for what it covers.
Verify before you rely on this
At a glance
ADHA Direct Access chart
Direct access
Yes
Since 2010/2014/2019 (effective 10/1/19)
Category
General Supervision
Maryland law
Statute
Md. Health Occupations Code Ann. § 4-308
ADHA Practice Act chart
Permitted functions
14 of 22
Verified September 2026
Regulated by
Maryland State Board of Dental Examiners
Maryland’s Direct-Access Provision: General Supervision
Dental hygienist may practice under the general supervision of a dentist in a nursing home, assisted living program, medical office, and a group home or adult day care center.
A dental hygienist practicing under the general supervision of a licensed dentist in these facilities shall have a written agreement with the supervising dentist that clearly sets forth the terms and conditions under which the dental hygienist may practice.
Provider services: Initial appointment is limited to dental hygiene tasks and procedures including toothbrush prophylaxis, application of fluoride, dental hygiene instruction, full mouth debridement, and other duties as may be delegated, verbally or in writing, by the supervising dentist.
Requirements: Dental hygienist must hold an active license, hold a current certificate evidencing Health Care Provider Level C Proficiency, or its equivalent, in cardiopulmonary resuscitation, have at least 3,000 hours of active clinical practice in direct patient care, and ensure that the facility where the dental hygienist will practice under general supervision has: • A written medical emergency plan in place; • equipment, including portable equipment and appropriate armamentarium, available for the appropriate delivery of dental hygiene services, unless the dental hygienist provides the equipment; and • Adequate safeguards to protect the patient's health and safety.
What a Dental Hygienist Can Do in Maryland: Permitted Functions & Supervision Levels
Maryland's ADHA row tops out at general supervision — no function on the chart reaches direct access for this state.
Oral prophylaxis, x-rays, topical anesthesia, fluoride, sealants, scaling and root planing, soft tissue curettage, study cast impressions, placing and removing periodontal dressings, and removing sutures are listed at general supervision, meaning a dentist authorizes the service in advance but need not be present.
Local anesthesia, administering nitrous oxide, and prescriptive authority sit at direct supervision, where the dentist must be present.
Placing sutures, dental hygiene diagnosis, treatment planning, dental hygiene assessment, Botox, lasers, vaccines, and dermal fillers are not listed on the chart for Maryland.
- No function on Maryland's row reaches direct access (A); the least restrictive level listed is general supervision (G), covering 11 of the 22 functions.
- Local anesthesia, administering nitrous oxide, and prescriptive authority are the three functions listed at direct supervision (D) for Maryland, meaning the dentist must be present.
- Removing sutures is listed at general supervision (G), but placing sutures is not listed on the chart for Maryland — the two related functions split.
- Eight functions, including dental hygiene diagnosis, treatment planning, dental hygiene assessment, Botox, lasers, vaccines, and dermal fillers, are not listed on the chart for Maryland.
- G
- General supervision: dentist needs to authorize prior to services, but need not be present
- D
- Direct supervision: dentist needs to be present
Read the chart the way ADHA means it
Source: ADHA Dental Hygiene Practice Act Overview: Permitted Functions and Supervision Levels by State (8.24.26 update). This document is intended for informational purposes only and does not constitute a legal opinion regarding dental practice in any state. To verify any information, please contact your state's dental board.
Local Anesthesia by Dental Hygienists in Maryland
Maryland authorized hygienists to administer local anesthesia in 2009.
The ADHA chart lists direct supervision, meaning the dentist must be present, for both block and infiltration injections.
Education must come from an accredited or board-approved program, and the chart lists a NERB exam requirement, authorized by rules.
The course requirement it records is 20 hours didactic and 8 hours clinical.
Confirm current course and permit rules with the Maryland State Board of Dental Examiners before enrolling or applying.
- State & Year Implemented
- 2009
- Supervision Required
- Direct
- Block and/or Infiltration
- Both
- Education Required
- Accredited/Board Approved
- Exam Required
- Yes – NERB
- Authorized by Statute or Rule
- Rules
- Legal Requirements for Local Anesthesia Courses
- 20 hrs didactic; 8 hrs clinical
Source: ADHA Local Anesthesia Administration by Dental Hygienists – State Chart (Revised December 2025). This document is intended for informational purposes only and does not constitute a legal opinion regarding dental practice in any state. To verify any information, please contact your state's dental board.
Silver Diamine Fluoride by Dental Hygienists in Maryland
ADHA's silver diamine fluoride document names SDF directly for Maryland: the entry states that a dental hygienist's scope of practice, under Health Occupations §4-101, allows applying a medicinal agent to a tooth for a prophylactic purpose, and that the Maryland State Board of Dental Examiners includes SDF on its Permissible Procedures chart, referenced to September 20, 2017.
ADHA lists supervision as General, meaning a dentist authorizes the application in advance but does not need to be present.
The entry states no additional training, course, or setting condition specific to SDF; it rests on the medicinal-agent provision and the Board's permissible-procedures listing.
