The AAO, in cooperation with the Washington State Society of Orthodontists and AAO/WSSO members in Washington, has successfully defeated a proposal that would have permitted Washington dental hygienists to perform many orthodontic procedures under only general, rather than close or direct, supervision.

In 2018, the Washington Dental Quality Assurance Commission (“DQAC”) proposed revisions to section 246-817-550 of the Washington Administrative Code, which governs acts that may be performed by licensed dental hygienists under general supervision. 

The proposed rule would have significantly added to the listed tasks hygienists are permitted to perform under only general supervision, rather than close supervision, defined by WAC 246-817-510(1) as “a supervising dentist whose patient is being treated has personally diagnosed the condition to be treated and has personally authorized the procedures to be performed,” as well as being “continuously on-site and physically present in the treatment facility while the procedures are performed” and capable of responding in case of an emergency.  Most notably, subsections (32) through (37) of the proposed additional tasks included: (a) placing and removal of orthodontic separators; (b) selection and fitting or trying in orthodontic bands and appliances; (c) preparation of teeth for bonding of orthodontic appliances; (d) bonding of attachments for clear aligners; (e) removal and replacement of archwires; and (f) removal of orthodontic appliances. 

The AAO and WSSO believe that the proposed revisions to WAC 246-817-550 would have been detrimental to patient health and safety if enacted.  As a result, the AAO submitted written comments opposing the proposed rule revision.  Through the Component Legal Support Fund, AAO Attorney Trey Lawrence attended the March 1, 2019 public hearing on the proposed rule and spoke against the proposed rule revisions.  Approximately 15 Washington orthodontists, organized by WSSO Legislative Chair Dr. Michelle Neal, also attended the hearing and spoke against the proposed rule revisions.  SmileDirectClub’s Chief Clinical Officer Dr. Jeffrey Sulitzer also attended the public hearing and indicated his support for the proposed rule.  In the end, the Commission voted unanimously to send the proposed rule back to the Rules Committee for revision.

The AAO Component Legal Support Fund, established by a vote of the 2015 House of Delegates, provides grants to component organizations to assist with state legal and legislative issues that impact orthodontic practices.  To date, the CLSF is assisting over 25 components with a number of issues.

 Please note, every orthodontist (as a citizen of and licensed dental provider in his or her state) and orthodontic patient has the right, independently and individually, to express his or her opinion on any dental issue to his or her state dental board, the Food and Drug Administration (FDA), and elected officials (e.g. Attorney General, Governor, state representative, etc.). If you feel so compelled, you can look up and contact the appropriate entity. Contact information for state and provincial dental regulatory authorities can be found at