Dental Hygienist Requirements in Tennessee: Scope of Practice & Direct Access
Dental Hygienists in Tennessee are regulated by the Tennessee Board of Dentistry. The ADHA records a direct-access provision for Tennessee — 2013 provision (Sec. 63-5-109) — 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 2013
Category
2013 provision
Tennessee law
Statute
Sec. 63-5-109
ADHA Practice Act chart
Permitted functions
13 of 22
Verified September 2026
Regulated by
Tennessee Board of Dentistry
Tennessee’s Direct-Access Provision: 2013 provision
Dental hygienist may apply dental sealants or topical fluoride to the teeth of individuals in a setting under the direction of a state or local health department, without requiring an evaluation by a dentist prior to such application, under a protocol established by the state or a metropolitan health department.
What a Dental Hygienist Can Do in Tennessee: Permitted Functions & Supervision Levels
Tennessee splits its 22 ADHA-listed dental hygiene functions between two supervision levels, with none listed at direct access.
Oral prophylaxis, x-rays, topical anesthesia, fluoride, pit/fissure sealants, placing and removing periodontal dressings, and prescriptive authority sit at general supervision, where a dentist authorizes the service in advance but does not need to be present.
Local anesthesia, scaling and root planing, administering nitrous oxide, study cast impressions, and removing sutures sit at direct supervision, meaning the dentist must be present while the hygienist performs them.
Soft tissue curettage, placing sutures, dental hygiene diagnosis, treatment planning, dental hygiene assessment, Botox, lasers, vaccines, and dermal fillers are not listed on the chart for Tennessee.
- Five of the 22 functions are listed at direct supervision (D) for Tennessee: local anesthesia, scaling and root planing, administering nitrous oxide, study cast impressions, and removing sutures, so the dentist must be present for each.
- Local anesthesia is listed at direct supervision (D) on the Practice Act chart, matching the Local Anesthesia chart's own supervision level of Direct since 2004.
- Scaling and root planing sits at direct supervision (D) rather than general supervision like most other everyday functions such as oral prophylaxis and fluoride.
- Dental hygiene diagnosis, treatment planning, and dental hygiene assessment are not listed on the chart for Tennessee, which ADHA records as not listed, a narrower statement than a ban.
- No function is listed at direct access (A) or collaborative practice (CP) for Tennessee; general supervision is the least restrictive level the chart shows for this state.
- 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 Tennessee
Tennessee authorized hygienists to administer local anesthesia in 2004.
The ADHA chart lists direct supervision, meaning a dentist must be present, for both block and infiltration injections.
Education is required from an accredited or board-approved program, and the chart lists no separate exam.
Authorization comes through board rules, and the course requirement is 24 hours didactic and 8 hours clinical.
Confirm current course and permit rules with the Tennessee Board of Dentistry before enrolling or applying.
- State & Year Implemented
- 2004
- Supervision Required
- Direct
- Block and/or Infiltration
- Both
- Education Required
- Accredited/Board Approved
- Exam Required
- No
- Authorized by Statute or Rule
- Rules
- Legal Requirements for Local Anesthesia Courses
- 24 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 Tennessee
Tennessee's SDF entry does not name silver diamine fluoride specifically.
ADHA places it under a scope-of-practice provision, §0460-03-.09, that covers application of topical fluoride and desensitizing agents.
ADHA lists supervision as General, meaning a dentist authorizes the service in advance but does not need to be present.
The quoted provision states only that scope of practice includes application of topical fluoride and desensitizing agents — it attaches no training requirement, course, permit, collaborative agreement, or setting restriction beyond that.
ADHA lists no additional references or board minutes for this entry.
Confirm current SDF rules with the Tennessee Board of Dentistry.
Scope of practice includes application of topical fluoride and desensitizing agents.
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 Tennessee Board of Dentistry.
Frequently Asked Questions
Does a dentist have to supervise a dental hygienist in Tennessee?
Only for specific services in specific settings.
Tennessee's provision (Sec. 63-5-109) lets a dental hygienist apply dental sealants or topical fluoride without a prior dentist evaluation, but only in a setting under the direction of a state or local health department, and only under a protocol established by the state or a metropolitan health department.
Outside sealants, topical fluoride, and those health-department settings, dentist supervision requirements apply.
Confirm current details with the Tennessee Board of Dentistry.
Who regulates dental hygienists in Tennessee?
Dental Hygienists in Tennessee are regulated by the Tennessee Board of Dentistry.
Scope of practice is set by state law and changes over time, so verify current rules directly with the board before relying on them.
Can a dental hygienist in Tennessee give local anesthesia without a dentist present?
No. The ADHA Practice Act chart lists local anesthesia at direct supervision for Tennessee, meaning the dentist must be present while the hygienist administers it.
The Local Anesthesia chart agrees, listing direct supervision for both block and infiltration since 2004, authorized through board rules, with a course requirement of 24 hours didactic and 8 hours clinical.
Confirm current requirements with the Tennessee Board of Dentistry.
Which hygiene functions in Tennessee require the dentist to be in the room?
Five functions on the ADHA chart carry direct supervision for Tennessee: local anesthesia, scaling and root planing, administering nitrous oxide, study cast impressions, and removing sutures.
Direct supervision means the dentist must be present.
Everything else the chart lists for Tennessee sits at general supervision, and several functions, including dental hygiene diagnosis and treatment planning, are not listed at all.
The chart does not show which cells carry ADHA's numbered footnotes, so check the Tennessee Board of Dentistry's rules for any condition attached to these functions.
Does the Tennessee chart list dental hygiene diagnosis or prescriptive authority?
Prescriptive authority is listed at general supervision for Tennessee, meaning a dentist authorizes it in advance but need not be present.
Dental hygiene diagnosis, dental hygiene assessment, and treatment planning are not listed on the chart for Tennessee, which ADHA records as not listed rather than granted.
What each of those terms would cover in practice is defined by Tennessee law, not by the chart, so check the Tennessee Board of Dentistry's rules before relying on either.
Does Tennessee's chart cover Botox, vaccines, or dermal fillers for hygienists?
Botox, vaccines, dermal fillers, and lasers are not listed on the ADHA Practice Act chart for Tennessee.
Not listed means the function does not appear on the chart at all, a narrower statement than a ban.
Because the chart is silent on these functions, hygienists should check directly with the Tennessee Board of Dentistry about whether and how any of them may be performed.
Does Tennessee's ADHA entry specifically name silver diamine fluoride?
No. Tennessee's entry does not use the term silver diamine fluoride.
ADHA instead cites a scope-of-practice provision, §0460-03-.09, that covers application of topical fluoride and desensitizing agents, and places SDF under that broader category.
The document lists no separate approval, training requirement, or board minutes naming SDF by name.
Confirm with the Tennessee Board of Dentistry whether SDF application is covered under this provision.
What supervision does a Tennessee hygienist need to apply SDF?
ADHA lists General supervision for this provision, meaning a dentist authorizes the application in advance but does not need to be present.
The quoted text — "Scope of practice includes application of topical fluoride and desensitizing agents" — states no additional training, course, permit, or collaborative-agreement condition.
Because the entry does not name SDF directly, confirm with the Tennessee Board of Dentistry whether this general-supervision fluoride provision is understood to cover SDF specifically.
More Tennessee & 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 Tennessee Board of Dentistry.