Scope of practice allows dental hygienist to apply medicinal agent to a tooth for a prophylactic purpose and the Board includes SDF on its permissible procedures chart.
Source: ADHA State Specific Information on Silver Diamine Fluoride (Revised September 2025). This document is intended for informational purposes only and does not constitute a legal opinion regarding dental practice in any state. To verify any information, please contact your state's dental board.
What Direct Access Does — and Doesn’t — Cover
Direct access is one dimension of scope, not scope itself. The ADHA’s direct-access chart records whether a dental hygienist can initiate treatment and treat a patient without a dentist present — the function-by-function supervision levels and the local anesthesia rules above come from two separate ADHA charts, and the three do not always line up neatly.
Don’t generalize from a direct-access provision to any other part of scope, and confirm specifics with the Maryland State Board of Dental Examiners.
Frequently Asked Questions
Does a dentist have to supervise a dental hygienist in Maryland?
It depends on the setting.
Statewide, a dentist must supervise a dental hygienist.
Under the 2010/2014/2019 General Supervision provision (Md.
Health Occupations Code Ann. § 4-308), that requirement relaxes to general supervision — no dentist physically present — only in a nursing home, assisted living program, medical office, or group home or adult day care center, and only under a written agreement with a supervising dentist that sets the terms and conditions of practice.
To qualify, the hygienist needs an active license, Health Care Provider Level C CPR proficiency (or its equivalent), and at least 3,000 hours of active clinical practice, and the facility must meet its own emergency-plan and equipment requirements.
The initial appointment is also limited to a specific task list plus whatever the supervising dentist delegates.
Confirm current requirements with the Maryland State Board of Dental Examiners.
Who regulates dental hygienists in Maryland?
Dental Hygienists in Maryland are regulated by the Maryland State Board of Dental Examiners.
Scope of practice is set by state law and changes over time, so verify current rules directly with the board before relying on them.
Does a dentist have to be present for local anesthesia in Maryland?
Yes.
The ADHA Practice Act chart lists local anesthesia at direct supervision for Maryland, and the Local Anesthesia chart agrees: direct supervision has applied since Maryland authorized the procedure in 2009, covering both block and infiltration injections.
That is a stricter level than most other listed functions on Maryland's row, which sit at general supervision.
Confirm the current permit and supervision rules with the Maryland State Board of Dental Examiners.
Does the Maryland chart give hygienists prescriptive authority?
Prescriptive authority is listed on Maryland's ADHA row, but at direct supervision, not direct access — the dentist must be present when it is exercised.
The chart does not list dental hygiene diagnosis, treatment planning, or dental hygiene assessment for Maryland at all.
What prescriptive authority covers in practice is defined by Maryland law, not the chart, so read the Maryland State Board of Dental Examiners' rules before relying on it.
Does 'not listed' mean Botox and vaccines are banned for Maryland hygienists?
No. The ADHA chart marks Botox, vaccines, dermal fillers, lasers, placing sutures, dental hygiene diagnosis, treatment planning, and dental hygiene assessment with a dash for Maryland, which ADHA records as not listed on the chart — not the same as being off-limits.
The chart doesn't say whether Maryland law permits, restricts, or is simply silent on these functions, so confirm current scope directly with the Maryland State Board of Dental Examiners.
Does a Maryland dental hygienist need a dentist present to apply silver diamine fluoride?
No, according to the entry ADHA quotes.
It lists supervision as General for Maryland, meaning a dentist authorizes SDF application in advance but does not need to be physically present.
The entry ties this to the hygienist's scope of practice under Health Occupations §4-101 to apply a medicinal agent for a prophylactic purpose, and to the Maryland State Board of Dental Examiners' Permissible Procedures chart, referenced to September 20, 2017.
Confirm current requirements with the Maryland State Board of Dental Examiners.
Does the Maryland entry name silver diamine fluoride specifically?
Yes.
Unlike entries that only cover fluoride generally, ADHA's document states that the Maryland State Board of Dental Examiners includes SDF on its Permissible Procedures chart, referenced to September 20, 2017.
The underlying scope-of-practice provision, Health Occupations §4-101, speaks more broadly to applying a medicinal agent to a tooth for a prophylactic purpose.
The entry states no additional training or setting requirement specific to SDF.
Confirm current procedures with the Maryland State Board of Dental Examiners.
More Maryland & Dental Hygienist Resources
Sourced from the ADHA Direct Access States chart (Revised February 2025), the ADHA Dental Hygiene Practice Act Overview: Permitted Functions and Supervision Levels by State (8.24.26 update) and the ADHA Local Anesthesia Administration by Dental Hygienists – State Chart (Revised December 2025), and the ADHA State Specific Information on Silver Diamine Fluoride (Revised September 2025). Verified September 2026. This page is general information, not legal advice — confirm current rules with the Maryland State Board of Dental Examiners.