Can Hygienists Place or Remove Sutures? By State

Placing sutures is one of the most restricted functions on the ADHA's entire chart.

The Practice Act Overview (8.24.26 update) lists it as permitted hygienist scope in only 4 of the 51 jurisdictions it tracks — Arizona (Direct supervision), Arkansas (Indirect), Minnesota (Indirect), and South Dakota (Indirect).

Everywhere else, the chart shows no listed supervision level for this function at all.

Removing sutures is far more common — listed as permitted in 44 of the 51 jurisdictions, with supervision that ranges from a dentist needing to be present down to a hygienist's own determination.

Because the chart treats these as two separate rows, check both before assuming your scope on either one.

Placing sutures means closing a soft-tissue wound with stitches — typically after a surgical procedure like an extraction or periodontal surgery that a dentist has performed.

Removing sutures is the follow-up step once that tissue has healed enough for the stitches to come out, usually at a later visit.

Because they happen at different points in a patient's care and carry different levels of clinical risk, the ADHA chart lists them as entirely separate functions with their own supervision levels — permission to remove sutures says nothing about whether you may place them, and vice versa.

The codes that appear on these two rows come directly from the chart's own legend:

• D — Direct Supervision: the dentist needs to be present.
• ID — Indirect Supervision: the dentist must authorize the procedure and be in the dental office while it's performed.
• G — General Supervision: the dentist authorizes the service beforehand but need not be present.
• A — Direct Access: the hygienist can provide the service based on their own determination, without specific authorization.
• "-" — not listed as a permitted function in the chart. That isn't the same as prohibited — it means the chart records no permitted supervision level for that state, so confirm directly with the board.

Where a state's cell lists more than one letter — like California's or Nevada's or Oregon's G/A for suture removal, or Hawaii's D/G — those are separate listed settings (commonly private versus public practice), never a range and never blended into one answer.

Quote the cell exactly as the chart lists it.

Suture placement is listed as permitted hygienist scope in only 4 jurisdictions: Arizona under Direct supervision, and Arkansas, Minnesota, and South Dakota under Indirect supervision.

Every other jurisdiction shows no listed supervision level for this function.

Source: ADHA Dental Hygiene Practice Act Overview, 8.24.26 update.

A "-" means the function isn't listed as permitted in that state's row — not that it's necessarily prohibited.

Quoting the chart as written, here is the supervision level listed for every jurisdiction.

General supervision (G) alone is the most common listing, covering 20 of the 51.

A direct-supervision requirement (D) is the only listed level in 15 jurisdictions — Alabama, Arizona, the District of Columbia, Louisiana, Mississippi, New Jersey, North Carolina, Pennsylvania, Rhode Island, Tennessee, Vermont, Washington, West Virginia, Wisconsin, and Wyoming — and Hawaii's D/G brings the total requiring the dentist present in at least one setting to 16.

Seven jurisdictions — Connecticut, Georgia, Idaho, Illinois, Indiana, Iowa, and Kansas — show no listed supervision level for this function at all.

Source: ADHA Dental Hygiene Practice Act Overview, 8.24.26 update.

Multi-letter cells (like California's, Nevada's, and Oregon's G/A, or Hawaii's D/G) are separate settings, not a range — quoted here exactly as the chart lists them.

Placing sutures, listed in just 4 of 51 jurisdictions, is nearly as restricted as Botox, listed in only 3 of 51 on the same chart.

Removing sutures, at 44 of 51, sits close to soft tissue curettage's 43 of 51 — above this chart's Administer N2O row, listed in 34 of 51 (see nitrous oxide for that function's own administer-vs-monitor detail, which comes from a separate ADHA chart) — and well short of near-universal functions like local anesthesia.

Placing sutures, at 4 of 51, sits far below all three.

Don't assume permission for one function on this chart implies permission for another — the ADHA lists each one separately, and this article covers only the two suture rows.

A "-" on this chart means the function isn't listed as permitted in that state's row — it does not mean the state prohibits it outright, only that the chart doesn't record an authorized supervision level there.

Even where a level is listed, confirm exactly what it requires in practice, since practice acts and their interpretation change over time.

Start with your state dental board's practice act, and treat this chart and this article as a snapshot dated to 8.24.26 rather than a permanent rule.

For the rest of what a hygienist can and can't do, see our full breakdown of hygienist scope limits.

This article is general information, not legal or clinical advice. Scope-of-practice and supervision rules vary by state and change over time — confirm current requirements with your state dental board.